Mometasone (Nasal) (Nasonex)

1. Health Canada Product Monograph — Mometasone (Nasal)

• Seasonal and perennial allergic rhinitis.
• Used as an antibiotic-sparing measure for mild-to-moderate acute rhinosinusitis in some patients. High-dose mometasone (400 mcg/day) is the benchmark regimen shown to provide modest benefit for this indication — lower doses are no better than placebo.

• Intranasal corticosteroids are poorly systemically absorbed and undergo extensive first-pass metabolism; very little, if any, drug is expected to reach the fetus with maternal intranasal use.

• Considered safe during breastfeeding given minimal intranasal absorption and rapid first-pass hepatic metabolism.

• No specific dose adjustment is described for older adults.

• Authorized from 3 years of age at a lower dose than adults.

• Adults and children 12 years and older: 2 sprays (50 mcg/spray) per nostril once daily.
• For acute rhinosinusitis as an antibiotic-sparing measure, a high-dose regimen equivalent to 400 mcg/day (4 sprays per nostril once daily, or divided) has been studied — confirm the exact regimen with the current product information, since this exceeds standard allergic rhinitis dosing.
• Children 3-11 years: 1 spray per nostril once daily.
• Aim the spray upward and away from the nasal septum to reduce the risk of local irritation and nosebleeds.
• Requires initial priming before first use; re-prime if the device has not been used for 14 days or more.
• Maximal effect is achieved after 7-14 days of consistent, correctly timed use.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• Acute overdose from intranasal use is unlikely to cause significant systemic effects given minimal systemic absorption.

• Nasal burning or stinging, nosebleeds (epistaxis).

Serious side effects require immediate discussion with the prescriber or emergency care.

• Rare nasal septal perforation with prolonged, high-dose, or improperly directed use.
• Rare systemic corticosteroid effects with prolonged high-dose use.

• Use with caution in patients with recent nasal surgery or nasal septal ulcers.
• Use with caution in active or quiescent nasal/systemic tuberculosis, or untreated fungal, bacterial, or viral nasal/sinus infection.

• Known hypersensitivity to mometasone furoate or any component of the product.

• No clinically significant systemic drug interactions at recommended intranasal doses.

• None known.

• Use consistently, at the same time each day, without missed doses.

• Store at room temperature. Do not freeze.

• This spray needs to be used every day, exactly as directed, to work — it will not relieve symptoms right away, and full benefit can take up to 2 weeks.
• Aim the spray toward the outer wall of the nostril, away from the centre of your nose.
• If prescribed a high-dose regimen for sinusitis, confirm the exact number of sprays with your pharmacist — this differs from the usual allergy dose.
• Mild nosebleeds or nasal burning are common; contact your prescriber if they are severe or persistent.