Do you take Singulair for asthma or allergies? Are you wondering about possible Singulair alternatives?
In this article, I’ll go through what Singulair is and how it works. I’ll also walk you through both prescription-only and over-the-counter Singulair alternatives, including the estimated cost and pros and cons of each one.
What Is Singulair? How Does It Work?
Singulair, or montelukast, is a leukotriene receptor antagonist (LTRA).
Leukotrienes are released by the immune system in response to allergens, such as pollen, and promote inflammation, bronchoconstriction (tightening of the airways in the lungs), breathing difficulties, and other allergy symptoms.
The active ingredient, montelukast, in leukotriene receptor antagonists like Singulair binds to these receptors and opposes their function.
Singulair is usually used to prevent asthma attacks and treat seasonal allergies. Singulair isn’t effective for acute asthma attacks or sudden, extreme allergic reactions. Instead, it’s commonly used long-term for maintenance purposes and is usually safe for extended, regular use.
Why Use an Alternative to Singulair?
There are several main reasons why patients with asthma and/or allergy symptoms might be looking for Singulair alternatives.
Generally speaking, the reasons to choose another medication rather than Singulair are cost, side effects, and effectiveness.
Currently, a month’s supply (30 tablets) of Singulair costs around $246. You might be considering a Singulair alternative in order to save money.
For many patients, Singulair has no major side effects. However, some Singulair users report negative side effects like headache, nausea, stomach pain, diarrhea, skin reactions, or worsening asthma.
One of the most worrying (though rare) side effects of Singulair is a change in mood or depressive symptoms, which may include suicidal thoughts or actions. For this reason, some patients with histories of anxiety or depression choose an alternative to Singulair.
For whatever reason, Singulair might not effectively treat your symptoms. Perhaps a medication with a different active ingredient will work better for you, or maybe you need a stronger drug than Singulair.
Singulair is usually used to treat asthma or allergies.
Top 5 Singulair Alternatives
The following Singulair alternatives are often used to treat asthma or allergies. For each one, I’ll go through how it compares to Singulair in terms of cost, side effects, and effectiveness.
#1: Nasonex (Mometasone)
Nasonex is a mometasone nasal spray used to treat congestion, runny nose, and other seasonal allergy symptoms, as well as nasal polyps. It is available by prescription or over-the-counter.
Estimated Cost (Without Insurance): One 60-spray bottle of Nasonex costs about $150.
- Nasonex is more effective for allergic rhinitis (inflammation of the nasal passages) and congestion than Singulair for most users.
- Also, Nasonex virtually never causes side effects like depression, behavioral changes, or suicidal thoughts or behaviors. These are more common with Singulair, so if you have trouble with anxiety or depression, Nasonex may be a better choice.
- Some negative side effects of Nasonex include headaches, bronchitis, nausea, sore throat, nosebleeds, and sores or white spots inside the nose or mouth.
- The main downside of Nasonex is that it doesn’t work right away. It should be used twice daily, starting one to two weeks before allergy season, in order to be effective by the time your allergy symptoms start.
How Does It Compare?
- Nasonex is generally cheaper than Singulair, and is usually as effective or more effective in treating allergy symptoms like nasal congestion and inflammation. However, Singulair is more effective for asthma symptoms and in preventing asthma attacks.
#2: Flonase (Fluticasone)
Flonase is a corticosteroid nasal spray that’s used to treat allergy symptoms by reducing nasal inflammation. It’s available over-the-counter.
Estimated Cost: For a bottle that contains around 120 sprays, you should expect to pay about $25 over-the-counter.
- Flonase is available at most pharmacies and only needs to be used when you’re experiencing asthma or allergy symptoms, so it’s cheaper, and unlike Singulair, you don’t have to take it every day.
- Flonase doesn’t have as many reported side effects as Singulair, especially those such as insomnia, aggression, anxiety, and depression or other behavioral changes.
- Because Flonase comes in spray form, it can be hard to keep track of how much you’ve taken or how much you have left.
- Also, Flonase is a Category C drug, meaning that risks can’t be ruled out for pregnant or nursing moms. Singulair is a Category B drug, so it’s generally considered safer for unborn and breastfeeding babies.
How Does It Compare?
- Flonase is generally considered the first-choice treatment for seasonal allergies by doctors, because it doesn’t have to be used long-term and doesn’t carry as much of a risk of side effects as daily-use medications like Singulair.
- One study found Flonase and other nasal sprays containing fluticasone to be superior to montelukast for allergy symptoms.
- However, if you experience negative side effects with Flonase, have had nasal surgery, or have an irritated nasal passage, Singulair or another oral medication might be preferable to Flonase.
Nasal sprays like Flonase can be the best available treatments for allergy symptoms.
#3: Sudafed (Pseudoephedrine)
Sudafed is a nasal decongestant used to treat allergy symptoms such as sinusitis and stuffy nose. It is often available over-the-counter, but requires a prescription in some states in the U.S.
