Mometasone (Nasonex) nasal formulations include nasal spray and nasal implant. Rhinosinusitis, nasal polyps, nasal congestion, and allergic rhinitis are all treated with it as a topical corticosteroid. It takes about 2 weeks for the drug to exert its maximum effects. The duration of the implant may last for three months (90 days).

Mometasone (Nasonex) Uses:

• Nasal congestion linked with seasonal rhinitis (spray only):

  • Both adults and children under the age of two experience relief from seasonal allergic rhinitis-related nasal congestion.

• Allergic rhinitis (seasonal and perennial) (spray only):

  • It has been used for more than two years to treat nasal symptoms in both adults and children caused by seasonal allergic rhinitis and perennial allergic rhinitis.

• Nasal polyps:

  • Additionally, it is applied to individuals older than 18 years old who have nasal polyps. Patients who have had ethmoid sinus surgery should consider the Implant. 

• Off Label Use of Mometasone in Adults:

  • Acute rhinosinusitis is a complementary therapy. 
  • Persistent rhinosinusitis

• Seasonal allergic rhinitis (prophylaxis) (spray only):

  • Additionally, adults and children older than 12 years old can use it to stop the nasal symptoms of seasonal allergic rhinitis.

Mometasone Dose in Adults:

Mometasone (Nasonex) Dose for the Management of Seasonal and Perennial Allergic Rhinitis:

• The maximum daily dosage permitted is 200 mcg.
• Intranasal: Two sprays (each containing 100 mcg) can be used one time a day. 

Mometasone (Nasonex) Dose in the treatment of Nasal congestion associated with seasonal rhinitis:

• Intranasal: It can be given as 2 sprays (100 mcg) in each nostril once a day with a maximum total daily dose of 200 mcg.

Mometasone (Nasonex) Dose in the treatment of Nasal polyps:

• Implant:
  • In the ethmoid sinus, 1 implant (1,350 mcg) was inserted under endoscopic observation for up to 3 months.
• Intranasal:
  • For a daily dosage of 400 mcg, it can be given as 2 sprays (100 mcg each) in each nostril twice a day. 
  • In certain people, 2 sprays of 100 mcg in each nostril once a day may be beneficial. 

Mometasone (Nasonex) Dose for the prophylaxis of seasonal allergic rhinitis:

• Intranasal:
  • Two to four weeks before the predicted start of pollen season, the treatment should commence.
  • It can be given as 2 sprays (100 mcg) in each nostril one time in a day with a total daily dose of 200 mcg.

Mometasone (Nasonex) Dose in the treatment of Acute Rhinosinusitis, adjunctive treatment (off-label):

• Intranasal:
  • The following dosing recommendations have been made:
    • A total of two sprays (100 mcg each) are administered twice daily for a daily dosage of 400 mcg. 
    • If the symptoms are not sufficiently controlled, the dosage can be raised to four 200 mcg sprays twice a day for a total of 800 mcg.
  • The IDSA and AAO-HNS guidelines propose intranasal corticosteroids like mometasone but do not specify a specific dosage.

Acute mild to moderate, uncomplicated rhinosinusitis therapy with mometasone (Nasonex) dose:

• For intranasal administration, use two 100 mcg sprays, twice daily, for a total dosage of 400 mcg. 
• It should be administered for 15 days.

Mometasone Dose in Children:

Mometasone (Nasonex) Dose in the Allergic rhinitis; perennial (relief of nasal symptoms) and seasonal (relief of nasal symptoms and congestion):

Spraying intranasally (50 mcg each spray):

• Treatment:

  • Children 2 to 11 years:
    • 100 mcg/day, or 50 mcg (1 spray) per nostril, administered once daily.
  • Children ≥12 years and Adolescents:
    • 200 mcg/day in total, divided into 100 mcg (2 sprays) administered once daily each nostril.

• Prevention :

  • Children ≥12 years and Adolescents:
    • Beginning two to four weeks before the start of the pollen season, administer 100 mcg (2 sprays) per nostril once a day for a total dosage of 200 mcg per day.

Mometasone (Nasonex) Dose in the treatment of Nasal airway obstruction/ adenoidal hypertrophy:

• Children and teenagers aged three to fifteen:

  • Intranasal:
    • For the first six weeks, it can be administered orally in the form of a spray at a dose of 50 micrograms (1 spray) per nostril, for a total daily dose of 100 micrograms. Then, for the first 14 days of each month, the same quantity can be administered orally every 24 hours.

