For an adult with allergic rhinitis, is mometasone furoate 50 micrograms two sprays per nostril nightly an appropriate dose?

Mometasone 50mcg 2 Sprays Each Nostril Nightly: Dose Assessment

No, this is not the correct dose—the standard FDA-approved regimen for adults with allergic rhinitis is mometasone furoate 50 mcg per spray, 2 sprays per nostril once daily in the morning, not at night, for a total daily dose of 200 mcg. 1

Standard Dosing for Adults and Adolescents ≥12 Years

• The FDA-approved dose is 2 sprays (50 mcg each) per nostril once daily, totaling 200 mcg/day. 2, 3, 1
• This should be administered in the morning as a single daily dose, not divided or given at night. 1, 4
• Multiple dose-ranging studies confirm that 200 mcg once daily is the optimal therapeutic dose for seasonal and perennial allergic rhinitis in adults. 4, 5, 6

Why Once Daily Morning Dosing, Not Nightly?

• Intranasal corticosteroids work best with consistent daily use at the same time each day, and morning administration aligns with the FDA labeling and all clinical trial protocols. 1, 5
• The onset of symptom relief begins within approximately 7-12 hours after the first dose, with maximal efficacy requiring days to weeks of continuous use. 2, 5
• There is no clinical evidence supporting nightly-only dosing—all efficacy data are based on once-daily morning administration. 4, 5, 6

When Higher Dosing May Be Appropriate

• For nasal polyps specifically, the dose is 2 sprays per nostril twice daily (400 mcg/day total). 3
• For severe or refractory post-nasal drip or rhinosinusitis symptoms, consider increasing to 2 sprays per nostril twice daily (400 mcg/day), then reducing to maintenance dosing once symptoms are controlled. 2
• The European Position Paper on Rhinosinusitis demonstrates that 200 mcg twice daily (400 mcg/day) produces significantly greater symptom improvements than once-daily dosing in post-viral rhinosinusitis patients. 7, 2

Pediatric Dosing (Ages 2-11 Years)

• Children ages 2-11 years should receive 1 spray per nostril once daily (100 mcg total daily dose), not 2 sprays. 2, 3, 1
• Dose-ranging studies in children ages 6-11 years confirm that 100 mcg once daily is the most appropriate therapeutic dose, with 200 mcg providing no additional benefit. 8

Critical Administration Points

• Use the contralateral hand technique (opposite hand for each nostril), aiming slightly away from the nasal septum, to reduce epistaxis risk by four times. 2, 1
• Shake the bottle well before each use and prime the pump if starting a new bottle or if not used in one week. 1
• Do not close the opposite nostril during administration. 2, 1

Common Pitfalls to Avoid

• Nightly-only dosing is not standard practice and lacks supporting evidence—correct the timing to once daily in the morning. 1, 4, 5
• Patients must understand this is maintenance therapy requiring daily use, not as-needed rescue therapy. 2, 3
• If symptoms do not improve after one week of proper use, the patient should consult their physician rather than increasing the dose independently. 1
• The most common adverse events are headache, epistaxis, and pharyngitis, all generally mild to moderate in severity. 3, 5, 9

Safety Profile

• Mometasone furoate at recommended doses (200 mcg/day) causes no suppression of the hypothalamic-pituitary-adrenal axis in adults or children, even with long-term use. 2, 5, 9
• Studies demonstrate no effect on growth in children at recommended doses compared to placebo. 2, 3
• Long-term daily use is safe and appropriate when clinically indicated, as intranasal corticosteroids do not cause rhinitis medicamentosa (rebound congestion) unlike topical decongestants. 2