What is the recommended dosage and treatment regimen for ASMANEX (mometasone furoate) in asthma management?

ASMANEX (Mometasone Furoate) Dosage and Treatment Regimen for Asthma Management

Mometasone furoate (ASMANEX) delivered via dry powder inhaler (Twisthaler) is recommended at a dosage of 200 mcg once daily in the evening for mild to moderate persistent asthma, with the option to increase to 400 mcg once daily for more severe cases. 1, 2

Dosage Recommendations by Age and Severity

Adults and Adolescents:

• Mild to moderate persistent asthma:

  • 200 mcg once daily in the evening 2
  • Alternative: 100 mcg twice daily 3

• Moderate persistent asthma previously treated with other inhaled corticosteroids:

  • 400 mcg once daily in the evening 1, 2
  • Alternative: 200 mcg twice daily 2

• Severe persistent asthma (including oral corticosteroid-dependent asthma):

  • 400 mcg twice daily 2, 4

Children (4-11 years):

• Persistent asthma:
  • Starting dose: 100 mcg once daily in the evening 3
  • May increase to 100 mcg twice daily if needed 3

Administration Considerations

• Timing of dose: Evening administration of once-daily dosing is more effective than morning administration 1
• Frequency options: Once-daily dosing is as effective as twice-daily dosing at equivalent total daily doses 3, 2
• Device: Administered via a breath-actuated dry powder inhaler (Twisthaler) 1

Comparative Efficacy

• Mometasone furoate 100-200 mcg twice daily is as effective as:
  • Beclomethasone dipropionate 200 mcg twice daily 2
  • Budesonide 400 mcg twice daily 2
  • Fluticasone propionate 250 mcg twice daily 2

Special Populations

• Oral corticosteroid-dependent patients: Mometasone furoate 400-800 mcg twice daily can effectively reduce or eliminate the need for oral corticosteroids 2, 4

Monitoring and Follow-up

• Assess response to therapy after 1-4 weeks 5
• Monitor for improvement in:
  • Lung function (PEF >75% of predicted or best) 5
  • Symptom control 3
  • Reduced rescue medication use 3
  • Quality of life measures 1, 3

Safety Profile

• Common side effects: Oral candidiasis, headache, pharyngitis, and dysphonia 2
• Systemic effects: Minimal systemic activity at recommended doses 1, 2
• Pediatric considerations: No significant effect on growth velocity or hypothalamic-pituitary-adrenal axis at approved doses 3

Clinical Pearls

• Mometasone furoate has approximately 1% oral bioavailability, minimizing systemic effects 6
• The drug has a long half-life, making it suitable for once-daily dosing 6
• For patients transitioning from other inhaled corticosteroids, mometasone furoate provides comparable efficacy with the convenience of once-daily dosing 3, 4
• Patients should be instructed to rinse their mouth after each use to minimize the risk of oral candidiasis 5

Common Pitfalls to Avoid

• Underdosing: Starting with too low a dose in patients with moderate to severe asthma may lead to inadequate control 4
• Improper timing: For once-daily dosing, evening administration is superior to morning administration 1
• Abrupt discontinuation: When discontinuing oral corticosteroids in favor of inhaled mometasone, taper oral steroids gradually to avoid adrenal insufficiency 2
• Inadequate device training: Ensure proper inhaler technique with the Twisthaler device for optimal drug delivery 3