If you're taking Montair (Montelukast) for asthma or allergies and wondering if there's something better, you're not alone. Many people start on Montelukast because it’s easy - one pill a day, no inhaler, no side effects like jitteriness. But after a few months, some notice their symptoms aren’t fully under control. That’s when questions pop up: Is there a stronger option? A cheaper one? Something that works faster?
What Montair (Montelukast) Actually Does
Montelukast, sold as Montair in the UK, is a leukotriene receptor antagonist. It blocks substances called leukotrienes that cause airway swelling and mucus buildup. It’s approved for asthma maintenance and allergic rhinitis - meaning it helps prevent symptoms, not treat them when they hit.
It’s not a rescue inhaler. You won’t feel immediate relief if you’re wheezing. Instead, it works over days to weeks. Studies show it reduces asthma attacks by about 30-50% in kids and adults when taken daily. For allergies, it cuts sneezing and runny nose, but not as well as nasal steroids.
Side effects are usually mild - headache, stomach upset, or fatigue. Rarely, it’s linked to mood changes like depression or agitation. The FDA added a black box warning for this in 2020. If you or your child become unusually irritable, anxious, or have nightmares after starting Montelukast, talk to your doctor.
Top Alternatives to Montair (Montelukast)
There are several options depending on whether your main issue is asthma, allergies, or both.
1. Inhaled Corticosteroids (ICS) - Like Fluticasone or Budesonide
These are the gold standard for asthma control. Unlike Montelukast, they directly reduce inflammation in the airways. They work faster - most people notice improvement in 1-2 weeks. For persistent asthma, they’re more effective than Montelukast.
Studies from the British Thoracic Society show ICS reduce asthma exacerbations by 60% compared to 35% with Montelukast. They’re also better at improving lung function.
Downside? You need to use an inhaler. Some people hate the feeling of spraying medicine into their throat. But with a spacer, side effects like hoarseness or thrush are rare and easy to prevent with rinsing after use.
2. Combination Inhalers - Fluticasone/Salmeterol (Seretide) or Budesonide/Formoterol (Symbicort)
If your asthma isn’t controlled with ICS alone, doctors often add a long-acting beta agonist (LABA). These combo inhalers give you both anti-inflammatory and bronchodilator action in one puff.
A 2023 UK primary care review found patients switched from Montelukast to Seretide had 40% fewer emergency visits and used rescue inhalers half as often.
They’re not first-line for allergies alone, but if you have both asthma and seasonal allergies, this combo often beats Montelukast.
3. Antihistamines - Cetirizine, Loratadine, Fexofenadine
If your main problem is sneezing, itchy eyes, or a runny nose from pollen or dust, antihistamines are simpler and often more effective than Montelukast.
One 2022 trial compared Montelukast with cetirizine in adults with seasonal allergic rhinitis. Cetirizine reduced symptoms by 68% versus 51% with Montelukast. Plus, it works within an hour.
Non-drowsy versions like loratadine and fexofenadine are available over the counter in the UK. They’re cheaper too - a month’s supply costs under £5 at most pharmacies.
4. Nasal Corticosteroids - Fluticasone Nasal Spray (Flixonase), Mometasone (Nasonex)
For nasal allergies, these are the most powerful option. They target inflammation right where it’s happening - inside your nose.
A Cochrane review found nasal steroids reduce congestion, sneezing, and runny nose better than oral antihistamines or Montelukast. About 70% of users see major improvement within 3-7 days.
They’re not for asthma, but if you have allergic rhinitis with mild asthma, using both a nasal spray and a low-dose ICS inhaler is often more effective than Montelukast alone.
5. Biologics - Omalizumab (Xolair), Mepolizumab (Nucala)
These are for severe asthma that doesn’t respond to standard treatment. They’re injectable, given every 2-4 weeks, and target specific immune pathways.
They’re not alternatives for mild cases. But if you’ve tried Montelukast, ICS, and combination inhalers - and still have flare-ups - your GP might refer you to a specialist.
