Mometasone: clinical use

Prescribing considerations

• Confirm the formulation and licensed indication; inhaled, nasal and topical preparations are not interchangeable.
• Twisthaler is preventive treatment and unsuitable for immediate relief of bronchospasm. Check technique and access to appropriate reliever treatment.
• Assess cumulative corticosteroid exposure across inhaled, nasal, topical, oral, injected and ophthalmic products.
• For topical treatment, minimise exposure on the face, flexures, damaged skin, large areas and under occlusion. Children have greater systemic exposure relative to body size.
• Treat or control infection appropriately; corticosteroids may mask infection and alter lesion appearance.
• Review unexplained blurred vision or other visual symptoms for corticosteroid-associated ocular disease.

Contraindications and cautions

• Hypersensitivity to mometasone furoate or formulation excipients.
• Topical products: untreated bacterial, fungal, viral or parasitic skin infection; rosacea, acne, perioral dermatitis, skin atrophy, wounds or ulcerated skin. Product-specific restrictions also apply to genital or perianal itch and napkin eruptions.
• Scalp lotion: infected, atrophic, wounded or ulcerated scalp.
• Nasal spray: untreated localised nasal infection and recent nasal surgery or trauma before healing.
• Inhaler: not for acute asthma attacks; use cautiously with untreated respiratory tuberculosis or untreated fungal, bacterial or systemic viral infection.

Monitoring

• Check asthma control, inhaler technique, oral candidiasis and hoarseness.
• With prolonged nasal use, assess persistent epistaxis, irritation, infection or mucosal changes.
• Review topical treatment response and signs of infection, skin atrophy or withdrawal.
• Consider adrenal suppression, growth, bone and ocular risks when exposure is extensive, prolonged, high or combined with other corticosteroids or strong CYP3A inhibitors.

Clinical pharmacology

Mometasone furoate is a synthetic glucocorticoid with strong local anti-inflammatory activity. Systemic bioavailability is low after correct inhaled, nasal or topical use, but absorption increases with damaged skin, large treated areas, occlusion, prolonged exposure and metabolic inhibition.

Formulation and product differences

• Twisthaler is a breath-actuated dry-powder inhaler containing lactose. It requires a sufficiently forceful inhalation and must be kept dry.
• Clarinaze is an aqueous nasal suspension containing benzalkonium chloride, which can irritate or swell the nasal lining with prolonged exposure.
• Ovixan cream contains propylene glycol and cetostearyl alcohol, which may cause local irritation or contact reactions.
• Ointment is greasier and more occlusive, suiting very dry, scaly or cracked lesions; excipients can cause local reactions.
• Elocon Scalp Lotion is an alcohol-based scalp preparation containing propylene glycol and should be kept away from the eyes.

Cream

Route: Cutaneous

Strengths: 1 mg/g, 0.1% w/w

Ointment

Route: Cutaneous

Strengths: 0.1% w/w

Nasal preparation

Route: Nasal

Strengths: 50 micrograms, 0.05%, 0.05% w/w