mometasone (nasal)

REMS

Treatment of nasal symptoms of seasonal and perennial allergic rhinitis.
Prophylaxis of nasal symptoms of seasonal allergic rhinitis (mometasone Rx only).
Treatment of nasal polyps (mometasone Rx only).

Action ⬆ ⬇

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects:

Decrease in symptoms of allergic rhinitis and nasal polyps.

Pharmacokinetics ⬆ ⬇

Absorption: Negligible absorption; action is primarily local following nasal use.

Distribution: Crosses the placenta and enters breast milk in small amounts.

Metabolism/Excretion: Rapidly and extensively metabolized by the liver; primarily excreted in bile.

Half-Life: 5.8 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Intranasal	within 2 days	1–2 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to mometasone.

Use Cautiously in:

Active untreated infections;
Diabetes or glaucoma;
Underlying immunosuppression (resulting from disease or concurrent therapy);
Systemic glucocorticoid therapy (should not be abruptly discontinued when intranasal therapy is started);
Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids);
OB: Other intranasal corticosteroids are preferred for allergic rhinitis during pregnancy;
Pedi: Children 2 yr (safety and effectiveness not established); prolonged or high-dose therapy may lead to complications.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: pharyngitis, cataracts, epistaxis, glaucoma, nasal burning, nasal irritation, nasopharyngeal fungal infection, sinusitis

Endo: adrenal suppression (↑ dose, long-term therapy only), ↓growth (children)

GI: vomiting

GU: dysmenorrhea

MS: pain

Neuro: headache

Resp: cough

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including atazanavir, clarithromycin, cobicistat, itraconazole, ketoconazole, nefazodone, nelfinavir, orritonavir may ↑ levels and the risk of toxicity.

Route/Dosage ⬆ ⬇

Treatment of Season and Perennial Allergic Rhinitis

(Adults and Children ≥12 yr): Rx or OTC mometasone: 2 sprays in each nostril once daily (not to exceed 2 sprays in each nostril once daily).
(Children 2–11 yr): Rx or OTC mometasone: 1 spray in each nostril once daily.

Prophylaxis of Seasonal Allergic Rhinitis

(Adults and Children ≥12 yr): Rx mometasone:2 sprays in each nostril once daily initiated 2–4 wk prior to beginning of pollen season.

Treatment of Nasal Polyps

(Adults ≥18 yr): Rx or OTC mometasone: 2 sprays in each nostril 1–2 times daily (not to exceed 2 sprays in each nostril twice daily).

Availability ⬆ ⬇

(Generic available)

Nasal spray: 50 mcg/metered spray (delivers 120 or 144 sprays)^OTC
In combination with: olopatadine (Ryaltris). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
- Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
- Monitor growth rate in children receiving chronic therapy; use lowest possible dose.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Implementation ⬆ ⬇

After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before glucocorticoid nasal spray.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Before first-time use, prime unit by spraying 10 times or until fine spray appears. If not used for at least 7 days, reprime by spraying 2 times or until fine spray appears. Prior to administering dose, gently blow nose to clear nostrils. Close 1 nostril. Tilt head forward slightly and insert nasal applicator into other nostril. Spray and breathe inward through nostril. Breathe out through mouth. Repeat procedure in other nostril. Warn patient that temporary nasal stinging may occur.
Instruct patient to notify health care professional if symptoms do not improve within 2 wk or if symptoms worsen.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