Singulair vs. Pulmicort
See how Singulair and Pulmicort compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Singulair is a once-daily pill that also treats allergic rhinitis, while Pulmicort is a twice-daily inhaled steroid used only for asthma maintenance.
Singulair carries a boxed warning for neuropsychiatric side effects, including suicidal thoughts, that Pulmicort does not carry.
Neither drug treats a sudden asthma attack, so both require a separate fast-acting rescue inhaler on hand.
Singulair vs. Pulmicort Drug Summary
Singulair
Singulair (montelukast) is a leukotriene receptor antagonist that blocks the airway-narrowing chemicals released during asthma and allergy flares. It is approved for long-term asthma prevention, exercise-induced bronchoconstriction, and seasonal or perennial allergic rhinitis. It comes as a tablet, chewable tablet, or oral granules taken once a day.
Pulmicort
Pulmicort (budesonide) is an inhaled corticosteroid that reduces inflammation directly in the airways. It is approved as ongoing maintenance therapy for asthma in patients six and older, delivered through a dry powder inhaler used twice daily. It is also available as a nebulized suspension for younger children.
Singulair vs. Pulmicort Side Effects
Singulair
Pulmicort
Singulair vs. Pulmicort Dosage
Singulair
Pulmicort
| STAGE | DOSE | WHEN |
| Starting dose | 4 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 180 mcg twice daily | At the start |
| Maximum dose | 720 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
Singulair
| STAGE | DOSE | WHEN |
| Starting dose | 4 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Pulmicort
| STAGE | DOSE | WHEN |
| Starting dose | 180 mcg twice daily | At the start |
| Maximum dose | 720 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
Singulair vs. Pulmicort Indications
Singulair
Singulair works by blocking leukotrienes, the molecules that trigger airway swelling and mucus production. It is approved for long-term asthma control, exercise-induced bronchoconstriction, and both seasonal and perennial allergic rhinitis. It acts too slowly to stop an asthma attack already underway.
Chronic asthma prophylaxis
Exercise-induced bronchoconstriction prevention
Seasonal allergic rhinitis relief
Pulmicort
Pulmicort works by delivering a corticosteroid straight to the lungs to calm inflamed airways over time. It is approved only for ongoing asthma maintenance in people six and older, not for allergies or quick symptom relief. Like Singulair, it is not meant to treat a sudden asthma attack.
Maintenance asthma treatment (ages 6+)
Prophylactic therapy to reduce asthma attacks
Off-label: eosinophilic esophagitis management
Singulair vs. Pulmicort Pros and Cons
Singulair
Singulair offers a needle-free, inhaler-free way to manage asthma and doubles as an allergy treatment, which appeals to people who struggle with inhaler technique. Its FDA boxed warning for mood and behavior changes means doctors weigh it more carefully than a typical inhaled steroid. It now has generic competition, though coverage still varies by plan.
Pros
No inhaler technique needed — pill, chewable, or granules
Once-daily dosing
Also treats seasonal and perennial allergic rhinitis
Chewable and granule forms suit young children
Cons
Boxed warning for neuropsychiatric effects, including suicidal thoughts
Not for treating an asthma attack in progress
Chewable tablets contain phenylalanine, a caution with PKU
Rare risk of Churg-Strauss syndrome when oral steroids are tapered
Pulmicort
Pulmicort delivers steroid medication straight to the airways, which many clinicians see as a more direct way to control asthma inflammation. It lacks Singulair's psychiatric boxed warning but requires correct inhaler technique twice a day to work well. Pricing and coverage are broadly similar to Singulair, so the choice usually comes down to delivery method and side-effect profile.
Pros
Delivers steroid directly to the airways, limiting systemic exposure
Also available as a nebulized Respules suspension for children under 6
No boxed psychiatric warning
Long-established track record as an inhaled corticosteroid
Cons
Twice-daily inhaler technique can be hard for young kids to master
Contains trace milk proteins, a risk for severe milk allergy
Can cause oral thrush if the mouth isn't rinsed after use
Flexhaler device not approved for children under 6
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