Accolate

Action

Antagonizes activity of three leukotrienes at specific receptor sites in airway smooth muscle, inhibiting inflammation

Availability

Tablets (coated): 10 mg, 20 mg

Indications and dosages

➣ Prophylaxis and long-term treatment of asthma

Adults and children ages 12 and older: 20 mg P.O. b.i.d.

Children ages 5 to 11: 10 mg P.O. b.i.d.

Off-label uses

• Exercise-induced bronchospasm

• Chronic urticaria

Contraindications

• Hypersensitivity to drug or its components

• Hepatic impairment, including hepatic cirrhosis

Precautions

Use cautiously in:

• acute asthma attacks

• concurrent use of warfarin

• patients older than age 55

• pregnant patients

• breastfeeding patients (use not recommended)

• children younger than age 5 (safety not established).

Administration

• Give at least 1 hour before or 2 hours after a meal.

Adverse reactions

CNS: headache, dizziness, asthenia, insomnia, depression (especially in children and adolescents)

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia

Hepatic: hepatic dysfunction including liver failure and death (rare)

Musculoskeletal: joint or back pain, myalgia

Other: fever, infection, pain

Interactions

Drug-drug. Aspirin: increased zafirlukast blood level

Erythromycin, theophylline: decreased zafirlukast blood level

Warfarin: increased warfarin effects, greater risk of bleeding

Drug-food. Any food: decreased rate and extent of zafirlukast absorption

Patient monitoring

• Assess patient's respiratory status to help evaluate drug efficacy.

See Monitor liver function tests closely; watch for signs and symptoms of liver dysfunction.

Patient teaching

• Tell patient to take at least 1 hour before or 2 hours after a meal.

• Advise patient to take exactly as prescribed, even if he is symptom-free.

See Tell patient to immediately report asthma attack. Advise him not to use drug for rapid relief of bronchospasm.

• Instruct patient to continue taking other asthma drugs unless prescriber directs otherwise.

See Instruct patient to immediately report signs and symptoms of liver dysfunction (nausea, anorexia, fatigue, lethargy, pruritus, jaundice, flulike symptoms, or right upper quadrant abdominal pain).

• Instruct patient or caregiver to report insomnia or depression.

• Instruct female patient to consult prescriber if she plans to breastfeed.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.