Biologics can cut asthma attacks by 50-70% in the right patients. But they cost over £1,000 a month. The NHS only prescribes them if you meet strict criteria.
When to Stick With Montelukast
Montelukast isn’t useless. It still has a place.
- If you can’t use inhalers - maybe due to coordination issues, fear of side effects, or dislike of sprays.
- If you have mild asthma and allergic rhinitis together, and symptoms are manageable.
- If you’re a child under 6 who can’t use inhalers reliably.
- If you’re on a tight budget and can’t afford newer meds (though many alternatives are cheaper).
It’s also sometimes used for exercise-induced asthma. Some athletes take it 2 hours before activity to prevent symptoms - and it works decently for that.
What Doesn’t Work as an Alternative
Don’t waste time on things that don’t help.
- Decongestants (pseudoephedrine): They unblock your nose fast, but don’t touch inflammation. Risky for high blood pressure and heart issues.
- Herbal remedies (butterbur, quercetin): No strong evidence they work better than placebo for asthma or allergies.
- Steam inhalation or saline rinses: Helpful for comfort, but won’t stop asthma attacks or prevent allergic reactions.
How to Decide What’s Right for You
Here’s a simple guide based on your main symptoms:
| Your Main Symptom | Best Alternative | Why |
|---|---|---|
| Wheezing, chest tightness (asthma) | Inhaled corticosteroid (e.g., fluticasone) | Reduces airway inflammation directly - more effective than Montelukast |
| Runny nose, sneezing (allergies) | Nasal corticosteroid (e.g., flixonase) | Targets nasal inflammation better than oral meds |
| Itchy eyes, sneezing, mild asthma | Antihistamine (e.g., cetirizine) | Faster relief, cheaper, no inhaler needed |
| Severe asthma, not controlled by other meds | Biologic (e.g., omalizumab) | For extreme cases only - requires specialist referral |
| Can’t use inhalers | Montelukast (keep using it) | Still a valid option when inhalers aren’t practical |
What to Do Next
If you’re thinking about switching:
- Track your symptoms for 2 weeks. Note how often you use your rescue inhaler, how many nights you wake up wheezing, or how bad your allergies feel.
- Make a list of what you don’t like about Montelukast. Is it not working? Too expensive? Side effects?
- Book an appointment with your GP or asthma nurse. Don’t stop Montelukast cold turkey - you could trigger a flare-up.
- Ask: “What’s the next step if Montelukast isn’t enough?” They’ll likely suggest a trial of an ICS or nasal spray.
Most people who switch from Montelukast to an inhaled steroid or nasal spray see better control within a month. It’s not about abandoning Montelukast - it’s about upgrading when you need to.
Frequently Asked Questions
Is Montelukast better than an inhaler for asthma?
No. Inhaled corticosteroids are more effective at controlling asthma long-term. Montelukast is weaker and slower. Inhalers deliver medicine directly to the lungs, while Montelukast works through the bloodstream. For moderate to severe asthma, inhalers are the first choice.
Can I take Montelukast and an antihistamine together?
Yes. Many people do - especially if they have both asthma and allergies. Montelukast handles airway inflammation, while antihistamines like cetirizine tackle sneezing and itching. There’s no dangerous interaction. Always check with your pharmacist if you’re taking other meds.
Why is Montelukast still prescribed if it’s not the best?
Because it’s easy. One pill a day, no technique needed, no side effects like dry mouth or throat irritation. It works well enough for mild cases, especially in children or people who refuse inhalers. It’s not the strongest option, but it’s the simplest for some.
Are there cheaper alternatives to Montair?
Yes. Generic montelukast costs about £3-£5 for a month’s supply in the UK. Antihistamines like loratadine are under £5. Nasal sprays like flixonase are around £10-£15. Inhaled steroids like fluticasone are free or low-cost on NHS prescription. Most alternatives are cheaper than branded Montair.
How long does it take for alternatives to work?
