Broncast is indicated in the treatment of asthma as add-on therapy in those patients with mild to moderate persistent asthma who are inadequately controlled on inhaled corticosteroids and in whom “as-needed” short-acting β-agonists provide inadequate clinical control of asthma.
Broncast 10mg tablets may also be an alternative treatment option to low-dose inhaled corticosteroids for patients with mild persistent asthma who do not have a recent history of serious asthma attacks that required oral corticosteroid use, and who have demonstrated that they are not capable of using inhaled corticosteroids
Broncast 10mg tablets is also indicated in the prophylaxis of asthma in which the
predominant component is exercise-induced bronchoconstriction.

Dose and method of administration:
The dosage for adults 15 years of age and older with asthma, or with asthma and concomitant seasonal allergic rhinitis, is one 10 mg tablet daily to be taken in the evening.
General recommendations. The therapeutic effect of BRONCAST on parameters of asthma control occurs within one day. BRONCAST may be taken with or without food. Patients should be advised to continue taking BRONCAST even if their asthma is under control, as well as during periods of worsening asthma. BRONCAST should not be used concomitantly with other products containing the same active ingredient, montelukast.
No dosage adjustment is necessary for the elderly, or for patients with renal insufficiency, or mild to moderate hepatic impairment. There are no data on patients with severe hepatic impairment. The dosage is the same for both male and female patients.
Therapy with BRONCAST in relation to other treatments for asthma.
BRONCAST can be added to a patient's existing treatment regimen.
Inhaled corticosteroids: Treatment with BRONCAST can be used as add-on therapy in
patients when inhaled corticosteroids plus "as needed" short acting β-agonists provide inadequate clinical control. BRONCAST should not be abruptly substituted for inhaled corticosteroids 5mg chewable tablets are available for pediatric patients 6 to 14 years of age.

Patients should be advised never to use oral montelukast to treat acute asthma attacks and to keep their usual appropriate rescue medication for this purpose readily available. If an acute attack occurs, a short-acting inhaled beta-agonist should be used. Patients should seek their doctor's advice as soon as possible if they need more inhalations of short-acting beta-agonists than usual.
Montelukast should not be abruptly substituted for inhaled or oral corticosteroids.
There are no data demonstrating that oral corticosteroids can be reduced when montelukast is given concomitantly.
In rare cases, patients on therapy with anti-asthma agents including montelukast may present with systemic eosinophilia, sometimes presenting with clinical features of vacuities consistent with Churg-Strauss syndrome, a condition which is often treated with systemic corticosteroid therapy. These cases usually, but not always, have been associated with the reduction or withdrawal of oral corticosteroid therapy. The possibility that leukotriene receptor antagonists may be associated with emergence of Churg-Strauss syndrome can neither be excluded nor established. Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. Patients who develop these symptoms should be reassessed and their treatment regimens evaluated.

Montelukast may be administered with other therapies routinely used in the prophylaxis and chronic treatment of asthma. In drug-interactions studies, the recommended clinical dose of montelukast did not have clinically important effects on the pharmacokinetics of the following medicinal products: theophylline, prednisone, prednisolone, oral contraceptives (ethinyl oestradiol/norethindrone 35/1), terfenadine, digoxin and warfarin.
The area under the plasma concentration curve (AUC) for montelukast was decreased approximately 40% in subjects with co-administration of phenobarbital. Since montelukast is metabolized by CYP 3A4, 2C8, and 2C9, caution should be exercised, particularly in children, when montelukast is co-administered with inducers of CYP 3A4, 2C8, and 2C9, such as phenytoin, phenobarbital and rifampicin.
In vitro studies have shown that montelukast is a potent inhibitor of CYP 2C8. However, data from a clinical drug-drug interaction study involving montelukast and rosiglitazone (a probe substrate representative of medicinal products primarily metabolized by CYP 2C8) demonstrated that montelukast does not inhibit CYP 2C8 in vivo. Therefore, montelukast is not anticipated to markedly alter the metabolism of medicinal products metabolized by this enzyme (e.g., paclitaxel, rosiglitazone, and repaginate).
In vitro studies have shown that montelukast is a substrate of CYP 2C8, and to a less
significant extent, of 2C9, and 3A4. In a clinical drug-drug interaction study involving
montelukast and gemfibrozil (an inhibitor of both CYP 2C8 and 2C9) gemfibrozil increased the systemic exposure of montelukast by 4.4-fold. No routine dosage adjustment of montelukast is required upon co-administration with gemfibrozil or other potent inhibitors of CYP 2C8, but the physician should be aware of the potential for an increase in adverse reactions.
Based on in vitro data, clinically important drug interactions with less potent inhibitors of CYP 2C8 (e.g., trimethoprim) are not anticipated. Co-administration of montelukast with itraconazole,
A strong inhibitor of CYP 3A4, resulted in no significant increase in the systemic exposure of montelukast.

