What is the proper dosing and administration of mometasone (mometasone furoate) for adults and children?

How to Prescribe Mometasone

Intranasal Mometasone (Allergic Rhinitis)

For adults and children ≥12 years with allergic rhinitis, prescribe 2 sprays per nostril once daily (200 μg total daily dose), and for children 2-11 years, prescribe 1 spray per nostril once daily (100 μg total daily dose). 1

Standard Dosing for Allergic Rhinitis

• Adults and adolescents ≥12 years: 2 sprays (50 μg each) per nostril once daily = 200 μg total daily dose 1
• Children 2-11 years: 1 spray per nostril once daily = 100 μg total daily dose 1
• Onset of action: Approximately 7-12 hours, with maximal efficacy reached in days to weeks 1, 2
• Administration: Use regularly (not as-needed) to maintain symptom control 1

Nasal Polyps (Adults Only)

• Adults ≥18 years with nasal polyps: 2 sprays per nostril twice daily = 400 μg total daily dose 1
• The twice-daily dosing reflects the more severe inflammatory burden in nasal polyps and produces significantly greater symptom improvements compared to once-daily dosing 1

Key Administration Points

• Direct spray away from the nasal septum to prevent repetitive direct application and reduce risk of septal perforation 3
• Periodically examine the nasal septum to ensure no mucosal erosions are present 3
• Efficacy is comparable to fluticasone propionate and beclomethasone dipropionate for allergic rhinitis 2

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Inhaled Mometasone (Asthma)

For asthma management in patients ≥4 years, prescribe mometasone dry powder inhaler based on disease severity: low dose (100-200 μg daily), medium dose (200-400 μg daily), or high dose (>400 μg daily), with once-daily dosing as effective as divided dosing. 3, 4

Dosing by Age and Severity

Children 5-11 years 3:

• Low dose: 100 μg daily (1 inhalation of 100 μg)
• Medium dose: 200 μg daily (2 inhalations of 100 μg or 1 inhalation of 200 μg)
• High dose: >400 μg daily

Adults and adolescents ≥12 years 3:

• Low dose: 200 μg daily
• Medium dose: 400 μg daily
• High dose: >400 μg daily

Administration Flexibility

• Once-daily dosing (400 μg) is as effective as twice-daily dosing (200 μg twice daily) for improving lung function and asthma symptoms 4
• Can be administered in the morning or evening with equivalent efficacy 4
• Available as dry powder inhaler delivering 100 μg or 200 μg per inhalation 5

Therapeutic Equivalence

• Mometasone 200 μg daily is therapeutically equivalent to fluticasone propionate 100 μg daily, beclomethasone dipropionate 200 μg daily, or budesonide 400 μg daily 6, 4
• When switching from another inhaled corticosteroid due to insurance denial, use the dosing equivalency table to maintain appropriate asthma control 6

Oral Corticosteroid-Dependent Asthma

• For patients requiring oral corticosteroids, mometasone 400-800 μg twice daily can reduce oral corticosteroid requirements while improving lung function 4

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Topical Mometasone (Dermatologic Conditions)

For dermatologic conditions like psoriasis or eczema in patients ≥12 years, apply mometasone 0.1% lotion, cream, or ointment once daily to affected areas until control is achieved. 7, 8

Dosing and Administration

• Application frequency: Once daily 7, 8
• Formulations: 0.1% lotion, cream, or ointment 7, 8
• Method: Apply a few drops (lotion) or thin layer (cream/ointment) and massage lightly until it disappears 7
• Age restriction: Not recommended for children <12 years due to lack of safety and efficacy data 7

Duration and Monitoring

• Discontinue therapy when control is achieved 7
• If no improvement within 2 weeks, reassess diagnosis 7
• Mometasone ointment once daily is significantly more effective (p<0.01) than fluocinolone ointment three times daily for psoriasis 8

Important Precautions

• Do not use with occlusive dressings unless directed by physician 7
• Do not apply in diaper area if patient requires diapers or plastic pants, as these constitute occlusive dressing 7
• Minimal risk of local adverse effects with once-daily application 8

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Safety Profile Across All Formulations

Common Adverse Effects

• Intranasal: Nasal irritation/burning, headache, epistaxis, pharyngitis 1, 2
• Inhaled: Oral candidiasis, headache, pharyngitis, dysphonia 4
• Topical: Transient, mild to moderate local effects 9

Systemic Safety

• Mometasone has approximately 1% oral bioavailability and minimal systemic effects at appropriate doses 5
• No detectable effect on hypothalamic-pituitary-adrenal axis function in studies ≤1 year duration 2
• Low atrophogenicity due to molecular biotransformation favoring epidermal over dermal cells 9
• High lipophilicity and rapid hepatic biotransformation result in low systemic availability 9

Drug Interactions

• Potent CYP3A4 inhibitors (ritonavir, ketoconazole) can increase systemic concentrations of mometasone, potentially causing Cushing syndrome or adrenal insufficiency 3

Contraindications

• Hypersensitivity to mometasone or its components 1

Special Populations

• Pregnancy: Safety data limited; use only if benefit outweighs risk
• Children <2 years (intranasal): Not approved 1
• Children <4 years (inhaled): Not approved 5
• Children <12 years (topical): Not recommended 7