Mometasone

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Mometasone
Mometasone furoate.svg
Mometasone furoate ball-and-stick.png
Clinical data
Trade namesNasonex, Asmanex, Elocon, others[1]
Other namesLAS-41002, 9α,21-Dichloro-11β,17α-dihydroxy-16α-methylpregna-1,4-diene-3,20-dione 17α-(2-furoate)
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • AU: B3[2]
  • US: N (Not classified yet)[2]
Routes of
administration
Topical, inhalation (nasal spray)
Drug classCorticosteroid; Glucocorticoid
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityNasal spray is virtually undetectable in plasma; but systemic availability is comparable to fluticasone[3]
Protein binding98% to 99%
MetabolismLiver
Elimination half-life5.8 hours
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.125.600 Edit this at Wikidata
Chemical and physical data
FormulaC22H28Cl2O4 for mometasone
C27H30O6Cl2 as furoate
Molar mass427.361 g/mol (mometasone)
521.4 g/mol (furoate)
3D model (JSmol)
 ☒NcheckY (what is this?)  (verify)

Mometasone, also known as mometasone furoate, is a steroid medication used to treat certain skin conditions, hay fever, and asthma.[4][5][6] Specifically it is used to prevent rather than treat asthma attacks.[4] It can be applied to the skin, inhaled, or used in the nose.[4][5][6] Mometasone furoate, not mometasone is used in medical products.[7]

Common side effects when used for asthma include headache, sore throat, and thrush.[4] It is therefore recommended to rinse the mouth after use.[4] Long term use may increase the risk for glaucoma and cataracts.[4] Common side effects when used in the nose includes upper respiratory tract infections and nose bleeds.[6] Common side effects when applied on the skin include acne, skin atrophy, and itchiness.[5] It works by decreasing inflammation.[4]

Mometasone furoate was patented in 1981 and came into medical use in 1987.[8] It is available as a generic medication.[9] In 2017, it was the 197th most commonly prescribed medication in the United States, with more than two million prescriptions.[10][11]

Medical uses[edit]

Mometasone furoate is used in the treatment of inflammatory skin disorders (such as eczema and psoriasis) (topical form), allergic rhinitis (such as hay fever) (topical form), asthma (inhalation form)[12][13] for patients unresponsive to less potent corticosteroids, and penile phimosis.[14] In terms of steroid strength, it is more potent than hydrocortisone, and less potent than dexamethasone.[15]

Some low-quality evidence suggests the use of mometasone for symptomatic improvement in children with adenoid hypertrophy.[16]

Mometasone is used to alleviate inflammation and itchiness in skin conditions that respond to treatment with glucocorticoids such as psoriasis and atopic dermatitis.[17][18]

Nasal mometasone is used in adults (including the elderly) and children over two years of age, to diminish the symptoms such as hay fever (seasonal allergic rhinitis) and other allergies (perennial rhinitis), including nasal congestion, discharge, pruritus, and sneezing and to treat nasal polyps.[19]

It is not useful for the common cold.[20]

Asthma[edit]

Mometasone furoate can be used with formoterol for the treatment of asthma, due to its anti-inflammatory properties.[16][21]

Contraindications[edit]

People should not use inhaled mometasone or mometasone nasal spray if:

  • glaucoma or cataracts
  • hypersensitivity or allergic to any ingredient in mometasone

Those who are using mometasone nasal or inhaled for a long period of time (e.g. more than three months) should get regular eye exams to check for glaucoma and cataracts and should take precautions to avoid infections such as taking a vitamin D supplement, staying away from those with an infection (chickenpox, measles, colds or flu, COVID-19), washing foods, hand washing and calling a family doctor at the first sign of a severe infection.

People should not use mometasone topical (skin cream) if:

  • hypersensitive or allergic to any ingredient in the skin cream

Mometasone furoate is in class C in terms of safety while use during pregnancy. Therefore, its risks to the baby cannot be ruled out. Therefore, the use in pregnancy is not recommended.

Side effects[edit]

The nasal spray form of mometasone may cause the following side effects:

Serious side effects include: Thrush (fungal infection in the nose or throat), slow wound healing, eye problems such as glaucoma or cataracts, weakened immune system (immunodeficiency) which causes an increased susceptibility to infections and adrenal insufficiency.

The inhaled form of mometasone for asthma may cause the following side effects

  • headache
  • stuffy or runny nose
  • dry throat
  • swelling of nose, throat and sinuses
  • flu like symptoms
  • painful menstrual periods

Serious side effects may include : allergic reactions (anaphylaxis), increased risk of osteoporosis, glaucoma and cataracts, thrush in the mouth or throat, growth retardation in children, bronchospasms, adrenal insufficiency and weakened immune system which causes an increased susceptibility to infections.

