What is the recommended dose of mometasone (nasal corticosteroid) for allergic rhinitis?

Mometasone Dose for Allergic Rhinitis

For adults and children ≥12 years with allergic rhinitis, use mometasone furoate nasal spray 2 sprays per nostril once daily (200 mcg total daily dose), and for children ages 2-11 years, use 1 spray per nostril once daily (100 mcg total daily dose). 1

Age-Specific Dosing

Children Ages 2-11 Years

• Administer 1 spray (50 mcg) per nostril once daily for a total of 100 mcg/day 1, 2
• This dosing is FDA-approved and supported by dose-ranging studies demonstrating that 100 mcg once daily provides optimal efficacy in pediatric patients without additional benefit from higher doses 3
• The 100 mcg dose showed continued symptom improvement through 29 days of treatment, whereas the 25 mcg dose demonstrated minimal further improvement after initial response 3

Adolescents and Adults ≥12 Years

• Administer 2 sprays (50 mcg each) per nostril once daily for a total of 200 mcg/day 1, 2
• Dose-ranging studies in adults confirmed that 200 mcg once daily is the optimal dose, providing consistent reduction in total nasal symptom scores throughout treatment 4
• The 800 mcg dose provided no significant additional benefit over 200 mcg, establishing 200 mcg as the therapeutic ceiling 4

Administration Technique to Maximize Efficacy

• Prime the bottle before first use by pumping until fine mist appears (typically 10 pumps if starting new bottle or if unused for one week) 2
• Have patient blow nose gently before administration to clear nostrils 2
• Use contralateral hand technique: hold spray bottle in opposite hand relative to the nostril being treated and aim slightly away from nasal septum 5, 2
• This contralateral technique reduces epistaxis risk by four-fold compared to ipsilateral technique 5
• Patient should sniff gently while pressing down on spray nozzle, then breathe out through mouth 2

Onset and Duration of Action

• Therapeutic effect begins within 7-12 hours, with maximum efficacy reached over days to weeks 6, 5
• For patients with predictable seasonal allergic rhinitis, initiate therapy before symptom onset and continue throughout allergen exposure period for optimal control 5
• Daily continuous use is essential—mometasone works best when used regularly, not as-needed 5, 2

Safety Profile

Growth and Systemic Effects in Children

• Studies with mometasone furoate at recommended doses show no effect on growth compared to placebo 1, 5
• No clinically significant hypothalamic-pituitary-adrenal axis suppression detected in studies up to one year duration at doses up to 200 mcg daily in children 6, 3
• Growth suppression has only been reported with beclomethasone dipropionate at twice the recommended dose, not with mometasone 1

Common Side Effects

• Most frequent adverse events include headache, viral infection, pharyngitis, epistaxis, and cough—all generally mild to moderate 1
• Local nasal irritation and epistaxis can be minimized with proper spray technique directing away from septum 1, 2
• Overall incidence of adverse events similar to placebo 6

When Standard Dosing is Insufficient

• If inadequate response after one week, reassess diagnosis and adherence before escalating therapy 2
• For moderate-to-severe allergic rhinitis not responding to mometasone monotherapy, add intranasal antihistamine (azelastine) rather than increasing corticosteroid dose 5
• The combination of fluticasone propionate and azelastine shows >40% relative improvement compared to either agent alone, and this principle applies to mometasone combinations as well 5
• A short 5-7 day course of oral corticosteroids may be appropriate for very severe or intractable symptoms, but long-term oral steroids are contraindicated 1, 5

Important Contraindications and Cautions

• Contraindicated in patients with hypersensitivity to mometasone or any component of the formulation 1
• Periodically examine nasal septum during long-term use to detect mucosal erosions that may precede septal perforation 1, 5
• Do not spray into eyes; if accidental exposure occurs, rinse well with water 2
• Mometasone does not cause rhinitis medicamentosa and is safe for long-term daily use, unlike topical decongestants which must be limited to 3 days 5