Santomet (mometasone furoate, topical): Uses, Dosage & Side Effects

What it's for (Indications)

Mometasone furoate nasal spray is indicated for a range of inflammatory conditions primarily affecting the nasal passages.
It is approved for the treatment of nasal symptoms associated with seasonal allergic rhinitis and perennial allergic rhinitis in adult and pediatric patients aged 2 years and older.
This includes symptoms such as sneezing, nasal congestion, rhinorrhea, and nasal itching.
Furthermore, it is indicated for the prophylaxis of nasal symptoms of seasonal allergic rhinitis in adult and adolescent patients aged 12 years and older, particularly when initiated 2 to 4 weeks prior to the anticipated start of the pollen season.
Mometasone furoate nasal spray is also prescribed for the treatment of nasal polyps in adult patients aged 18 years and older, aiding in the reduction of polyp size and associated symptoms.
Lastly, it is indicated for the treatment of symptoms associated with acute rhinosinusitis in adult and adolescent patients aged 12 years and older, helping to alleviate inflammation and discomfort.

Dosage Information

Type	Guideline
Standard	The dosage of mometasone furoate nasal spray varies depending on the indication and patient age. For the treatment of seasonal or perennial allergic rhinitis, adult and adolescent patients (12 years of age and older) are typically recommended two sprays (50 mcg per spray) in each nostril once daily, for a total daily dose of 200 mcg. Some patients may achieve symptom control with one spray per nostril once daily (total 100 mcg). Pediatric patients aged 2 to 11 years should receive one spray (50 mcg) in each nostril once daily, for a total daily dose of 100 mcg. For the treatment of nasal polyps in adults aged 18 years and older, the recommended dosage is two sprays (50 mcg per spray) in each nostril twice daily, for a total daily dose of 400 mcg. Once symptoms are controlled, a reduction to two sprays in each nostril once daily (total 200 mcg) may be considered. For the treatment of symptoms associated with acute rhinosinusitis in adult and adolescent patients (12 years of age and older), the recommended dosage is two sprays (50 mcg per spray) in each nostril twice daily, for a total daily dose of 400 mcg. Consistent daily use is crucial for optimal therapeutic effect.

Type

Guideline

Standard

The dosage of mometasone furoate nasal spray varies depending on the indication and patient age. For the treatment of seasonal or perennial allergic rhinitis, adult and adolescent patients (12 years of age and older) are typically recommended two sprays (50 mcg per spray) in each nostril once daily, for a total daily dose of 200 mcg. Some patients may achieve symptom control with one spray per nostril once daily (total 100 mcg). Pediatric patients aged 2 to 11 years should receive one spray (50 mcg) in each nostril once daily, for a total daily dose of 100 mcg. For the treatment of nasal polyps in adults aged 18 years and older, the recommended dosage is two sprays (50 mcg per spray) in each nostril twice daily, for a total daily dose of 400 mcg. Once symptoms are controlled, a reduction to two sprays in each nostril once daily (total 200 mcg) may be considered. For the treatment of symptoms associated with acute rhinosinusitis in adult and adolescent patients (12 years of age and older), the recommended dosage is two sprays (50 mcg per spray) in each nostril twice daily, for a total daily dose of 400 mcg. Consistent daily use is crucial for optimal therapeutic effect.

Safety & Warnings

Common Side Effects

Common adverse reactions associated with mometasone furoate nasal spray are generally mild and localized to the nasal passages.
These include epistaxis (nosebleed), headache, pharyngitis, nasal irritation or burning sensation, nasal ulceration, and sneezing.
Less common but potentially more serious adverse events can occur.
These may involve local effects such as nasal septal perforation, particularly with prolonged or improper use, and the development of Candida albicans infection in the nose or throat, requiring antifungal treatment and temporary discontinuation of the spray.
Systemic effects, though rare at recommended doses due to low systemic bioavailability, can include glaucoma and/or cataracts with prolonged use, warranting ophthalmologic monitoring.
Hypersensitivity reactions, including angioedema, bronchospasm, and anaphylaxis, have been reported.
In pediatric patients, there is a potential for reduction in growth velocity with long-term use, necessitating growth monitoring.
Adrenal suppression is a rare but possible systemic effect, especially with higher than recommended doses or in susceptible individuals.

Serious Warnings

Black Box Warning: Mometasone furoate nasal spray does not carry a formal FDA Black Box Warning. However, several serious warnings and precautions are paramount for its safe and effective use. Clinicians and patients must be aware of the potential for local nasal adverse effects, including nasal septal perforation, particularly with prolonged use, and the development of localized infections with Candida albicans, which may necessitate discontinuation and appropriate antifungal treatment. A critical consideration is the potential for immunosuppression; patients using corticosteroids are at increased risk for certain infections, especially chickenpox and measles, and should avoid exposure if not immune. Furthermore, mometasone furoate should be used with extreme caution in individuals with active or quiescent tuberculosis, untreated fungal, bacterial, systemic viral infections, or ocular herpes simplex. Although systemic effects are typically minimal at recommended intranasal doses, prolonged use may lead to clinically significant adrenal suppression, and vigilance is required when discontinuing systemic corticosteroids or in times of stress. Growth velocity in pediatric patients receiving intranasal corticosteroids should be routinely monitored. Lastly, long-term use may contribute to glaucoma and/or cataracts, requiring periodic ophthalmologic evaluation.
Several critical warnings must be considered when prescribing or using mometasone furoate nasal spray.
Local nasal effects are prominent, including the potential for nasal septal perforation, which manifests as a persistent whistling sound during breathing or chronic crusting.
Nasal candidiasis may occur and should be treated appropriately.
Caution is advised in patients who have recently undergone nasal surgery or experienced nasal trauma, as corticosteroids can impair wound healing; the spray should not be used until healing is complete.
Immunosuppression is a significant concern; patients receiving corticosteroids are more susceptible to infections, including serious ones like chickenpox and measles.
Exposure to such infections should be avoided, and medical advice sought promptly if exposure occurs.
Mometasone furoate should be used with caution in patients with active or quiescent tuberculosis infections of the respiratory tract, or in untreated fungal, bacterial, systemic viral infections, or ocular herpes simplex.
While systemic effects are generally low, prolonged use, especially at high doses, can lead to systemic corticosteroid effects, including hypercorticism and adrenal suppression.
Growth velocity in children should be monitored regularly as intranasal corticosteroids can cause a reduction.
Ocular effects such as glaucoma and cataracts have been reported with long-term use, thus periodic eye examinations are recommended for patients on chronic therapy.

How it Works (Mechanism of Action)

Mometasone furoate is a synthetic corticosteroid that exhibits potent anti-inflammatory effects. Its primary mechanism of action involves binding to glucocorticoid receptors located within the cytoplasm of target cells. This binding initiates a complex cascade of events that ultimately modulates gene expression, leading to a reduction in inflammation. Specifically, mometasone furoate is believed to inhibit the release of arachidonic acid by inducing phospholipase A2 inhibitory proteins, thus preventing the synthesis and release of inflammatory mediators such as prostaglandins and leukotrienes. It also reduces the chemotaxis and activation of inflammatory cells, including eosinophils, neutrophils, macrophages, and lymphocytes, at the site of inflammation. Furthermore, it decreases vascular permeability and inhibits the release of cytokines and other inflammatory mediators from mast cells and other cell types, thereby suppressing the allergic response and inflammatory process in the nasal mucosa. Due to its high topical potency and low systemic bioavailability when administered intranasally, mometasone furoate primarily exerts its therapeutic effects locally within the nasal passages, minimizing systemic side effects.