Antihistamines work in 1-2 hours. Nasal steroids take 3-7 days to reach full effect. Inhaled corticosteroids take 1-2 weeks. Biologics can take 4-8 weeks. Montelukast also takes 1-2 weeks. So none are instant - but some are much faster than others.
Final Thoughts
Montelukast isn’t bad - it’s just not the strongest tool for the job. If you’re still struggling with symptoms, it’s not your fault. It’s probably just the wrong tool. Switching to an inhaler or nasal spray can make a huge difference. Talk to your doctor. Don’t suffer in silence thinking you have to stick with what you were given. There are better, faster, and often cheaper options out there.
Andy Ruff
Let me be crystal clear-Montelukast is a Band-Aid on a broken leg. People take it because it’s easy, not because it works. I’ve seen patients on it for years while their lungs slowly collapse, all because they’re too lazy to learn how to use an inhaler. The fact that this post even has to explain that inhaled steroids are superior is a national disgrace. If you’re still on Montelukast and your asthma isn’t perfectly controlled, you’re not just mismanaged-you’re endangering yourself. Stop making excuses and get your act together.
S Love
Thank you for this thorough, well-researched breakdown. I appreciate how you clearly distinguished between prevention and rescue, and emphasized that Montelukast is not a substitute for inhaled corticosteroids. Many patients don’t realize that ‘one pill a day’ doesn’t mean ‘one pill does everything.’ The comparison table is especially helpful-it’s rare to see such clarity in patient education. Keep sharing this kind of information; it saves lives.
Pritesh Mehta
Let us not forget the Indian context-where access to inhalers is still a luxury for millions. In rural villages, a child with asthma is given Montelukast because it’s cheap, stable at room temperature, and doesn’t require training. To dismiss it as ‘weak’ is the arrogance of Western privilege. The NHS may have guidelines, but the world doesn’t operate on British Thoracic Society protocols. Montelukast is not a failure-it’s a lifeline. The real issue isn’t the drug, it’s the systemic failure to deliver proper care to the poor. Philosophy without compassion is just noise.
Billy Tiger
Ive been on montair for 5 years and my doctor said its fine but last week i had a near death episode and now im thinking maybe i shouldve listened to the internet instead of the guy with the stethoscope
Katie Ring
It’s not about which drug is stronger-it’s about who gets to decide what ‘stronger’ means. The medical system tells you Montelukast is fine because it’s easy to prescribe, not because it’s optimal. But you’re the one living with the wheezing, the sleepless nights, the fear. No algorithm or guideline can measure that. If you feel like it’s not enough, it’s not enough. Trust yourself. Your body isn’t wrong-you’ve just been sold a myth of convenience.
Adarsha Foundation
I appreciate the depth of this post. I’ve been using montelukast for my seasonal allergies and it’s helped, but I’ve also started using a nasal spray on high-pollen days-and the difference is night and day. I didn’t want to switch because I thought I was being ‘difficult,’ but now I realize it’s just about finding what fits. Thank you for normalizing that it’s okay to upgrade your treatment. No shame in seeking better.
Alex Sherman
Of course Montelukast is inferior-it’s the pharmaceutical industry’s way of keeping patients docile. Why train someone to use an inhaler when you can just hand them a pill that makes them feel like they’re doing something? It’s not medicine-it’s behavioral management disguised as healthcare. The FDA black box warning? A footnote. The real tragedy is that we’ve normalized mediocrity in treatment because convenience trumps efficacy. And the worst part? You’ll never hear this from a drug rep.
Oliver Myers
Hey, I just wanted to say thank you for writing this-it’s so clear and kind. I’ve been on Montelukast for my kid since age 3, and we were terrified to switch because we thought we’d be letting the doctor down. But after reading your post, we talked to the asthma nurse and tried a low-dose inhaler with a spacer… and wow. No more midnight coughing fits. It’s not about abandoning Montelukast-it’s about evolving. And you made that feel safe. 🙏