2015 Nov;136(5):592e-6e. Clipboard, Search History, and several other advanced features are temporarily unavailable. Two drugs that inhibit the production of leukotrienes, zafirlukast (Accolate) and montelukast (Singulair), have been approved by the US Food and Drug Administration for the treatment of asthma.Zafirlukast and montelukast block LTs at the end of the inflammation cascade (Zafirlukast (20 mg twice daily) inhibits 3 LTs: LTCThrough a series of experiences, Schlesinger et al postulated that zafirlukast could prevent and treat capsular contracture after breast augmentation.Prevention of capsular contracture is complex and mul-tifactorial.To date, the evidence indicating that zafirlukast or montelukast prevented, softened, or inhibited capsular contracture is anecdotal, although many surgeons have perceived clinical improvement. These medications should not be used by pregnant patients, so caution was exercised in this regard. This article summarizes the proposed logic behind using these two asthma medications for the prevention and treatment of breast implant capsular contracture.Leukotrienes (LTs) are substances in the bloodstream, produced by leukocytes, that promote inflammation and smooth muscle contraction. Search for other works by this author on:

Twenty-three deaths were reported (8 of these 23 patients were taking no other medication); 12 of these deaths followed liver failure. A careful review revealed 66 cases of hepatitis or liver failure in patients who had each received a normal dose of zafirlukast; 13 of these patients were taking no other medication.
It should be noted that a rare vasculitis syndrome, Churg-Strauss syndrome, can develop in patients who have received either zafirlukast or montelukast, but careful review of multiple files with each company revealed that only asthma patients were reported to experience this syndrome.The author's initial clinical study involved 5 patients treated with the normal dose of zafirlukast. Assay these tissues for LTs and LT receptors. Dr. Gryskiewicz is clinical professor at the University of Minnesota Academic Health Center, Minneapolis, MN. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwideFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.

This discussion was thoroughly documented in the medical record. It should be noted that the Adverse Event Reporting System contains a disclaimer stating, “The reports have not been scientifically or otherwise verified as to a cause-and-effect relationship and cannot be used to estimate the incidence of adverse drug reactions.” Many physicians entered the specific code to indicate zafirlukast as the “primary suspect” in the adverse event.Merck has reported no pre- or postmarketing cases of hepatitis or liver failure in patients treated with mon-telukast. One member of the office staff was trained to recognize and grade capsular contractures and acted as the blinded examiner. Leukotrienes are implicated in the inflammatory cascade and have been postulated to be involved in the formation of CC.

Merck & Co reported no postmarketing cases of hepatitis or liver failure associated with montelukast. Two patients required liver transplants. Patients were given extensive informed consent as to the off-label use. If CysLT receptors are found, then characterize them pharmacologically.Adhere to recommended standards for reporting data on capsular contracture.Commit to having at least one blinded examiner check patients with capsular contracture in any study method.Develop and use an objective device, rather than subjective assessment, to measure, document, and communicate data about capsular contracture.Ideally, design prospective randomized double-blinded placebo-controlled studies approved by an institutional review board to measure prevention and treatment of capsular contracture and prevention of recurrence after capsulotomy/capsulectomy.All authors or discussants must disclose any proprietary, financial, or personal interest in a roduct, method, or design, including patents pending or issued.Oxford University Press is a department of the University of Oxford.
2020 Apr;145(4):901-911. doi: 10.1097/PRS.0000000000006629.Embrey M, Adams EE, Cunningham B, Peters W, Young VL, Carlo GL.Aesthetic Plast Surg. Please enable it to take advantage of the complete set of features!