Montelukast & coordination problems

I started on Montelukast in late October, and some time between then and the middle of December I developed a bad tremor that mostly affects my hands and arms.

I've also become extremely clumsy, regularly walking into stuff, and I drop things without warning. My hands frequently seize up, and then I can't send any signals to them to tell them to unseize - it feels like trying to think how to move someone else's hand. I also have loss of sensation in my fingers and thumbs, and difficulties (new) with my balance.

Most of the symptoms are worse when I've had a lot of reliever, or when my cortisol is low, or when my potassium or sodium is out, but even when all of these things are fine, I'm now very compromised in terms of my fine motor skills.

To put it in context, my step-son has mild cerebral-palsy / very bad dyspraxia. His fine motor skills are sufficiently poor that he's officially disabled, and mine are now often worse than his. Some days I can hardly write, and using any kind of tool is a challenge. Chopping veg, shelling peas, stirring things in a pan - all very messy!

My GP has been great, as always. She pointed out that while we would hope that it isn't, there's no reason why I shouldn't develop a neurological condition that just happens to coincide with developing other stuff, so she doesn't want to assume that it's 'just' Addison's. She had believed - as had I - that it was all to do with my salbutamol use, but now that I'm barely using it we can't blame it on that. I've been on salmeterol for nearly 20 years so that's not 'new' enough to explain the symptoms.

My GP thinks that if it's not med related then hopefully it's a condition called 'Essential Tremor' which can be progressive but can (hopefully) progress very slowly. It's basically the 'least bad' reason to have this problem. Like asthma, Essential Tremor is a bit of a bucket diagnosis - they are starting to better understand it as being a group of different conditions. Anyway, she's happy to refer me to a neurologist to get it followed up. I'm already under resp and endo, and will need *another* endo to do the diabetes side of things eventually. I'm meant to be under rheum as well but really couldn't face it, so I'm not sure how I feel about having yet another specialist. It all feels a bit much - the only people holding the whole picture are myself and my GP. So I think it would be good to rule out med-side-effects first.

The only med I added between October (when I know it was fine because we moved house and I was still able to do all the DIY stuff easily) and December (when I know it was awful because I couldn't wrap christmas presents) was Montelukast.

Has anyone else has this - severe reduction in motor coordination plus tremor - as a side effect of Montelukast? I'm reluctant to give it up, as I feel it has made a big difference to my asthma. Breathing and shaking beats not breathing!

I'm doing all the basic, sensible stuff like cutting out caffeine.

The treatment for Essential Tremor is usually beta-blockers. Obviously not great in asthma, but there are some less-asthma-affecting selective beta blockers, so I'll get a list of the ones my resp consultant would be ok with me taking when I see him this week, and then cross-reference them against the ones that work for ET. I'm not sure I can take them anyway as my blood pressure is already low enough to be an issue. The other option is stuff like PRN valium, but do you take a valium just to refill the sugar shaker? Hrm...

Anyway, if anyone has experience of this it'd be good to hear it...

Cx

[cici73]

I'm sorry you're having problems with Montelukast. I posted yesterday asking if anyone has experienced side effects of aggression/agitation.

I already have a fine hand tremor from other medications I take so I haven't noticed any increase.

I think that both our posts (and others) highlight that whilst its very effective in controlling asthma, Montelukast can produce noticeable side effects.

Hope your side effects fade.

[Hidden in reply to cici73]

I'm sorry you're having problems with Montelukast. I posted yesterday asking if anyone has experienced side effects of aggression/agitation.

I already have a fine hand tremor from other medications I take so I haven't noticed any increase.

I think that both our posts (and others) highlight that whilst its very effective in controlling asthma, Montelukast can produce noticeable side effects.

Hope your side effects fade.

Hi Cici, I should stress that I have no evidence that links the montelukast and the symptoms - I'm going to try not taking it for a bit and see if the tremor / coordination issues improve (faster than the asthma gets worse). I'll let you know whether it seems to be linked or not.

I had the headachey/weird sleep stuff a bit at the beginning, but I don't think I've noticed any mood related stuff.

Cx

[Hidden]

Interesting question. I've been on monolukast and haven't noticed a problem that I could trace to it.

Couldn't your LABA could also be a problem? Isn't it also a beta antagonist - just longer acting?

Have you thought about what make the tremour worse or better? Or is it a constant thing?

I have an essential tremour aka familial tremour (my mother has it too). It was first noted by a friend of mine whilst playing a card game (spit) when I was 12. Ventolin makes it worse, of course. But so does physical stress, such as being tired or working too hard at breathing regardless of ventolin. So does anger sometimes (sometimes body likes to co-opt existing symptoms to ""talk"" to us, I think).

I do hope the cause of your tremour is something innocuous.

[Hidden in reply to Hidden]

Couldn't your LABA could also be a problem? Isn't it also a beta antagonist - just longer acting?

That's the salmeterol that I referred to - I've been on it for 20 years so it would be strange if it only became a problem now...!

Have you thought about what make the tremour worse or better? Or is it a constant thing?

