Montelukast deprescribing and neuropsychiatric events in older adults: a cross-sectional descriptive report

Introduction: Montelukast possesses a Black Box Warning for neuropsychiatric events (NPEs). Older adults taking montelukast may experience NPEs more often than children and adults. Objective: To assess the period prevalence of montelukast deprescribing in older adults, identify deprescribing reasons, and determine NPE prevalence. Methods: This was a single-center, cross-sectional report of adults 65 years and older using montelukast between 1/1/2021 to 12/31/2022. Deprescribing was defined as prescription removal without subsequent documentation of (re)prescribing. Neuropsychiatric events and comorbidities were collected and reported using UK Medicine and Healthcare Products Regulatory Agency categories. Results: Four hundred thirteen older adults used montelukast during the study period, 19 participants (4.6%) were deprescribed montelukast, and six deprescribing events involved NPEs. Neuropsychiatric events and comorbidities were common among the 413 older adults (61.7%) and more so among those deprescribed montelukast (84.2%). Discussion: Montelukast deprescribing rates in older adults were nominally lower than national declines in montelukast prescribing during the same period. Differences in NPE and condition prevalence may be due to differing case-mix, comorbidities, health-system or provider attributes, or treatment interventions. Conclusions: Montelukast deprescribing rates were less than 5% among older adults seen within an academic health-system. Associations between montelukast and NPEs in older adults require investigation alongside strategies to facilitate deprescribing.