Can a patient with nasal congestion use mometasone (mometasone furoate)?

Can a Patient Use Mometasone for Nasal Congestion?

Yes, mometasone furoate nasal spray is highly effective for nasal congestion and should be used as first-line therapy, with a standard dose of 200 μg (two sprays per nostril) once daily for adults and adolescents ≥12 years, or 100 μg (one spray per nostril) once daily for children 2-11 years. 1

Evidence Supporting Mometasone for Nasal Congestion

Acute Post-Viral Rhinosinusitis

• Mometasone 200 μg twice daily significantly reduces nasal congestion in acute post-viral rhinosinusitis, with studies demonstrating superior efficacy compared to both placebo and amoxicillin 2
• The European Position Paper on Rhinosinusitis (2020) found that nasal congestion was significantly improved in the mometasone group compared to placebo across multiple trials 2
• Mometasone was cost-saving and increased quality-adjusted life years compared to antibiotics or placebo in post-viral rhinosinusitis 2

Seasonal Allergic Rhinitis (SAR)

• In patients with moderate-to-severe nasal congestion from SAR, mometasone produced a 25.2% reduction in congestion scores versus 16.0% with placebo (p < 0.001) over 15 days 3
• Among patients treated with mometasone, 37% experienced >30% improvement in nasal congestion versus 19% with placebo (p < 0.001), and 13% versus 7% experienced >50% improvement (p = 0.003) 4
• The response to mometasone improves with continuous use over 2 weeks, with greater mean response during the second versus first week of treatment 4

Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)

• The European Position Paper (2020) advises using nasal corticosteroids in patients with chronic rhinosinusitis, as they reduce nasal polyp size and prevent polyp recurrence after surgery 2
• Mometasone 200 μg twice daily for up to 12 months postoperatively reduces polyp recurrence to 2-3% versus 20% without treatment 5
• Corticosteroid-eluting implants delivering 1350 μg of mometasone over 90 days showed significant improvement in nasal obstruction/congestion scores compared to placebo 2

Dosing and Administration

Standard Dosing

• Adults and children ≥12 years: 200 μg once daily (two 50 μg sprays per nostril) 1, 6
• Children 2-11 years: 100 μg once daily (one 50 μg spray per nostril), with adult supervision 1, 6
• Onset of action: Approximately 7-12 hours after first administration 1

Administration Technique

• Direct the nasal spray away from the nasal septum to prevent repetitive direct application and reduce the risk of septal perforation 1
• Shake the bottle well before use and prime by pumping until fine mist appears if starting a new bottle or if not used in one week 6
• Mometasone works best when used daily on a regular schedule, not as-needed 1, 6

Combination Therapy for Severe Congestion

Adding Oxymetazoline for Rapid Relief

• When nasal congestion is severe enough to prevent adequate steroid penetration, combining mometasone with oxymetazoline provides faster onset of action than mometasone alone 7, 8
• The combination of mometasone plus oxymetazoline relieves SAR symptoms including congestion with better sustained efficacy than oxymetazoline alone 8
• When oxymetazoline is combined with intranasal corticosteroids from the outset, rebound congestion can be prevented entirely 7

Proper Protocol for Combination Use

• Apply oxymetazoline first, wait 5 minutes, then use mometasone 7
• Limit oxymetazoline to less than 3 days when used as short-term add-on therapy for severe nasal obstruction 7
• Never use oxymetazoline alone for more than 3 days without concurrent intranasal steroid therapy 7

Safety Profile

Systemic Effects

• Mometasone has a low risk of systemic effects due to its approximately 1% oral bioavailability and minimal systemic effects at appropriate doses 1
• Studies in children and adults have failed to demonstrate any consistent, clinically relevant effect on the hypothalamic-pituitary-adrenal axis, ocular pressure, cataract formation, or bone density at recommended doses 2
• One-year treatment with mometasone 100 μg daily in children aged 6-11 years showed negligible systemic exposure and no evidence of HPA axis suppression or ocular changes 9

Local Adverse Effects

• The most common adverse events are mild and localized: epistaxis and pharyngolaryngeal pain, occurring in approximately 1% of patients 3
• Local side effects such as nasal irritation, bleeding, and nasal septal perforation are rare and can be avoided with proper administration technique 2

Drug Interactions

• The use of potent CYP3A4 inhibitors (ritonavir, ketoconazole) with mometasone can increase systemic concentrations, potentially causing Cushing syndrome or adrenal insufficiency 1
• Mometasone is contraindicated in patients with hypersensitivity to mometasone or its components 1

Common Pitfalls to Avoid

• Do not expect immediate relief: Mometasone takes 7-12 hours for onset of action and improves further over 2 weeks of continuous use 1, 4
• Do not use as-needed dosing: Regular daily administration is required for optimal efficacy 1, 6
• Do not aim spray directly at the nasal septum: This increases risk of septal perforation 1
• If congestion is severe initially, consider adding short-term oxymetazoline (≤3 days) to allow adequate mometasone penetration 7
• For children requiring mometasone for longer than 2 months per year, check with their doctor 6