What are the uses and dosages of Mometasone (mometasone furoate)?

Mometasone Furoate: Clinical Uses and Dosages

Mometasone furoate is a medium-to-potent corticosteroid available in topical, intranasal, and inhaled formulations for treating corticosteroid-responsive dermatoses, allergic rhinitis, nasal polyps, and asthma, with dosing varying by formulation and indication. 1, 2

Topical Formulations (Cream, Ointment, Lotion 0.1%)

Approved Indications

• Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses including atopic dermatitis, psoriasis, and eczema 2
• Classified as medium-potency (class IV) topical corticosteroid 3

Dosing

• Apply once daily to affected areas and massage lightly until absorbed 2
• For lotion formulation: hold nozzle close to affected areas and gently squeeze a few drops 2
• Discontinue therapy when control is achieved; reassess diagnosis if no improvement within 2 weeks 2
• Not approved for use in children under 12 years of age 2

Maintenance Therapy for Eczema

• Apply twice weekly to previously affected areas for up to 36 weeks to prevent relapses, achieving 68% remission rate 3
• This proactive maintenance approach is recommended by the American Academy of Dermatology 3

Combination Therapy Options

• Combine with liberal application of fragrance-free emollients to entire body at least once daily to restore skin barrier function 3
• Addition of salicylic acid is safe for moderate to severe psoriasis (BSA ≤20%) in adults, but avoid salicylic acid in children due to greater risk of systemic absorption and toxicity 1
• Combination with tazarotene may provide synergistic effects with increased efficacy and duration of therapeutic effect 1

Important Precautions

• Do not use with occlusive dressings unless directed by physician 2
• Do not apply in diaper area if patient requires diapers or plastic pants, as these constitute occlusive dressing 2
• Use soap-free cleansers and urea- or glycerin-based moisturizers as adjunctive measures 3

Intranasal Formulation (Nasal Spray)

Approved Indications

• Seasonal and perennial allergic rhinitis 1
• Nasal polyps in adults 1

Dosing by Age

• Ages 2-11 years: 1 spray per nostril once daily 1
• Ages ≥12 years: 2 sprays per nostril once daily 1
• Adults with nasal polyps: 2 sprays per nostril twice daily 1
• Onset of action is approximately 7 hours 4

Clinical Considerations

• The American Academy of Otolaryngology-Head and Neck Surgery recommends considering patient preference between oral antihistamines and nasal steroids to promote better adherence 1
• Approved for children as young as 2 years 1

Inhaled Formulation (Dry Powder Inhaler)

Approved Indication

• Asthma management 1

Dosing

• Dosage varies based on asthma severity 1
• Once-daily administration of 400 μg appears as effective as twice-daily administration of 200 μg 1

Special Populations

Pregnancy and Lactation

• Moisturizers used with mometasone are considered safe during pregnancy and lactation by the American Academy of Dermatology 1
• Mometasone has negligible bioavailability and less potential for systemic side effects 3

Pediatric Considerations

• For infants and young children with eczema, less potent corticosteroids should be used due to increased risk of adrenal suppression 3
• Topical lotion formulation not recommended below 12 years of age 2
• Intranasal formulation approved for ages 2 and older 1

Comparative Efficacy

Potency Profile

• Exhibits high potency with greater anti-inflammatory activity and longer duration of action than betamethasone 5, 6
• Low potential to cause HPA axis suppression compared to other corticosteroids in its class 5, 6
• Low atrophogenic potential, no greater than betamethasone valerate 5, 6

Clinical Trial Data

• Once-daily mometasone 0.1% was significantly superior to twice-daily application of less potent glucocorticoids (clobetasone 0.05%, hydrocortisone 1.0%) 5
• More effective than ketoconazole 2.0% and hydrocortisone 1.0% for seborrhoeic dermatitis 5
• As effective as diflucortolone valerate 0.1% and more effective than betamethasone valerate 0.1% for psoriasis 5, 7

Safety Profile

Local Adverse Effects

• Transient, mild to moderate effects including burning, stinging, folliculitis, dryness, acneiform eruptions 5, 6
• Low risk of primary sensitization and cross-reactions 5, 6

Systemic Effects

• High lipophilicity and low percutaneous absorption result in low systemic availability 6
• Rapid hepatic biotransformation with no significant effect on HPA axis in studies ≤1 year duration 4, 6
• Molecular biotransformation results in lower affinity with dermal cells than epidermal cells, contributing to low atrophogenicity 6

Common Pitfalls to Avoid

• Do not continue beyond 2 weeks without reassessing if no improvement occurs 2
• Do not use in children under 12 years for topical lotion formulation 2
• Do not combine with occlusive dressings or use in diaper area without physician direction 2
• For infected eczema, add appropriate antibiotics (flucloxacillin for Staphylococcus aureus) before or concurrent with corticosteroid therapy 3