Is Nasonex (mometasone) safe to use during pregnancy?

Can You Use Nasonex During Pregnancy?

Yes, Nasonex (mometasone) can be safely used during pregnancy at recommended doses, though if you're starting a nasal corticosteroid for the first time during pregnancy, budesonide may be preferred due to more extensive human safety data. 1

Key Recommendations

If Already Using Nasonex Before Pregnancy

• Continue your current Nasonex regimen if it has been effectively controlling your symptoms. 1 No substantial difference in efficacy and safety has been shown among available intranasal corticosteroids, making it reasonable to continue any intranasal corticosteroid that adequately controlled symptoms before pregnancy. 1

If Starting Treatment During Pregnancy

• Intranasal budesonide is the preferred first choice when initiating nasal corticosteroid therapy during pregnancy, as it carries FDA Pregnancy Category B classification based on extensive human safety data. 1
• However, mometasone is explicitly listed as safe by expert panels at recommended doses alongside budesonide and fluticasone. 1

Safety Evidence

Reassuring Data

• A meta-analysis found no increased risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension with intranasal corticosteroid use during pregnancy. 1
• Recent systematic review (2018) concluded that intranasal mometasone at recommended therapeutic doses is safe after proper medical evaluation, with no significant association with congenital organ malformations. 2
• Gestational risk has not been confirmed in observational human data despite most intranasal corticosteroids carrying FDA Pregnancy Category C ratings. 1

Important Caveats

• Mometasone has less accumulated safety data compared to beclomethasone, budesonide, and fluticasone propionate, though available data remain reassuring. 1
• Always use the lowest effective dose for the shortest duration necessary, as with all medications during pregnancy. 1

Clinical Approach

Dosing Strategy

• Administer at the lowest effective dose that controls maternal symptoms adequately. 1
• Avoid exceeding recommended therapeutic doses to minimize any theoretical systemic absorption. 2

When to Avoid or Reconsider

• First trimester use requires careful consideration of risk-benefit ratio, though intranasal corticosteroids have not shown confirmed teratogenic risk. 1
• Consult with the patient's obstetrician when initiating or continuing therapy, particularly for complex cases. 1

Alternative Considerations

• If concerned about mometasone specifically, switch to intranasal budesonide (Pregnancy Category B) which has the most robust human safety data. 1
• Saline nasal rinses can be used as adjunctive therapy to minimize medication requirements. 3

Common Pitfalls to Avoid

• Don't discontinue effective therapy unnecessarily - untreated rhinitis can significantly impact maternal quality of life and potentially worsen comorbid conditions like asthma. 1
• Don't confuse intranasal with oral corticosteroids - oral corticosteroids carry different and more significant risks (cleft palate, preeclampsia, preterm delivery) especially in the first trimester. 1
• Don't use off-label formulations such as budesonide irrigations or nasal drops during pregnancy, as these are not recommended. 1