zafirlukast

(zah fur' luh kast)

Accolate

Pregnancy Category B

Drug classes
Antasthmatic
Leukotriene receptor antagonist

Therapeutic actions
Selectively and competitively blocks receptor for leukotriene D4 and E4, components of
SRS-A, thus blocking airway edema, smooth muscle constriction, and cellular activity
associated with inflammatory process that contribute to signs and symptoms of asthma.

Indications
• Prophylaxis and long-term treatment of bronchial asthma in adults and children >
5 yr

Contraindications and cautions

• Contraindicated with hypersensitivity to zafirlukast or any of its components;
acute asthma attacks; status asthmaticus; pregnancy, lactation.
• Use cautiously with hepatic or renal impairment; as oral steroid use is decreased;
patients who previously required corticosteroid therapy to control asthma.

Available forms
Tablet—10, 20 mg

Dosages
ADULTS AND CHILDREN > 12 YR
20 mg PO bid on an empty stomach.
PEDIATRIC PATIENTS 5–11 YR
10 mg PO bid on an empty stomach.

Pharmacokinetics
Route Onset Peak
Oral Rapid 3 hr

Metabolism: Hepatic; T1/2: 10 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Headache, dizziness, myalgia
• GI: Nausea, diarrhea, abdominal pain, vomiting, liver enzyme elevation
 • Other: Generalized pain, fever, accidental injury, infection; Churg-Strauss
syndrome (eosinophilia, vasculitic rash, pulmonary and cardiac complications)
when oral steroid dose is reduced

Interactions
Drug-drug
• Increased risk of bleeding with warfarin; these patients should have PT done
regularly and warfarin dose decreased accordingly
• Potential for increased effects and toxicity of calcium channel-blockers,
cyclosporine
• Decreased effectiveness with erythromycin, theophylline
• Possible severe reaction when oral steroid dose is reduced while on zafirlukast;
monitor patients very closely
Drug-food
• Bioavailability decreased markedly by presence of food; administer at least 1 hr
before or 2 hr after meals

Nursing considerations
Assessment
• History: Hypersensitivity to zafirlukast; impaired renal or hepatic function;
pregnancy, lactation; acute asthma or bronchospasm
• Physical: T; orientation, reflexes; R, adventitious sounds; GI evaluation; renal
and liver function tests

Interventions
• Administer on an empty stomach 1 hr before or 2 hr after meals.
• Ensure that drug is taken continually for optimal effect.
• Do not administer for acute asthma attack or acute bronchospasm.

Teaching points
• Take this drug on an empty stomach, 1 hr before or 2 hr after meals.
• Take this drug regularly as prescribed; do not stop taking it during symptom-free
periods; do not stop taking it without consulting your health care provider.
• Do not take this drug for acute asthma attack or acute bronchospasm; this drug is
not a bronchodilator; routine emergency procedures should be followed during
acute attacks.
• Avoid use of over-the-counter medications while using this drug; many of them
contain products that can interfere with drug or cause serious side effects. If you
feel that you need one of these products, consult your nurse or physician.
• These side effects may occur: Dizziness (use caution when driving or performing
activities that require alertness); nausea, vomiting (eat frequent small meals);
headache (analgesics may be helpful).
• Report fever, acute asthma attacks, severe headache.

Adverse effects in Italic are most common; those in Bold are life-threatening.