mometasone (inhalation)

Contraindicated in:

Hypersensitivity or intolerance to drug or milk proteins;
Acute attack of asthma/status asthmaticus.

Use Cautiously in:

Active untreated infections;
Diabetes or glaucoma;
Underlying immunosuppression (due to disease or concurrent therapy);
Systemic corticosteroid therapy (should not be abruptly discontinued when inhalation therapy is started; additional corticosteroids needed in stress or trauma);
Pedi: Safety and effectiveness not established in children <12 yr (aerosol) and <4 yr (powder); prolonged or high-dose therapy in children may lead to complications.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: dysphonia, hoarseness, cataracts, glaucoma, nasal congestion, oropharyngeal candidiasis, pharyngitis, sinusitis

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

GI: diarrhea, dry mouth, dyspepsia, nausea, taste disturbances

MS: back pain

Neuro: headache, agitation, depression, dizziness, fatigue, insomnia, restlessness

Resp: bronchospasm, cough, wheezing

Misc: CHURG-STRAUSS SYNDROME, HYPERSENSITIVITY REACTIONS ,(INCLUDING ANAPHYLAXIS, LARYNGEAL EDEMA, URTICARIA, AND BRONCHOSPASM)

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including , atazanavir, clarithromycin, cobicistat, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir may ↓ metabolism and ↑ levels; use with caution.

Availability ⬆ ⬇

Inhalation aerosol (Asmanex HFA): 50 mcg/metered inhalation in 13-g canisters (120 metered inhalations); 100 mcg/metered inhalation in 13-g canisters (120 metered inhalations); 200 mcg/metered inhalation in 13-g canisters (120 metered inhalations)
Powder for inhalation (Asmanex Twisthaler): 110 mcg (delivers 100 mcg/metered inhalation; in packages of 7 and 30 inhalation units); 220 mcg (delivers 200 mcg/metered inhalation; in packages of 14, 30, 60, and 120 inhalation units)
In combination with:
formoterol (Dulera). See Combination Drugs.

Route/Dosage ⬆ ⬇

Asmanex HFA

Inhaln (Adults and Children ≥12 yr): Not on inhaled corticosteroids: Two 100–mcg inhalations twice daily; not to exceed 800 mcg/day; Currently on chronic oral corticosteroids: Two 200–mcg inhalations twice daily; not to exceed 800 mcg/day.
Inhaln (Children 5–11 yr): Two 50–mcg inhalations twice daily; not to exceed 200 mcg/day).

Asmanex Twisthaler

Inhaln (Adults and Children ≥12 yr): Previously on bronchodilators or other inhaled corticosteroids: 220 mcg (1 inhalation) once daily, up to 440 mcg/day as a single dose or 2 divided doses; Previously on oral corticosteroids: 440 mcg (2 inhalations) twice daily (not to exceed 880 mcg/day).
Inhaln (Children 4–11 yr): 110 mcg once daily in evening (not to exceed 110 mcg/day).

US Brand Names ⬆ ⬇

Asmanex HFA, Asmanex Twisthaler

Action ⬆ ⬇

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects:

Decreased frequency and severity of asthma attacks.
Improved asthma symptoms.

Classifications ⬆ ⬇

Therapeutic Classification: antiasthmatics, corticosteroids

Pharmacologic Classification: corticosteroids (inhalation)

Pharmacokinetics ⬆ ⬇

Absorption: <1%; action is primarily local after inhalation.

Distribution: 10–25% is deposited in airways if a spacer device is not used. All cross the placenta and enter breast milk in small amounts.

Metabolism/Excretion: Primarily metabolized by the liver via the CYP3A4 isoenzyme after absorption from lungs; 75% excreted in feces.

Half-Life: 5 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Inhalation	within 24 hr	1–4 wk‡	unknown

‡Improvement in pulmonary function; ↓ airway responsiveness may take longer.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Instruct patient to read the Patient Information and Instructions for Use before using and with each Rx refill, in case of new information. Advise patient not to discontinue medication without consulting health care professional; gradual decrease is required.
Advise patients using inhalation corticosteroids and bronchodilator to use bronchodilator first and to allow 5 min to elapse before administering the corticosteroid, unless otherwise directed by health care professional.
Advise patient that inhalation corticosteroids should not be used to treat an acute asthma attack but should be continued even if other inhalation agents are used.
Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status.
Caution patient to avoid smoking, known allergens, and other respiratory irritants.
Advise patient to notify health care professional if sore throat or sore mouth occurs.
Advise patient to stop using medication and notify health care professional immediately if signs and symptoms of hypersensitivity reactions occur.
Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators.
Asmanex Twisthaler: Advise patient to remove cap while device is in upright position. To administer dose, exhale fully, then place mouthpiece between lips and inhale deeply and forcefully. Remove device from mouth and hold breath for 10 sec before exhaling (do not exhale into mouthpiece). Wipe the mouthpiece dry, if necessary, and replace the cap on the device. Rinse mouth with water; do not swallow, and spit out contents to help reduce risk of oropharyngeal candidiasis. Advise patient to discard twisthaler 45 days from opening or when dose counter reads "00", whichever comes first.

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Indications ⬇

Contraind./Precautions ⬆ ⬇