Use during pregnancy
Animal studies do not indicate harmful effects with respect to effects on pregnancy or
embryonal/foetal development.
Limited data from available pregnancy databases do not suggest a causal relationship
between Broncast 10mg tablets and malformations (i.e. limb defects) that have been rarely
reported in worldwide post marketing experience.

Broncast 10mg tablets may be used during pregnancy only if it is considered to be clearly
essential.
Use during lactation:
Studies in rats have shown that montelukast is excreted in milk (see section 5.3). It is not
known if montelukast is excreted in human milk.
Broncast 10mg tablets may be used in breast-feeding mothers only if it is considered to be
clearly essential.

Montelukast is not expected to affect a patient's ability to drive a car or operate machinery.
However, in very rare cases, individuals have reported drowsiness or dizziness.

• 10 mg film-coated tablets in approximately 4000 adult asthmatic patients 15 years of age and older.
• 10 mg film-coated tablets in approximately 400 adult asthmatic patients with seasonal allergic rhinitis 15 years of age and older. • 5 mg chewable tablets in approximately 1750 paediatric asthmatic patients 6 to 14 years of age.
The following drug-related adverse reactions in clinical studies were reported commonly (≥1/100 to <1/10) in asthmatic patients treated with montelukast and at a greater incidence than in patients treated with placebo:

The following drug-related adverse reactions in clinical studies were reported commonly (≥1/100 to <1/10) in patients treated with montelukast and at a greater incidence than in patients treated with placebo:

No specific information is available on the treatment of overdose with montelukast. In chronic asthma studies, montelukast has been administered at doses up to 200 mg/day to patients for 22 weeks and in short-term studies, up to 900 mg/day to patients for approximately one week without clinically important adverse experiences.
There have been reports of acute overdose in post-marketing experience and clinical studies with montelukast. These include reports in adults and children with a dose as high as 1000 mg (approximately 61 mg/kg in a 42 month old child). The clinical and laboratory findings observed were consistent with the safety profile in adults and paediatric patients. There were no adverse experiences in the majority of overdose reports. The most frequently occurring adverse experiences were consistent with the safety profile of montelukast and included abdominal pain, somnolence, thirst, headache, vomiting, and psychomotor hyperactivity.
It is not known whether montelukast is dialyzable by peritoneal- or haemo-dialysis.

Pharmacotherapeutic group: Leukotriene receptor antagonist
The cysteinylleukotrienes (LTC4, LTD4, LTE4) are potent inflammatory eicosanoids
released from various cells including mast cells and eosinophils. These important proasthmatic mediators bind to cysteinyl leukotriene receptors (CysLT) found in the human airway and cause airway actions, including bronchoconstriction, mucous secretion, vascular permeability, and eosinophil recruitment.
Montelukast is an orally active compound which binds with high affinity and selectivity to the CysLT1 receptor. In clinical studies, montelukast inhibits bronchoconstriction due to inhaled LTD4 at doses as low as 5 mg. Bronchodilator was observed within two hours of oral administration. The bronchodilator effect caused by a β-agonist was additive to that caused by montelukast. Treatment with montelukast inhibited both early- and late-phase bronchoconstriction due to antigen challenge. Montelukast, compared with placebo, decreased peripheral blood eosinophils in adult and paediatric patients. In a separate study, treatment with montelukast significantly decreased eosinophils in the airways (as measured in
sputum) and in peripheral blood while improving clinical asthma control.

