mometasone + olopatadine hydrochloride: clinical use

Prescribing considerations

• Confirm moderate to severe allergic rhinitis and review concurrent nasal, ocular and oral antihistamines or corticosteroids.
• Do not use below 12 years because safety and efficacy have not been established.
• Use caution with tuberculosis, systemic or local infections, immunosuppression, glaucoma, cataract or substantial cumulative corticosteroid exposure.
• Dizziness, fatigue and somnolence may impair driving or machinery use.

Contraindications and cautions

• Hypersensitivity to either active substance or an excipient
• Untreated localised infection involving the nasal mucosa
• Recent nasal surgery or trauma until healing is complete

Monitoring

• Periodically examine the nasal mucosa during prolonged use, including for ulceration, Candida infection or septal damage.
• Investigate blurred vision or other visual disturbance; ophthalmology assessment may be appropriate.
• Monitor adolescent growth during prolonged nasal corticosteroid treatment.
• Monitor for systemic corticosteroid effects when exposure may be increased, including with strong CYP3A inhibition or multiple corticosteroid products.

Clinical pharmacology

Olopatadine is a selective H1-antihistamine. Mometasone is a locally acting glucocorticoid that suppresses allergic and inflammatory mediators. No pharmacokinetic interaction between the components was identified; absorbed olopatadine is eliminated mainly in urine, while swallowed mometasone undergoes extensive first-pass metabolism.

Formulation and product differences

• The selected product is a prescription-only, fixed-combination metered nasal spray suspension.
• It contains benzalkonium chloride, which may cause nasal irritation or swelling, particularly with prolonged use.
• The bottle requires priming and re-priming according to the product instructions and should be discarded within two months of opening.

Nasal preparation

Route: Nasal

Strengths: 25 micrograms/actuation + 600 micrograms/actuation