Appropriate Use of Mometasone in Children
Mometasone furoate nasal spray is FDA-approved for children as young as 2 years old for allergic rhinitis, with a recommended dose of 1 spray per nostril (50 mcg/spray) daily for ages 2-11 years and 2 sprays per nostril daily for ages 12 years and older. 1
Indications and Dosing
Allergic Rhinitis
- Ages 2-11 years: 1 spray per nostril once daily (50 mcg/day)
- Ages ≥12 years: 2 sprays per nostril once daily (100 mcg/day)
- For nasal polyps (≥18 years only): 2 sprays per nostril twice daily 1
Atopic Dermatitis
- Not recommended for children under 12 years for topical use (mometasone lotion) 2
- For moderate to severe atopic dermatitis in children ≥12 years, can be used as a medium-potency topical corticosteroid 3
Efficacy and Safety Profile
Efficacy
- Mometasone furoate nasal spray effectively reduces total nasal symptom scores in children with both seasonal and perennial allergic rhinitis 4, 5
- Onset of action is approximately 7 hours in seasonal allergic rhinitis 6
- Long-term studies (up to 12 months) show sustained efficacy in children 5, 7
Safety Considerations
Growth Effects
- Unlike some other intranasal corticosteroids (such as beclomethasone), mometasone furoate has not shown evidence of growth suppression in yearlong studies using stadiometry in children 1, 8
- A 12-month study in children aged 6-11 years demonstrated no effect on growth with daily use of mometasone furoate nasal spray 7
HPA Axis Effects
- Cosyntropin stimulation testing has shown no evidence of hypothalamic-pituitary-adrenal (HPA) axis suppression in children at recommended doses 4, 8
- Even at doses up to 200 mcg once daily for 4 weeks, no detectable effects on HPA axis function were observed 4
Ocular Effects
- No evidence of posterior subcapsular cataracts or increased intraocular pressure with mometasone use in children 9, 7
Common Side Effects
- Most common adverse events include:
Administration Technique
- Shake container well before each use
- Have child tilt head slightly forward
- Direct spray away from the nasal septum to prevent irritation and potential septal perforation 9
- Administer at approximately the same time each day
Clinical Pearls and Precautions
For proactive therapy: In children with moderate to severe atopic dermatitis, twice-weekly application of mometasone to previously affected skin areas for up to 16 weeks may help prevent relapses 3
Avoid in children under 2 years: Safety and efficacy have not been established in this age group 1
Monitor for local side effects: Periodically examine the nasal septum for erosions, which may precede septal perforations 9
Duration of treatment: Use the lowest effective dose for the shortest duration needed to control symptoms 10
Avoid concomitant use of multiple corticosteroid-containing products (inhaled, oral, topical) as this may increase risk of systemic effects 9
Benzalkonium chloride in some formulations may promote ciliary stasis and reduce mucociliary transport 9
By following these guidelines, mometasone can be safely and effectively used in children with allergic rhinitis while minimizing potential adverse effects.