Mometasone

Corticosteroid, Glucocorticoid, Inhaled corticosteroid (ICS)

Mometasone furoate

Nasonex (intranasal), Asmanex (inhaled), Elocon (topical), Sinuva (sinus implant); with formoterol as Dulera

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Titration strategies

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Effects

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Pharmacy

Starting dose

Intranasal Nasonex 2 sprays/nostril daily (50 mcg/spray); inhaled Asmanex 220 mcg DPI 1-2 inhalations daily/BID; topical Elocon 0.1% cream daily

Preparations

Nasonex 50 mcg/actuation intranasal; Asmanex HFA MDI 100/200 mcg; Asmanex Twisthaler DPI 110/220 mcg; Elocon 0.1% cream/ointment/lotion; Sinuva sinus implant; Dulera (with formoterol)

US FDA Max

Intranasal 200 mcg/d (adults); inhaled 880 mcg/d

Common uses

Classification(s)

Classes

Corticosteroid, Glucocorticoid, Inhaled corticosteroid (ICS)

Pharmacology

Routes

Intranasal, inhaled, topical, intranasal sinus implant

Onset

Intranasal: symptom relief 12-24 hours; inhaled: bronchial effect 1-2 weeks

Duration

24 hours

Half-life

~5 hours (plasma)

Bioavailability

Intranasal: <1% systemic; inhaled lung deposition with extensive first-pass clearance

Pregnancy

Intranasal long considered acceptable; widely used in obstetric rhinitis.^{[citation needed]}

Legal status

OTC (Nasonex 24HR) and Rx-only (other forms) in US

Purported mechanism

Mometasone furoate is a high-affinity glucocorticoid receptor agonist with extensive hepatic first-pass clearance (CYP3A4) that minimizes systemic glucocorticoid exposure from inhaled, intranasal, or topical administration.▲0▼ Like other locally-acting corticosteroids, broadly suppresses inflammatory gene transcription; clinical onset is gradual for asthma controller use but rapid for allergic rhinitis. Once-daily intranasal dosing reflects strong receptor binding and slow tissue clearance.