Mometasone (Nasonex) Dose in the treatment of Nasal polyps:

• Adolescents ≥18 years: Intranasal:

  • Some people may benefit from a lesser dosage of 200 mcg once a day administered as 100 mcg (2 sprays) per nostril once daily.
  • Implant: 1 implant (1,350 mcg) placed in the ethmoid sinus with help of endoscopic visualization for up to 3 months.
  • Spray 100 mcg (2 sprays) per nostril twice a day with a total daily dose of 400 mcg/day.

Pregnancy Risk Category: C

• Poor results have been seen in research on animal reproduction.
• Mometasone can be continued by pregnant women who have been adequately treated with it. If it is started during pregnancy, the drug should be continued.
• Intranasal steroids may be administered within days of pregnancy if taken in the recommended doses.

Mometasone use during breastfeeding:

• The drug has a low systemic absorption (1%). 
• Intranasal sprays inhaled can cause systemic bioavailability, although this was not confirmed in clinical trials.
• Breast milk contains systemic corticosteroids.
• The literature recommends that during pregnancy, the clinician consider both the risks and benefits to both mother's and baby's health. 
• Breastfeeding does not affect the ability to provide the necessary treatment.

Dose in Kidney Disease:

No dose adjustments are required for renal impairment.

Dose in Liver disease:

Drug's systemic bioavailability can be increased in severe hepatic function derangement, however, in mild to moderate disease the dose adjustment is not recommended by the manufacturer.

Common Side Effects of Mometasone (Nasonex):

• Central Nervous System:

  • Headache

• Respiratory:

  • Epistaxis
  • Pharyngitis
  • Chronic Sinusitis
  • Blood In Nasal Mucosa

• Infection:

  • Viral Infection

Less Common Side Effects of Mometasone (Nasonex):

• Cardiovascular:

  • Chest Pain

• Dermatologic:

  • Skin Changes

• Gastrointestinal:

  • Vomiting
  • Diarrhea
  • Dyspepsia
  • Nausea

• Genitourinary:

  • Dysmenorrhea

• Hypersensitivity:

  • Hypersensitivity Reaction

• Neuromuscular & Skeletal:

  • Musculoskeletal Pain
  • Arthralgia
  • Myalgia

• Ophthalmic:

  • Conjunctivitis

• Otic:

  • Otalgia
  • Otitis Media

• Respiratory:

  • Upper Respiratory Tract Infection
  • Cough
  • Sinusitis
  • Asthma
  • Bronchitis
  • Flu-Like Symptoms
  • Nasal Mucosa Irritation
  • Rhinitis
  • Wheezing
  • Nasopharyngitis
  • Sinus Headache
  • Nasal Candidiasis
  • Nasal Mucosa Ulcer
  • Pharyngeal Candidiasis

Contraindications to Mometasone (Nasonex):

• Mometasone hypersensitivity and any other ingredient in the formulation are contraindications.
• Cross-reactions can be caused by physiochemical similarities among different drug groups.

Warnings and precautions

• Suppression of the adrenals:

  • If recommended dosages are exceeded or in those who are particularly susceptible to it, it may result in hypercortisolism or suppression of the hypothalamic-pituitary-adrenal (HPA) axis. But that is not typical.
  • Asthmatic patients who have been treated with systemic corticosteroids and then switched to aerosol steroids have died. 
  • An adrenal crisis can occur.
  • You should withdraw the steroid slowly.
  • The systemic steroids required to treat infections, surgical patients, and trauma patients cannot be delivered via aerosol steroids.

• Immunosuppression:

  • Additionally, corticosteroids can be used for extended periods of time to reduce the effectiveness of vaccines, raise the risk of secondary infections, conceal acute illnesses (including fungal infections), prolong and worsen viral infections, and disguise fungal infections. 
  • If you are not immune, stay away from measles and chickenpox outbreaks.

• Delay in wound healing

  • Intranasal steroids shouldn't be used in patients who have trauma, recent surgery, or nasal septal ulcers.

• Hypersensitivity reactions

  • There have been hypersensitivity reactions such as rash, pruritus, and angioedema. If such reactions occur, discontinue using the drug.

• Local nasal effects:

  • Perforation of the nasal septum, epistaxis, and irritation, as well as infection in the nose or pharynx, can commence. 
  • It is important to examine the nasal mucosa regularly. If an infection is detected, discontinue treatment.
  • Patients with trauma or nasal ulcers should avoid using nasal implants.

