What are the uses and dosages of Mometasone (corticosteroid)?

Mometasone: Uses and Dosages

Mometasone is a potent synthetic corticosteroid available in multiple formulations for treating asthma, allergic rhinitis, and inflammatory skin conditions, with specific dosing regimens based on age, condition severity, and formulation type. 1

Inhaled Mometasone for Asthma

Dosing Guidelines

• Adults and children ≥12 years:
  • Low dose: 200 mcg once daily
  • Medium dose: 400 mcg once daily
  • High dose: >400 mcg once daily 1

Administration Considerations

• Bioavailability is less than 1% when inhaled properly
• Metabolized primarily through CYP3A4 in the liver
• Terminal half-life of approximately 5 hours
• Excreted mainly in feces (74%) and minimally in urine (8%) 2

Side Effects

• Common: Oral thrush (candidiasis), dysphonia, cough
• Prevention: Use spacer with MDI, rinse mouth and spit after use 1, 3

Intranasal Mometasone for Allergic Rhinitis

Dosing Guidelines

• Children 2-11 years: 1 spray per nostril once daily (50 mcg/spray)
• Patients ≥12 years: 2 sprays per nostril once daily
• Adults ≥18 years with nasal polyps: 2 sprays per nostril twice daily 1

Side Effects

• Common: Headache, viral infection, pharyngitis, epistaxis, cough 1

Topical Mometasone for Dermatological Conditions

Available Formulations

• 0.1% cream, ointment, and lotion 4

Indications

• Atopic dermatitis
• Seborrheic dermatitis
• Psoriasis vulgaris
• Scalp psoriasis
• Other steroid-responsive dermatoses 4, 5

Dosing Guidelines

• Apply once daily to affected areas 4
• For maintenance therapy in chronic hand eczema, long-term intermittent use is effective 1
• In psoriasis, alternate-day application can maintain symptom control after initial daily treatment 4

Efficacy

• Comparable to twice-daily betamethasone dipropionate 0.05%
• Superior to less potent corticosteroids like hydrocortisone 1.0% 4, 6

Clinical Advantages

1. Once-daily dosing: Mometasone's long half-life allows for convenient once-daily administration in most indications 4, 7

2. Safety profile:

   • Low systemic bioavailability (approximately 1%)
   • Minimal HPA axis suppression at recommended doses
   • Lower atrophogenic potential compared to other potent corticosteroids 4, 5

3. Efficacy:

   • Potent anti-inflammatory activity
   • Longer duration of action than betamethasone
   • Effective in reducing nasal polyp size 1, 4

Important Considerations

• Hepatic impairment: Plasma concentrations may increase with severity of hepatic impairment 2
• Drug interactions: Ketoconazole and other CYP3A4 inhibitors may increase systemic exposure 2
• Pregnancy: Use only if potential benefit justifies potential risk to fetus

Monitoring Recommendations

• For long-term use of inhaled formulations, monitor for:

  • Signs of oral thrush
  • Growth in pediatric patients
  • Adrenal function with high doses

• For topical formulations, monitor for:

  • Skin atrophy (particularly with prolonged use)
  • Signs of systemic absorption with extensive application

Remember that the lowest effective dose should be used for the shortest duration needed to achieve and maintain control of symptoms, particularly for topical and inhaled formulations.