All that stuff I listed like low cortisol, low potassium, low sodium, too much ventolin - they all make it worse, but even at 'best', with no interference from those things, it still sucks.

I have an essential tremour aka familial tremour (my mother has it too). It was first noted by a friend of mine whilst playing a card game (spit) when I was 12. Ventolin makes it worse, of course. But so does physical stress, such as being tired or working too hard at breathing regardless of ventolin. So does anger sometimes (sometimes body likes to co-opt existing symptoms to ""talk"" to us, I think).

I've had a minor tremour since childhood, but this is quite different in severity. It could just be the progression of ET - it's normal to start getting worsening symptoms in your 40s (if it is going to be progressive) and I'm not far off that, at 37.

Stress definitely makes it worse, but even when I'm chilled out and had enough sleep and so on I'm struggling to do simple manual tasks. The whole bumping into things part is a bit worrying too.

I do hope the cause of your tremour is something innocuous.

Thanks - me too!

[yaf_user681_30355]

Hi curiouser and cici,

I was just wandering around the internet looking at different websites that list side effects of montelukast and Drugs.com mentions tremor and Medicine.Net mentions aggression. I had side effects the second time I was tried on it, I had flu-like symptoms. (Did nothing for my asthma both times I was put on it.) Those symptoms stopped the day I stopped taking it. My flu-like symptoms are not listed on the medication leaflet but were listed on one of the sites I looked on. Interesting...

[Hidden in reply to yaf_user681_30355]

Hi curiouser and cici,

I was just wandering around the internet looking at different websites that list side effects of montelukast and Drugs.com mentions tremor and Medicine.Net mentions aggression. I had side effects the second time I was tried on it, I had flu-like symptoms. (Did nothing for my asthma both times I was put on it.) Those symptoms stopped the day I stopped taking it. My flu-like symptoms are not listed on the medication leaflet but were listed on one of the sites I looked on. Interesting...

The flu-like symptoms are mentioned in my leaflet as a possible side effect. That's unlucky, but then if it didn't help your asthma either then it's no loss!

[cici73]

Very, fortunately Montelukast worked quickly and works well so at least it's worth while taking it.

[Hidden]

I get the shakes from time to time during summer, however during winter I take salbutamol quite a lot both as preventin before I go outside/exercise and as relief so I have the shakes almost all the time. It ranges from mildly annoying to dropping pans etc and being very clumsy. During these times I am usually taking 4lots of preventative salb for the cold and around 6relief per day, sometimes more and it definitely correlates with the amount of salbutamol I'm taking so does you think it's possible it's the same for you? Hope it gets sorted so you at least know what is going on. Like I said on the other montelukas post, it gave me a lot of stomach aches, cici finds she feels agressiive so it's possible it had some other strong effect on you. Mine died down but I guess its been too long for it to die down now.

[Hidden in reply to Hidden]

I get the shakes from time to time during summer, however during winter I take salbutamol quite a lot both as preventin before I go outside/exercise and as relief so I have the shakes almost all the time. It ranges from mildly annoying to dropping pans etc and being very clumsy. During these times I am usually taking 4lots of preventative salb for the cold and around 6relief per day, sometimes more and it definitely correlates with the amount of salbutamol I'm taking so does you think it's possible it's the same for you? Hope it gets sorted so you at least know what is going on. Like I said on the other montelukas post, it gave me a lot of stomach aches, cici finds she feels agressiive so it's possible it had some other strong effect on you. Mine died down but I guess its been too long for it to die down now.

Thanks UniGirl - missed you there as we overlapped!

If I have to use my reliever then it does get worse, the concern is that even when I don't, it's now so bad that it's on a par with my disabled step-son.

If it is the Montelukast then yes, I think you're right that if it was going to go then it would have done so by now - I've been taking it continually for 9 months or so.

I think unfortunately it probably is progressive essential tremor. That fits with things like it getting rapidly worse the longer I do something - for example unloading the dishwasher, the first few items aren't too bad, and by the time I get to the end I'm shaking like a pneumatic drill. My partner has been saying since Xmas that when she hugs me it feels like I'm vibrating inside.

I feel like when I'm shaky from ventolin the shakes continue even 'at rest'. With this, the shakes happen more on-action - so the further I reach for something the more shake there is. I also have what they call an 'intention tremour' - if I try to hit a target then the shaking gets worse the nearer I get to the target. My step-son has this too, hence I know to recognise it.

I guess I'll ask my resp cons which of the selective beta blockers he would prefer me to take and then see if that does anything without massively lowering my blood pressure...

Thanks,

Cx

[yaf_user681_30355]

The last time I was tried on it was autumn 2010 so, maybe it has been added since then...

[Hidden]

Curiouser, I haven't had that severe a response to Montelukast, but I have developed an essential tremor over the course of several months. It does make me feel like a live wire at times, but has not been debilitating for me (yet anyway). I hesitate to get off this medication myself because it does make my asthma much less bothersome. I do hope you find the root cause of your tremors. You are far from alone in this though.