The topical (skin cream) version may cause:

  • burning and itching at the application site
  • acne
  • changes in skin color
  • dryness at application site
  • skin sores

The only serious side effect that is known with mometasone topical is adrenal insufficiency.

Pharmacology[edit]

Pharmacodynamics[edit]

Mometasone furoate reduces inflammation by causing several effects:[19][22][23]

  • Reversing the activation of inflammatory proteins
  • Activating the secretion of anti-inflammatory proteins
  • Stabilizing cell membranes
  • Decreasing the influx of inflammatory cells

In addition to the glucocorticoid properties of mometasone furoate, it is a very potent agonist of the progesterone receptor as well as a partial agonist of the mineralocorticoid receptor.[24]

Mechanism of action[edit]

Mometasone — the metabolite of mometasone furoate.

Mometasone, like other corticosteroids, possesses anti-inflammatory, antipruritic, and vasoconstrictive properties. For allergies, corticosteroids reduce the allergic reactions in various types of cells (mastocytes and eosinophils) that are responsible for allergic reactions. Mometasone and other corticosteroids circulate in the blood easily, crossing cellular membranes and binding with cytoplasmic receptors, resulting in the transcription and synthesis of proteins. It also inhibits the actions of the enzyme cytochrome P450 2C8 which participates in the activity of monooxygenase.[25]

The inflammation is reduced in decreasing the liberation of hydrolase 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.[26] The proliferation of fibroblasts and collagen deposits is also reduced. It is believed that the action of corticosteroid anti-inflammatory agents is bound to inhibitive proteins of phospholipase A2, collectively called lipocortins. The lipocortins, in turn, control the biosynthesis of potent mediators of inflammation as the prostaglandins and leukotrienes, inhibiting the liberation of the molecular precursors of arachidonic acid. Intranasal mometasone alleviates symptoms such as rhinorrhea aquosa, nasal congestion, nasal drip, sneezing, and pharyngeal itching. Topical administration applied to skin reduces the inflammation associated with chronic or acute dermatosis.

Although mometasone furoate does not have significant systemic immunomodulatory effects, it can be considered a local immunosuppressive drug because clinical studies have shown reductions (vs. baseline ) in neutrophils (a white blood cell) in the nasal mucosa.[citation needed] It could be also considered an antihistamine along with its glucocorticoid effects because it significantly reduces histamine and eosinophil cationic protein levels.[citation needed]

Pharmacokinetics[edit]

Metabolism[edit]

Extensive metabolic hepatic metabolism of mometasone furoate to multiple metabolites occurs. No principal metabolites are detectable in plasma. After in vitro incubation, one of the minor metabolites formed is furoate 6β-hydroxymometasone. In human hepatic microsomes, the formation of these metabolites is regulated by CYP3A4.[19]

Mometasone[edit]

Mometasone by itself is a synthetic, steroidal glucocorticoid or corticosteroid that was never marketed.[27][28][29] The C17α furoate ester of mometasone, is the marketed medication.[27][28][29] Mometasone furoate acts as a prodrug of mometasone.[30] In addition to its glucocorticoid activity, mometasone also has very potent progestogenic activity and acts as a partial agonist of the mineralocorticoid receptor.[24]

Society and culture[edit]

Brand names[edit]

As of 2016 mometasone furoate was available worldwide in formulations for nasal, oral inhalation, and topical administration, for human and for veterinary use, and in combinations with other drugs, under many brand names.[1]

