Mometasone furoate

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Mometasone furoate
Mometasone furoate.png
Mometasone furoate ball-and-stick.png
Systematic (IUPAC) name
(11β,16α)-9,21-dichloro-11-hydroxy-16-methyl-3,20-dioxopregna-1,4-dien-17-yl 2-furoate
Clinical data
Trade names Elocon Elocom, Elomet, Elosalic Novasone Nasonex Asmanex Twisthaler Essex pharma markets the medication under the brand name Ecural mometAid.
AHFS/Drugs.com monograph
Pregnancy cat.
Legal status
  • Rx Only (US)
Routes topical, inhalation
Pharmacokinetic data
Bioavailability Nasal spray is virtually undetectable in plasma; but systemic availability is comparable to fluticasone.[1]
Protein binding 98% to 99%
Metabolism hepatic
Half-life 5.8 hours
Identifiers
CAS number 105102-22-5 YesY 83919-23-7
ATC code D07AC13 R01AD09, R03BA07
PubChem CID 441336
DrugBank DB00764
ChemSpider 390091 YesY
ChEBI CHEBI:47564 YesY
ChEMBL CHEMBL1161 YesY
Synonyms (9R,10S,11S,13S,14S,16R,17R)-9-chloro-17-(2-chloroacetyl)-11-hydroxy-10,13,16-trimethyl-3-oxo-6,7,8,9,10,11,12,13,14,15,16,17-dodecahydro-3H-cyclopenta[a]phenanthren-17-yl furan-2-carboxylate
Chemical data
Formula C22H28Cl2O4 for Mometasone
C27H30O6Cl2 as Furoate
Mol. mass 427.361 g/mol (Mometasone)
521.4 g/mol (Furoate)
 N (what is this?)  (verify)

Mometasone furoate is a glucocorticosteroid used topically to reduce inflammation of the skin or in the airways. It is a prodrug of the free form mometasone (INN).

Uses, administration, and pharmacodynamics[edit]

Mometasone furoate is used in the treatment of inflammatory skin disorders (such as eczema and psoriasis), allergic rhinitis (such as hay fever), asthma[2][3] for patients unresponsive to less potent corticosteroids, and penile phimosis.[4] In terms of steroid strength, it is more potent than hydrocortisone, and less potent than dexamethasone.[5]

It reduces inflammation by causing several effects:[6][7][8]

  • reversing the activation of inflammatory proteins
  • activating the secretion of anti-inflammatory proteins
  • stabilizing cell membranes
  • decreasing the influx of inflammatory cells

Mechanism of action[edit]

Mometasone, just as the other corticoids possesses anti-inflammatory, antipruritic, and vasoconstrictive properties. For allergies, corticosteroids reduce the allergic reactions in various types of cells (mastocytes and eosinofiles) that are responsible for allergic reactions. At the molecular level, corticosteroids circulate in the blood easily crossing cellular membranes and binding with great affinity to specific cytoplasmic receptors. The final result is the transcription and synthesis of proteins.

Mometasone inhibits the actions of the enzyme cytochrome P450 2C8 which participates in the activity of Monooxygenase.[9]

The inflammation is reduced in decreasing the liberation of hydrolace acids of leukocytes, the prevention of the accumulation macrophages in the sites of inflammation, the interference with adhesion of leukocytes to capillary walls, the reduction of the permeability of the capillary membranes and consequently edema, the reduction of complementary components, inhibition of histamine and kinin liberation, and interference with scar tissue formation.[10] The proliferation of fibroblasts and collagen deposits are also reduced. It is believed that the action of corticoid anti-inflammatory agents are bound to inhibitive proteins of phospholipase A2, collectively called lipocortins. The lipocortins, in turn, control the biosynthesis of potent mediators of inflammation as the prostaglandin's and leukotriens, inhibiting the liberation of the molecular precursors of arachidonic acid. Intranasal mometasone alleviates symptoms such as rhinorrea acuosa, nasal congestion, nasal drip, sneezing, and pharyngeal itching. Topical administration applied to skin reduces the inflammation associated with chronic or acute dermatosis.

Metabolism[edit]

There are extensive metabolic hepatic metabolism to multiple metabolites. There do not exist principal metabolites detectable in plasma. After in-vitro incubation, one of the minor metabolites formed is furoate 6ß-hydroxi-mometasone. In human hepatic microsomes, the formation of these metabolites is regulated by cytochromo P450 3A4.

Use[edit]

Mometasone is indicated for the alleviation of inflammatory and pruritic manifestations (with stinging and itching) of dermatosis which respond to treatment with glucocorticoides such as psoriasis and atopic dermatitis (affection dermic chronic, characterized by the apparition of squamous eruptions, accompanied by itching).

Nasal mometasone is employed in adults (including the elderly) and children of the age greater or equal to 2 years for diminishing the symptoms which may present themselves as hayfever (seasonal allergic rhinitis) or other allergies which present during longer parts of the year (perennial rhinitis), including nasal obstruction (congestion), nasal discharge, pruritus and sneezing.[11] To help prevent these symptoms, this drug can be used two to four weeks before the anticipated of the pollen season. Mometasone is also indicated for the treatment of nasal polyps (small formations in the mucosa of the nose) and symptoms associated with including congestion and hyposmia in adult patients over the age of 18. The principal symptom is the sensation of nasal obstruction. It can also produce nasal drip, sensation of tickling in the throat and loss of the sense of taste and smell.