In studies in adults, montelukast 10 mg once daily, compared with placebo, demonstrated significant improvements in morning FEV1 (10.4% vs 2.7% change from baseline), AM peak expiratory flow rate (PEFR) (24.5 L/min vs 3.3 L/min change from baseline), and significant decrease in total β-agonist use (-26.1% vs -4.6% change from baseline). Improvement in patient-reported daytime and night-time asthma symptoms scores was significantly better than placebo.
Studies in adults demonstrated the ability of montelukast to add to the clinical effect of inhaled corticosteroid (% change from baseline for inhaled beclometasone plus montelukastvsbeclometasone, respectively for FEV1: 5.43% vs. 1.04%; β-agonist use: -
8.70% vs. 2.64%). Compared with inhaled beclometasone (200 μg twice daily with a spacer device), montelukast demonstrated a more rapid initial response, although over the 12-week study, beclometasone provided a greater average treatment effect (% change from baseline for montelukastvsbeclometasone, respectively for FEV1: 7.49% vs 13.3%; β-agonist use: - 28.28% vs -43.89%). However, compared with beclometasone, a high percentage of patients treated with montelukast achieved similar clinical responses (e.g. 50% of patients treated with beclometasone achieved an improvement in FEV1 of approximately 11% or more over baseline while approximately 42% of patients treated with montelukast achieved the same
response).
In an 8-week study in paediatric patients 6 to 14 years of age, montelukast 5 mg once daily, compared with placebo, significantly improved respiratory function (FEV1 8.71% vs 4.16% change from baseline; AM PEFR 27.9 L/min vs 17.8 L/min change from baseline) and decreased 'as-needed' β-agonist use (-11.7% vs +8.2% change from baseline).
In a 12-month study comparing the efficacy of montelukast to inhaled fluticasone on asthma control in paediatric patients 6 to 14 years of age with mild persistent asthma, montelukast was non-inferior to fluticasone in increasing the percentage of asthma rescue-free days (RFDs), the primary endpoint. Averaged over the 12-month treatment period, the percentage of asthma RFDs increased from 61.6 to 84.0 in the montelukast group and from 60.9 to 86.7 in the fluticasone group. The between group difference in LS mean increase in the percentage of asthma RFDs was statistically significant (-2.8 with a 95% CI of -4.7, -0.9), but within the limit pre-defined to be clinically not inferior. Both montelukast and fluticasone also improved
asthma control on secondary variables assessed over the 12 month treatment period:
• FEV1 increased from 1.83 L to 2.09 L in the montelukast group and from 1.85 L to 2.14 L in the fluticasone group. The between-group difference in LS mean increase in FEV1 was - 0.02 L with a 95% CI of -0.06, 0.02. The mean increase from baseline in % predicted FEV1 was 0.6% in the montelukast treatment group, and 2.7% in the fluticasone treatment group.
The difference in LS means for the change from baseline in the % predicted FEV1 was -2.2% with a 95% CI of -3.6, -0.7.
• The percentage of days with β-agonist use decreased from 38.0 to 15.4 in the montelukast group, and from 38.5 to 12.8 in the fluticasone group. The between group difference in LS means for the percentage of days with β-agonist use was 2.7 with a 95% CI of 0.9, 4.5.
• The percentage of patients with an asthma attack (an asthma attack being defined as a period of worsening asthma that required treatment with oral steroids, an unscheduled visit to

the doctor's office, an emergency room visit, or hospitalisation) was 32.2 in the montelukast
group and 25.6 in the fluticasone group; the odds ratio (95% CI) being significant: equal to 1.38 (1.04, 1.84).
• The percentage of patients with systemic (mainly oral) corticosteroid use during the study period was 17.8% in the montelukast group and 10.5% in the fluticasone group. The between group difference in LS means was significant: 7.3% with a 95% CI of 2.9; 11.7.

Significant reduction of exercise-induced bronchoconstriction (EIB) was demonstrated in a 12-week study in adults (maximal fall in FEV1 22.33% for montelukastvs 32.40% for placebo; time to recovery to within 5% of baseline FEV1 44.22 min vs 60.64 min). This effect was consistent throughout the 12-week study period. Reduction in EIB was also demonstrated in a short term study in paediatric patients (maximal fall in FEV1 18.27% vs 26.11%; time to recovery to within 5% of baseline FEV1 17.76 min vs 27.98 min). The effect in both studies was demonstrated at the end of the once-daily dosing interval.
In aspirin-sensitive asthmatic patients receiving concomitant inhaled and/or oral
corticosteroids, treatment with montelukast, compared with placebo, resulted in significant improvement in asthma control (FEV1 8.55% vs -1.74% change from baseline and decrease in total β-agonist use -27.78% vs 2.09% change from baseline).

