Nasonex Dosing for Post-Nasal Drip
For post-nasal drip in adults and adolescents ≥12 years, use Nasonex (mometasone furoate) 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
Standard Dosing Regimen
The recommended dose is 2 sprays (50 mcg each) per nostril once daily for a total of 200 mcg/day in adults and children ≥12 years. 1, 2 This dosing has been validated in multiple clinical trials demonstrating significant improvement in nasal symptoms including post-nasal drip compared to placebo. 3
For pediatric patients ages 2-11 years, the dose is reduced to 1 spray per nostril once daily (100 mcg total daily dose). 1, 4
Evidence Supporting This Dosing
The European Position Paper on Rhinosinusitis demonstrates that mometasone furoate 200 mcg twice daily (400 mcg/day) produced significant improvements in post-nasal drip symptoms in post-viral rhinosinusitis patients, with the twice-daily regimen showing greater efficacy than once-daily dosing. 3 However, for routine post-nasal drip management, the standard once-daily 200 mcg dose is appropriate and FDA-approved. 1, 2
Clinical trials show that 200 mcg once daily is the optimal dose for symptom control, as the 800 mcg dose provided no additional benefit over 200 mcg, while lower doses (50-100 mcg) showed less consistent early activity. 5
When to Consider Higher Dosing
For severe or refractory post-nasal drip, particularly in the context of nasal polyps or severe inflammatory conditions, consider increasing to 2 sprays per nostril twice daily (400 mcg total daily dose). 1 This higher dosing reflects the more severe inflammatory burden and has demonstrated significantly greater symptom improvements compared to once-daily dosing in clinical trials. 3, 1
Administration Technique to Maximize Efficacy
- Shake the bottle well before each use 2
- Prime the pump if starting a new bottle or if unused for one week (pump until fine mist appears) 2
- Blow nose gently to clear nostrils before administration 2
- Use the contralateral hand technique: hold the spray bottle in the opposite hand relative to the nostril being treated, aiming slightly away from the nasal septum 1, 6 This reduces epistaxis risk by four times. 6
- Insert only the tip of the nozzle into the nostril 2
- Breathe in gently while pressing down on the spray nozzle 2
- Do not close the opposite nostril during administration 6
Timeline for Symptom Relief
Counsel patients that onset of action may be delayed approximately 12 hours, with maximal efficacy reached in days to weeks. 1, 7 This is critical patient education, as premature discontinuation due to lack of immediate relief is a common pitfall. Regular daily use rather than as-needed dosing is essential to maintain symptom control. 1, 7
Safety Profile and Common Side Effects
The most common adverse events include headache, viral infection, pharyngitis, epistaxis (nosebleeds), and cough—all generally mild to moderate in severity. 1 Epistaxis can be minimized with proper spray technique directing away from the septum. 1, 6
Mometasone furoate is safe for long-term use, with no suppression of the hypothalamic-pituitary-adrenal axis at recommended doses, even with continuous administration. 6, 4 Studies demonstrate no effect on growth in children at recommended doses compared to placebo. 6, 4
Contraindications
Mometasone is contraindicated in patients with hypersensitivity to mometasone or any component of the formulation. 1, 6
Duration of Treatment
Continue treatment for a minimum of 8-12 weeks to allow adequate time for symptomatic relief and proper assessment of therapeutic benefit. 6 Long-term daily use is safe and appropriate when clinically indicated, as intranasal corticosteroids do not cause rhinitis medicamentosa (rebound congestion) unlike topical decongestants. 6
Periodically examine the nasal septum during long-term use (every 6-12 months) to detect mucosal erosions that may precede septal perforation, though this complication is rare. 6