Estimated Cost (Without Insurance): Sudafed is generally inexpensive, with 24 tablets costing around $8-10 at generic pharmacies.
- One study found that Sudafed (pseudoephedrine) was more effective than montelukast in treating nasal congestion.
- If you’re experiencing congestion as your primary symptom, Sudafed is an inexpensive OTC alternative to a prescription drug like Singulair.
- Some Sudafed users report negative side effects like anxiety, restlessness, hyperactivity, a racing heartbeat, high blood pressure, insomnia, or hallucinations. Also, Sudafed can make users drowsy.
- Sudafed, unlike Singulair, doesn’t treat asthma or prevent asthma attacks. Also, after four days of use, Sudafed doesn’t work as effectively.
How Does It Compare?
- Sudafed is a cheap, convenient alternative to Singulair if your main allergy symptom is nasal congestion or inflammation of the nasal passages.
- One study at the University of Chicago found Sudafed and Singulair to be equally effective in the treatment of hay fever and to have similar side effects.
- However, Sudafed isn’t appropriate for long-term use, for more severe allergy symptoms, or for people with asthma.
#4: Allegra (Fexofenadine)
Allegra is an antihistamine, meaning that it inhibits the release of histamines—compounds that trigger allergic reactions—in response to allergens such as pollen. It relieves allergy symptoms like itching, hives, watery eyes, and congestion. It’s available OTC.
Estimated Cost: 30 tablets of Allegra will cost you around $20 at most generic pharmacies.
- Allegra users don’t report side effects of depression or weight gain as commonly as Singulair users.
- Allegra can be used in babies six months or older, while Singulair isn’t safe for a baby until he or she has reached 12 months of age. Also, Allegra, unlike Singulair, comes in liquid form as well as tablet form, which some users (especially children) might find easier to take.
- Users of Allegra some report negative side effects such as impotence, other sexual side effects, drowsiness, and weight loss.
- Allegra can’t be prescribed to anyone with kidney disease, as it can (rarely) cause kidney damage or failure.
- Allegra is only used to treat allergy symptoms. It isn’t approved or effective in treating asthma.
- The risks of taking Allegra while pregnant are unknown. It’s generally considered to be safer to take Singulair than Allegra while pregnant.
How Does It Compare?
- Allegra users who experience adverse reactions to the medication report different, but potentially just as serious, side effects—such as kidney damage or failure, rapid weight loss, anxiety, impotence, and other sexual side effects—as those frequently experienced by Singulair users.
- Allegra is an inexpensive, and often effective, allergy medication, but won’t be as helpful if asthma attacks or other breathing difficulties are your main symptoms.
- Allegra is generally considered to be safe for regular use, but there aren’t as many studies on long-term use of the drug as there are on chronic use of Singulair, so there isn’t as much data available overall.
#5: Accolate (Zafirlukast)
Accolate is an alternative to Singulair for asthma and allergies. Like Singulair, it's a prescription-only LTRA except that the active ingredient is different (zafirlukast rather than montelukast).
Estimated Cost (Without Insurance): Accolate tends to be cheaper than Singulair. Currently, a month’s supply of Accolate would cost you around $126.80.
- Although changes in mood and behavior can be side effects of both medications, Singulair users report more frequent suicidal thoughts and behaviors, as well as more symptoms of depression as a result of taking the drug. This is rarer among Accolate users.
- Additionally, overall, more patients report negative side effects with Singulair than they do with Accolate.
- Although Singulair users report more side effects over, Accolate carries a higher risk of liver failure than does Singulair. Though this side effect is rare, it is serious. More Accolate users report certain other adverse side effects, such as severe headaches, as well.
- On a less serious note, Accolate has to be taken twice a day, unlike Singulair, which some users don’t prefer as it’s more difficult to remember to take.
- Also, Accolate hasn’t been on the market as long as Singulair, and it isn’t prescribed as often. Therefore, we simply don’t have as much data on Accolate’s side effects, particularly of long-term use of the drug.
How Does It Compare?
- One study didn’t find many differences in the effects, or effectiveness, of Accolate and Singulair. Overall, the two medications are very similar both in how, and how well, they work for people with asthma and/or allergies.
- The biggest differences between Accolate and Singulair are their cost and side effects, with prices usually much lower for Accolate than for Singulair, and fewer users reporting suicidal thoughts or attempts when using Accolate as opposed to Singulair.
- Also, although Accolate and Singulair are both leukotriene inhibitors and thus very similar, their active ingredients are different, so one may work for you while the other doesn’t. Many users report more success with Singulair than with Accolate, and vice versa.
Have friends who also need help with test prep? Share this article!
Laura Dorwart is a Ph.D. student at UC San Diego. She has taught and tutored hundreds of students in standardized testing, literature, and writing.