Absorption: montelukast is rapidly absorbed following oral administration. for the 10 mg
film-coated tablet, the mean peak plasma concentration (cmax) is achieved three hours (tmax)
after administration in adults in the fasted state. the mean oral bioavailability is 64%. the oral
bioavailability and cmax are not influenced by a standard meal. safety and efficacy were
demonstrated in clinical trials where the 10 mg film-coated tablet was administered without
regard to the timing of food ingestion.
for the 5 mg chewable tablet, the cmax is achieved in two hours after administration in adults
in the fasted state. the mean oral bioavailability is 73% and is decreased to 63% by a standard
meal.
Distribution: montelukast is more than 99% bound to plasma proteins. the steady state volume of distribution of montelukast averages 8-11 litres. studies in rats with radiolabelled montelukast indicate minimal distribution across the blood-brain barrier. in addition, concentrations of radiolabelled material at 24 hours post-dose were minimal in all other tissues.
Biotransformation: montelukast is extensively metabolised. in studies with therapeutic doses, plasma concentrations of metabolites of montelukast are undetectable at steady state in adults and children.
Cytochromes p450 2c8 is the major enzyme in the metabolism of montelukast.
Additionallycyp3a4 and 2c9 may have a minor contribution, although itraconazole, an
inhibitor of 3a4, was shown not to change pharmacokinetic variables of montelukast in healthy subjects that received 10 mg montelukast daily. based on in vitro results in human liver microsomes, therapeutic plasma concentrations of montelukast do not inhibit cytochromes p450 3a4, 2c9, 1a2, 2a6, 2c19, or 2d6. the contribution of metabolites to the therapeutic effect of montelukast is minimal.
Elimination: the plasma clearance of montelukast averages 45 ml/min in healthy adults.
Following an oral dose of radiolabelled montelukast, 86% of the radioactivity was recovered in 5-day faecal collections and <0.2% was recovered in urine. Coupled with estimates of montelukast oral bioavailability, this indicates that montelukast and its metabolites are excreted almost exclusively via the bile.
Characteristics in patients: no dosage adjustment is necessary for the elderly or mild to moderate hepatic insufficiency. studies in patients with renal impairment have not been undertaken. Because montelukast and its metabolites are eliminated by the biliary route, no dose adjustment is anticipated to be necessary in patients with renal impairment.
There are no data on the pharmacokinetics of montelukast in patients with severe hepatic insufficiency (child-pugh score >9).
With high doses of montelukast (20- and 60-fold the recommended adult dose), a decrease in plasma theophylline concentration was observed. this effect was not seen at the recommended dose of 10 mg once daily.

In animal toxicity studies, minor serum biochemical alterations in ALT, glucose, phosphorus and triglycerides were observed which were transient in nature. The signs of toxicity in animals were increased excretion of saliva, gastro-intestinal symptoms, loose stools and ion imbalance. These occurred at dosages which provided >17-fold the systemic exposure seen at the clinical dosage. In monkeys, the adverse effects appeared at doses from 150 mg/kg/day (>232-fold the systemic exposure seen at the clinical dose). In animal studies, montelukast did not affect fertility or reproductive performance at systemic exposure exceeding the
clinical systemic exposure by greater than 24-fold. A slight decrease in pup body weight was noted in the female fertility study in rats at 200 mg/kg/day (>69-fold the clinical systemic exposure). In studies in rabbits, a higher incidence of incomplete ossification, compared with concurrent control animals, was seen at systemic exposure >24-fold the clinical systemic exposure seen at the clinical dose. No abnormalities were seen in rats. Montelukast has been shown to cross the placental barrier and is excreted in breast milk of animals.
No deaths occurred following a single oral administration of montelukast sodium at doses up to 5000 mg/kg in mice and rats (15,000 mg/m2 and 30,000 mg/m2 in mice and rats, respectively).
The maximum dose tested. This dose is equivalent to 25,000 times the recommended daily adult human dose (based on an adult patient weight of 50 kg).
Montelukast was determined not to be phototoxic in mice for UVA, UVB or visible light spectra at doses up to 500 mg/kg/day (approximately >200-fold based on systemic exposure).
Montelukast was neither mutagenic in in vitro and in vivo tests nor tumorigenic in rodent species.

Lactose
Crosscarmellose sodium 
Colloidal silicone dioxide 
Mg-stearate 
Hypromellose 
Titanium dioxide 
Yellow Iron Oxide 
Red Iron Oxide

None.

Store below 30°C.
Store in the original package in order to protect from light and moisture.

Packaged in polyamide/PVC/aluminium blister package in:
Blisters in packages of: 28 Tablets
Blisters (unit doses), in packages of: 28 tablets.

Any unused product or waste material should be disposed of in accordance with local requirements.