It was available As of 2016, as the single active agent in the following brands: Alcom, Altosone, Asmanex, Atozon, Aureox, Belloseta, Bioelementa, Biometasona, Bloctimo, Borgasone, Breso, Broner, Codermo, Cortynase, Cutimom, Cutizone, Cutticom, Dance, Demoson, Dergentil, Derimod, Dermacortine, Dermaten, Dermome, Dermosona, Dermotasone, Dermovel, Desdek, Ecelecort, Ecural, Edelan, Elica, Elisone, Elisox, Elitasone, Elna, Elocan, Elocom, Elocon, Elocortin, Elofute, Elomet, Elomox, Eloskin, Eloson, Elosone, Elovent, Elox, Etacid, Eversone, Eztom, F-Din, Fenisona, Flazcort, Flogocort, Fremomet, Frondava, Fu Mei Song, Fulmeta, Furo, Furoato de Mometasona, Furoderm, Gistan-H, Honmet, Iflacort, Intercon, Ivoxel, Kalmente, Konex, Ladexol, Lisoder, Logren, Loksin, Lomeane, M-Furo, Makiren, Mefurosan, Melocort, Mena, Mesone, Metacortil, Metactiv, Metaflam, Metagra, Metasafe, Metason, Metasone, Metaspray, Metatop, Metaz, Metmin, Metsone, Midermin, Mifusin, Minyear, Mofacort, Mofulex, Mofur, Mofuroate, Molison, Momate, Momax, Momecon, Momecort, Momecutan, Momederm, MomeGalen, Momegen, Momekort, Momelab, Momentum, Momeplus, Momerid, Momeson, Momesone, Momester, Momet, Mometa, Mometagen, Mometason, Mometasona, Mometasona Furoato, Mometasone Furoate, Mometasone Furoate Hydrate, Mometasonfuroaat, Mometasonfuroat, Mometasoni furoas, Mometasonum, Mometasyn, Mometasyn, Mometax, Mometazon, Mometazona, Mometazona Fuorat, Mometazonfuroat, Mometix-AQ, Momevate, Momexa, Mommex, Mommox, Momtas, Monaliz, Monez, Monovel, Monovo, Mosone, Motaderm, Motaneal, Movesan, Mtaz, Mundoson, Murozo, Myrey, Narinex, Nasamet, Nasehaler, Nasocure, Nasomet, Nasometin, Nasonex, Nassomet, Nazofix, Nazoster, Netonox, Nexomist, Novasone, Ovison, Ovixan, Oximax, Pharmecort, Pluster, Pronasal, Propel, Prospiril, Pydercon, Rinelon, Rinitek, Rino-Val, Rinobudex, Rinonex, Rinosal, Rinosona, Rinoval, Risonel, Sensicort, Septopic, Silkaren, Soneta, Suavicort, Suqi, Synaller, Tabunex, Topcort, Topison, Uniclar, Uniderm, Vizomet, Yperod, Zalconex, and Zynovate.[1]

Combinations[edit]

The following combination drugs were available as of 2016:[1]

References[edit]

  1. ^ a b c d "International brands for Mometasone". Drugs.com. Retrieved 17 November 2016.
  2. ^ a b "Mometasone Use During Pregnancy". Drugs.com. 14 February 2020. Retrieved 1 April 2020.
  3. ^ Tayab ZR, Fardon TC, Lee DK, Haggart K, McFarlane LC, Lipworth BJ, Hochhaus G (November 2007). "Pharmacokinetic/pharmacodynamic evaluation of urinary cortisol suppression after inhalation of fluticasone propionate and mometasone furoate". British Journal of Clinical Pharmacology. 64 (5): 698–705. doi:10.1111/j.1365-2125.2007.02919.x. PMC 2203259. PMID 17509041.
  4. ^ a b c d e f g "Mometasone Furoate Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 11 March 2019.
  5. ^ a b c "Mometasone Furoate topical Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 11 March 2019.
  6. ^ a b c "Mometasone Furoate eent Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 11 March 2019.
  7. ^ "Mometasone". DrugBank. Retrieved 30 April 2020.
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  9. ^ British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 265. ISBN 9780857113382.
  10. ^ "The Top 300 of 2020". ClinCalc. Retrieved 11 April 2020.
  11. ^ "Mometasone - Drug Usage Statistics". ClinCalc. Retrieved 11 April 2020.
  12. ^ Tan RA, Corren J (December 2008). "Mometasone furoate in the management of asthma: a review". Therapeutics and Clinical Risk Management. 4 (6): 1201–8. doi:10.2147/TCRM.S3261. PMC 2643101. PMID 19337427.
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  19. ^ a b c "Nasonex label" (PDF). FDA. January 2011.
  20. ^ "Mometasone Nasal Spray: MedlinePlus Drug Information". MedlinePlus. 2020-03-19. Retrieved 2020-03-19. Mometasone nasal spray should not be used to treat symptoms (e.g., sneezing, stuffy, runny, itchy nose) caused by the common cold. Mometasone nasal spray is in a class of medications called corticosteroids. It works by blocking the release of certain natural substances that cause allergy symptoms.
  21. ^ Bousquet J (May 2009). "Mometasone furoate: an effective anti-inflammatory with a well-defined safety and tolerability profile in the treatment of asthma". International Journal of Clinical Practice. 63 (5): 806–19. doi:10.1111/j.1742-1241.2009.02003.x. PMID 19392928. S2CID 2040993.
  22. ^ Publishers, Jones and Bartlett (2009-07-15). Nurse's Drug Handbook 2010. p. 677. ISBN 978-0-7637-7900-9.
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  25. ^ Walsky RL, Gaman EA, Obach RS (January 2005). "Examination of 209 drugs for inhibition of cytochrome P450 2C8". Journal of Clinical Pharmacology. 45 (1): 68–78. doi:10.1177/0091270004270642. PMID 15601807. S2CID 670198.
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External links[edit]

  • "Mometasone". Drug Information Portal. U.S. National Library of Medicine.