Drug reference

Mometasone

Corticosteroid · Anti-inflammatory, Anti-allergic, Antiasthmatic, Dermatological agent

Also known as Mometasone Furoate, Nasonex, Elocon, Asmanex Twisthaler

START

Confirm allergic rhinitis, asthma, or dermatologic indication. Rule out active nasal/oral infection. For asthma: ensure NOT for acute bronchospasm. Teach proper inhaler/spacer technique.

TYPICAL MAX

880 mcg BID (inhalation); 200 mcg/nostril/day (nasal). Do not exceed.

STOP IF

Severe nasal bleeding, signs of adrenal suppression (fatigue, weakness, weight loss, hypotension), severe allergic reaction, worsening of untreated infection

WATCH

Growth velocity in children (stadiometry every 6 months), signs of candidiasis (inhalation — rinse mouth after use), intraocular pressure (annual eye exam with prolonged use), nasal mucosa integrity

CDSCO approvedJan AushadhiATC R01AD09

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1d · 1-2 days (nasal); 1-2 weeks (inhalation)
PEAK: 2w · 1-2 weeks (max effect)
t½: 5.8h · ~5.8 h (absorbed fraction)
DURATION: 1d · 24 h (nasal/topical); 12 h (inhalation BID)

EXCRETION

Biliary/fecal (metabolites); <1% renal; extensive first-pass

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

FDA PLLR: Animal studies showed fetal harm at high systemic doses. Limited human data. Use during pregnancy only if benefit clearly outweighs risk. Budesonide has the most safety data in pregnancy among inhaled corticosteroids.

FDA category + note

Available in India

281 branded formulations and 358 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Mometasone furoate is a synthetic corticosteroid with potent anti-inflammatory, anti-allergic, and vasoconstrictive properties. It binds to intracellular glucocorticoid receptors (GR) in target cells, forming a steroid-receptor complex that translocates to the nucleus and modulates gene transcription. This results in: (1) inhibition of phospholipase A2, reducing arachidonic acid release and downstream prostaglandin and leukotriene synthesis; (2) suppression of inflammatory cytokine production (IL-1, IL-2, IL-6, TNF-alpha, IFN-gamma); (3) decreased mast cell and eosinophil recruitment; and (4) reduced vascular permeability. Mometasone has a high topical-to-systemic potency ratio due to extensive first-pass hepatic metabolism and low systemic bioavailability.

Indications

Allergic rhinitis (nasal spray)Nasal polyps (prophylaxis/treatment)Asthma prophylaxis (inhalation — maintenance only, not acute bronchospasm)Dermatitis, eczema, psoriasis (topical cream/ointment/lotion)Chronic obstructive pulmonary disease (COPD) maintenance (off-label, inhalation)

Dosing

Adult: Allergic rhinitis: 2 sprays (100 mcg) in each nostril daily; maintenance: 1 spray (50 mcg) in each nostril daily. Nasal polyps: 2 sprays in each nostril BID. Asthma: 220-440 mcg inhalation BID (max 880 mcg BID). Topical: apply thin layer to affected area daily.
Pediatric: Allergic rhinitis (2-11 years): 1 spray (50 mcg) in each nostril daily. (12+ years): adult dosing. Asthma (4-11 years): 110 mcg BID. Topical (≥2 years): apply thin layer daily.
Renal adjustment: No adjustment required.
Hepatic adjustment: No adjustment required (extensive first-pass metabolism but minimal systemic exposure).
Geriatric: No specific adjustment. Monitor for systemic corticosteroid effects with prolonged high-dose use.
Max dose: 880 mcg BID (inhalation); 200 mcg/nostril/day (nasal)

Pharmacokinetics

Onset

Nasal: 1-2 days for symptom relief. Inhalation: 1-2 weeks for asthma control. Topical: 2-3 days for skin improvement.

Peak effect

Nasal: 1-2 weeks (maximum effect). Inhalation: 1-2 weeks.

Duration

24 hours (nasal, topical); 12 hours (inhalation BID).

Half-life

~5.8 hours (plasma elimination; reflects absorbed fraction).

Bioavailability

Nasal: <1% (oral bioavailability of swallowed portion). Inhalation: <1% (oral bioavailability of swallowed portion). Topical: <0.4% (percutaneous absorption).

Protein binding

~98-99% (bound to albumin).

Metabolism

Extensive hepatic first-pass metabolism via CYP3A4 (primary) to multiple metabolites. No active metabolites. 5-beta-hydroxy and delta-1,2-dehydro metabolites are primary.

Excretion

Biliary/fecal (major, as metabolites). Renal: <1% (as metabolites).

Contraindications

Hypersensitivity to mometasone or any component
Untreated localized nasal, oral, or systemic infections (bacterial, fungal, viral including herpes simplex, TB)
Status asthmaticus or acute asthma attack (inhalation)
Recent nasal surgery/trauma (nasal spray — until healed)

Side effects

Common

Nasal irritation, burning, dryness, epistaxis (nasal spray)Oropharyngeal candidiasis (inhalation)Hoarseness, dysphonia (inhalation)Skin atrophy, thinning, striae (prolonged topical use)Headache

Serious

Adrenal suppression/HPA axis suppression (with prolonged high-dose systemic absorption)
Growth retardation in children (chronic high-dose inhalation/nasal)
Glaucoma, cataracts (prolonged use — especially with high-dose inhaled/nasal)
Septal perforation (nasal spray — rare)
Increased susceptibility to infections (localized immunosuppression)
Psychiatric effects (mood changes, depression, aggression — rare with inhaled corticosteroids)

Pregnancy & lactation

Pregnancy

Lactation

Minimal systemic absorption means negligible excretion in breast milk. Compatible with breastfeeding per AAP. Monitor infant for thrush if using inhalation.

Drug interactions

Cyp3a4 Inducers

Moderate

Database

CYP3A4 inducers may reduce systemic exposure of mometasone by increasing hepatic metabolism, potentially reducing therapeutic efficacy.

Monitor symptom control. May need to increase mometasone dose or switch to alternative therapy.