Montelukast y cambios conductuales en pacientes con comorbilidad neuropsiquiatrica: dos casos clínicos

Introduction. Montelukast is a leukotriene receptor antagonist recommended as a second-line therapy for asthma management. Although neuropsychiatric adverse effects have been reported in otherwise healthy individuals, evidence regarding this association in patients with pre-existing neuropsychiatric conditions is lacking. The objective of this report is to describe two cases of behavioral disturbances in patients with baseline neuropsychiatric diagnoses. Case presentation. 1) An 8-year-old male patient with autism spectrum disorder received montelukast and levocetirizine for asthma management. Ten days later, he developed self-injurious and aggressive behavior, irritability, and lack of recognition of his caregivers. Fluoxetine was added as a control strategy without success. Symptoms resolved after discontinuation of montelukast. 2) A 15-year-old patient with Down syndrome, without baseline pharmacologic treatment, received montelukast and levocetirizine for asthma management. He subsequently developed marked self-injurious and aggressive behaviors that resolved upon discontinuation of the medication regimen. Conclusion: Montelukast may trigger neuropsychiatric disturbances in asthmatic patients with pre-existing neuropsychiatric conditions. The relationship between these events requires further clarification. Avoiding the use of montelukast for asthma management in this population is recommended.