Use in Asthma[edit]

Thanks to its anti-inflammatory properties, the furoate of mometasone can be employed together with formoterol for the treatment of asthma.[12]

Warnings[edit]

If you encounter any of the following situations after treatment or they develop during treatment, your doctor can prescribe a reduction in dose of this medication, or you may need additional treatment to control the condition. Once informed, your doctor can decide whether if any change in treatment is necessary. In some cases, it may be necessary to interrupt treatment.

Before commencing the utilization of mometasone it's worth evaluating whether the patient suffers from any of the following conditions:

  • Ulcers in the nose
  • Tuberculosis (historical or presently active)
  • Infection (fungal, bacterial, or viral)
  • Occular infection by Herpes Simplex Virus

Use in Atheletes[edit]

This medication is a suspension for nasal pulverization, it is not a drug prohibited in sports. Although it may not be measured in blood, corticosteroids can be detected by urine analysis; for this reason, some sports agencies may require written authorization before utilization.

Availability[edit]

Merck markets the medication under the following brand names; Elocon (Elocom, Elomet, Elosalic), Elica and Novasone as a cream or ointment for skin conditions, Nasonex as a nasal spray for upper respiratory conditions such as nasal sinus inflammation, and Asmanex Twisthaler as a dry powder inhaler (DPI) for lower respiratory conditions.

Essex pharma markets the medication under the brand name Ecural, and Progreś Laboratories markets it under mometAid. It is also marketed by Perrigo as an ointment for the scalp. In India it is marketed by Intas under the trade name Eziwin and by Glenmark under the name of Momate.

It is also available as a veterinary drug in an otic (ears) form for treatment of otitis externa under the brand name Mometamax.[13]

References[edit]

  1. ^ Zia R Tayab, Tom C Fardon, Daniel K C Lee, Kay Haggart, Lesley C McFarlane, Brian J Lipworth, and Günther Hochhaus (November 2007). "Pharmacokinetic/pharmacodynamic evaluation of urinary cortisol suppression after inhalation of fluticasone propionate and mometasone furoate". Br J Clin Pharmacol 64 (5): 698–705. doi:10.1111/j.1365-2125.2007.02919.x. PMC 2203259. PMID 17509041. 
  2. ^ Tan RA, Corren J (December 2008). "Mometasone furoate in the management of asthma: a review". Ther Clin Risk Manag 4 (6): 1201–8. PMC 2643101. PMID 19337427. 
  3. ^ Bousquet J (May 2009). "Mometasone furoate: an effective anti-inflammatory with a well-defined safety and tolerability profile in the treatment of asthma". Int. J. Clin. Pract. 63 (5): 806–19. doi:10.1111/j.1742-1241.2009.02003.x. PMID 19392928. 
  4. ^ Khope S (March 2010). "Topical mometasone furoate for phimosis". Indian pediatr 47 (3): 282. PMID 20371899. 
  5. ^ Williams D. What does potency actually mean for inhaled corticosteroids?. The Journal Of Asthma: Official Journal Of The Association For The Care Of Asthma [serial online]. July 2005;42(6):409-417. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 25, 2011.
  6. ^ Product Information: NASONEX(R) nasal spray, mometasone furoate monohydrate nasal spray. Schering Corporation, Kenilworth, NJ, 2010.
  7. ^ Publishers, Jones and Bartlett (2009-07-15). Nurse's Drug Handbook 2010. p. 677. ISBN 978-0-7637-7900-9. 
  8. ^ Mani S. Kavuru (2007). "ch. 9 Anti-inflammatory agents". Diagnosis and Management of Asthma. ISBN 978-1-932610-38-3. 
  9. ^ Walsky, R. L.; Gaman EA; Obach RS. (Jan 2005). "Pharmacokientics, Pharmacodynamics, and Drug Metabolism". Examination of 209 drugs for inhibition of cytochrome P450 2C8. 45 (1) (Pfizer Global Research and Development ed.). USA.: J Clin Pharmacol. pp. 68–78. Retrieved 2012-11-17. 
  10. ^ Blaiss, MS. (Nov 2011). Safety update regarding intranasal corticosteroids for the treatment of allergic rhinitis. 32 (6). Allergy Asthma Proc. pp. 413–418. 
  11. ^ Stjärne, P.; Mösges R; Jorissen M; Passàli D; Bellussi L; Staudinger H; Danzig M. (Feb 2006). A randomized controlled trial of mometasone furoate nasal spray for the treatment of nasal polyposis 132 (2). Arch Otolaryngol Head Neck Surg. pp. 179–185. 
  12. ^ Bousquet, J. (May 2009). Mometasone furoate: an effective anti-inflammatory with a well-defined safety and tolerability profile in the treatment of asthma. 63 (5). Int J Clin Pract. pp. 806–819. 
  13. ^ "Mometamax". Intervet USA. Retrieved 19 June 2010. 

External links[edit]