• Hepatic impairment

  • The drug may accumulate in the systemic circulation in severe hepatic impairment. It should therefore be avoided

• Infections

  • Patients with active or late-stage tuberculosis infection, untreated systemic fungal or bacterial infections, or parasitic infections should be cautious. 
  • If you have ocular herpes, it is a sign to not administer it.
  • Untreated nasal mucosa infection should be treated immediately. 
  • If you suspect that there is a bacterial infection in the sinuses, it is important to administer concurrent antimicrobial therapy.

• Ocular disease:

  • Patients with cataracts or glaucoma should exercise caution since glaucoma and intraocular pressure may worsen. 
  • For individuals with vision impairments and chronic users, regular eye exams are advised.

Mometasone (nasal): Drug Interaction

Monitoring parameters:

• Adrenal insufficiency.
• Keep an eye out for any unfavorable nasal consequences, such as infection, epistaxis, a perforated nasal septum, or nasal ulcers.
• Signs and symptoms of HPA axis suppression.
• Growth (adolescents and children).
• cataracts and glaucoma, especially in individuals whose eyesight has changed.

How to administer Mometasone (Nasonex)?

Intranasal:

• Spray:
  • Only to be administered intravenously. 
  • Prior to the first usage, prime the pump by pressing it ten times or until a thin spray occurs. 
  • Reprime the pump with two sprays or until a fine mist is produced if it has been 7 or more days since the previous usage. 
  • Before using, shake. Clear your nostrils by blowing. 
  • Close off the other nostril after inserting the applicator into one and tilting the head slightly forward while maintaining the upright position of the bottle. 
  • Inhale through your nose. Press the pump to expel the spray while inhaling, and then exhale through your mouth. 
  • After each use, replace the cap after cleaning the spray tip with a clean tissue. Keep your lips, eyes, and nasal septum clear of the spray.
  • Even if the bottle isn't totally empty, throw it away once 120 medicinal sprays have been used.
• Implant:
  • Under endoscopic supervision, the implant should be placed in the ethmoid sinus; it should not be bent, twisted, or otherwise damaged. 
  • No more than twice should the implant be compressed or loaded into the delivery system.

Mechanism of action of Mometasone (Nasonex):

• It could lessen the synthesis, release, or activation of inflammatory endogenous chemical mediators (kinins and histamines, liposomal enzymes, and prostaglandins). 
• Leukocytes and macrophages could be necessary for the aforementioned chemicals to start reactions. In the region of the damage, it prevents cell migration and margination.

Duration:

• Implant: ≤90 days

Metabolism:

• Hepatic; extensive via CYP3A4 to multiple metabolites

Absorption:

• In plasma, undetectable 
• Instead of systemic absorption, direct local actions are what cause the clinical symptoms.

Half-life elimination:

• IV: ~5 to 6 hours

The onset of action:

• Spray:
  • Within 11 hours, symptoms of allergic rhinitis may improve; 
  • The maximum impact will be felt within 1 to 2 weeks of beginning treatment.

Protein binding:

• 98% to 99%

Bioavailability:

• Spray: <1%

Excretion:

• Bile (primary route):
• urine (limited)

International Brand Names of Mometasone:

• Nasonex
• Sinuva
• APO-Mometasone
• Mosaspray
• Nasonex
• SANDOZ Mometasone
• TEVA-Mometasone
• Akira
• Allermom
• Allermosone
• Alvogen
• Aquamet
• Aureox
• Avocom
• Azonaire
• Bloctimo
• Breso
• Cobizal
• Defonex
• Dezrinit
• Elisox
• Eztom
• Fironel
• Flonez
• Hexaler Nasal
• Kalmente
• Lisiker
• Lorome
• Mastasone
• Metanase
• Metason Nasal
• Metasone
• Metaspray
• Modexa
• Momenta
• Momepax
• Momester
• Mometik
• Mometomark
• Mometzona
• Mominex
• Mommex
• Mommox
• Monaliz
• Monez
• Monitazon
• Mosaspray
• Mosonaller
• Myrex
• Narinex
• Nasaflex
• Nasative
• Nasehaler
• Nasoaldo
• Nasocobi
• Nasocure
• Nasomet
• Nasometin
• Nasonex
• Nasonex Nasal Spray
• Nasostad
• Nazonex
• Netonox
• Nezelex
• Rinelon
• Rinitek
• Rinobudex
• Rinose
• Rinoval
• Sinocort
• Tabunex
• Uniclar
• Zalconex
• Zymocort

Mometasone  Brand Names in Pakistan: