March 27, 2008.
If They Don't Kill Us They Will Drive Us Crazy

Now it looks like Merck is going to join the rosters of pharmaceutical companies like
Hoffmann La Roche that make drugs that, if they don't kill you, at least will drive you crazy.
Roche has specialized for years in making drugs with psychiatric side effects like depression
and suicidality, including Accutane (acne), larium (malaria), and Tamiflu (bird flu).
Chantix (smoking cessation, Pfizer) has also led to some pretty trippy experiences amongst users. No wonder
when you take a drug that affects the frontal lobe of the brain. However, Larium gets the door prize for psychiatric
side effects, with over half of people who take it developing psychiatric symptoms.
Now the FDA is investigating whether the asthma medication,
Singulair (montelukast), is associated with an increased risk of suicide.

Montelukast (Singulair) and zafirlukast (Accolate) are part of a new generation of asthma medications
that are leukotriene antagonists. These medications work by inhibiting the cysteinyl leukotriene
CysLT-1 receptor, which is involved in the inflammatory response.
Side effects include headache, gastritis, runny nose, dizziness, nausea, stomach pain, joint pain, and fever.
In rare cases they may be associated with Churg-Strauss syndrome, which involves inflammation of the blood vessels.
Over the past year Merck has added psychiatric side effects as possible outcomes with Singulair, including tremor (March 2007), depression (April 2007), suicidality (suicidal thinking and behavior)
(October 2007), and anxiousness (February 2008). The FDA is also investigating Accolate and Zyflo for similar problems.

There are leukotriene receptors in the brain, and since this drug
binds to this receptor and since depression is mediated through the brain, this suggests a mechanism
by which Singulair could cause depression. Could other drugs in this class have similar effects?
The FDA is investigating all of the leukotriene antagonists, probably with good reason.



My book 'Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed Drugs, Vitamins, and Supplements' is now available at amazon and at local Borders and Barnes and Noble book stores.

Doug Bremner, MD, is a physician
and researcher in Atlanta GA
and author of Before You Take That Pill: Why the Drug Industry May be
Bad for Your Health: Risks and Side Effects You Won't Find on the Label of Commonly Prescribed
Drugs, Vitamins and Supplements






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