Mometasone Explained

Verifiedfields:changed
Watchedfields:changed
Verifiedrevid:457636529
Width:250
Width2:250
Tradename:Nasonex, Asmanex, Elocon, others
Dailymedid:Mometasone
Pregnancy Au:B3
Pregnancy Au Comment:[1]
Routes Of Administration:Topical, inhalation (nasal spray)
Class:Corticosteroid
Glucocorticoid
Atc Prefix:D07
Atc Suffix:AC13
Atc Supplemental:,
Legal Au:S4
Legal Au Comment:[2]
Legal Ca:Rx-only
Legal Us:Rx-only
Legal Us Comment:/ OTC[3] [4]
Legal Eu:Rx-only
Legal Eu Comment:[5]
Bioavailability:Nasal spray is virtually undetectable in plasma; but systemic availability is comparable to fluticasone[6]
Protein Bound:98% to 99%
Metabolism:Liver
Elimination Half-Life:5.8 hours
Index2 Label:as furoate
Cas Number:105102-22-5
Pubchem:441335
Pubchem2:441336
Drugbank:DB00764
Drugbank2:DB14512
Chemspiderid:390090
Chemspiderid2:390091
Unii:8HR4QJ6DW8
Unii2:04201GDN4R
Kegg:D08227
Kegg2:D00690
Chebi:6970
Chebi2:47564
Chembl:1201404
Chembl2:1161
Synonyms:LAS-41002, 9α,21-Dichloro-11β,17α-dihydroxy-16α-methylpregna-1,4-diene-3,20-dione 17α-(2-furoate)
Iupac Name:(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 Formula:C22H28Cl2O4 for mometasone
C27H30O6Cl2 as furoate
Smiles:CC1CC2C3CCC4=CC(=O)C=CC4(C3(C(CC2(C1(C(=O)CCl)O)C)O)Cl)C
Smiles2:CC1CC2C3CCC4=CC(=O)C=CC4(C3(C(CC2(C1(C(=O)CCl)OC(=O)C5=CC=CO5)C)O)Cl)C
Stdinchi:1S/C22H28Cl2O4/c1-12-8-16-15-5-4-13-9-14(25)6-7-19(13,2)21(15,24)17(26)10-20(16,3)22(12,28)18(27)11-23/h6-7,9,12,15-17,26,28H,4-5,8,10-11H2,1-3H3/t12-,15+,16+,17+,19+,20+,21+,22+/m1/s1
Stdinchi2:1S/C27H30Cl2O6/c1-15-11-19-18-7-6-16-12-17(30)8-9-24(16,2)26(18,29)21(31)13-25(19,3)27(15,22(32)14-28)35-23(33)20-5-4-10-34-20/h4-5,8-10,12,15,18-19,21,31H,6-7,11,13-14H2,1-3H3/t15-,18+,19+,21+,24+,25+,26+,27+/m1/s1
Stdinchikey:QLIIKPVHVRXHRI-CXSFZGCWSA-N
Stdinchikey2:WOFMFGQZHJDGCX-ZULDAHANSA-N

Mometasone, also known as mometasone y 3 s, is a steroid (specifically, a glucocorticoid) medication used to treat certain skin conditions, hay fever, and asthma.[7] [8] [9] Specifically it is used to prevent rather than treat asthma attacks.[7] It can be applied to the skin, inhaled, or used in the nose.[7] [8] [9] Mometasone furoate, not mometasone, is used in medical products.[10]

Common side effects when used for asthma include asthma and thrush.[7] It is therefore recommended to rinse the mouth after use.[7] Long-term use may increase the risk for glaucoma and cataracts.[7] Common side effects when used in the nose include upper respiratory tract infections and nose bleeds.[9] Common side effects when applied on the skin include acne, skin atrophy, and itchiness.[8] It works by decreasing inflammation.[7]

Mometasone furoate was patented in 1981 and came into medical use in 1987.[11] It is on the World Health Organization's List of Essential Medicines[12] and is available as a generic medication.[13] [14] In 2021, it was the 266th most commonly prescribed medication in the United States, with more than 1million prescriptions.[15] [16]

Medical uses

Mometasone furoate is used in the treatment of inflammatory skin disorders (such as eczema[17] and psoriasis) (topical form), allergic rhinitis (such as hay fever) (topical form), asthma (inhalation form)[18] [19] for patients unresponsive to less potent corticosteroids, and penile phimosis.[20] In terms of steroid strength, it is more potent than hydrocortisone, and less potent than dexamethasone.[21]

Some low-quality evidence suggests the use of mometasone for symptomatic improvement in children with adenoid hypertrophy.[22]

Mometasone is used to alleviate inflammation and itchiness in skin conditions that respond to treatment with glucocorticoids such as psoriasis and atopic dermatitis.[23] [24]

Nasal mometasone is used in people over two years of age to diminish the symptoms of hay fever (seasonal allergic rhinitis) and other allergies (perennial rhinitis), including nasal congestion, discharge, pruritus, and sneezing and to treat nasal polyps.

It is not useful for the common cold.[25]

Asthma

Mometasone furoate can be used with formoterol for the treatment of asthma, due to its anti-inflammatory properties.[22] [19]

Contraindications

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

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:

The risks of Mometasone furoate to the baby during pregnancy cannot be ruled out.

Side effects

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:

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:

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

Pharmacology

Pharmacodynamics

Mometasone furoate reduces inflammation by causing several effects:[26] [27]

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.[28]

Mechanism of action

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.[29]

The inflammation is reduced in decreasing the liberation of hydrolase acids of leukocytes, the prevention of the accumulation of 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.[30] 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. It could be also considered an antihistamine along with its glucocorticoid effects because it significantly reduces histamine and eosinophil cationic protein levels.

Pharmacokinetics

Metabolism

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.

Mometasone

Mometasone by itself is a synthetic, steroidal glucocorticoid or corticosteroid that was never marketed.[31] [32] [33] The C17α furoate ester of mometasone, is the marketed medication. Mometasone furoate acts as a prodrug of mometasone.[34] In addition to its glucocorticoid activity, mometasone also has very potent progestogenic activity and acts as a partial agonist of the mineralocorticoid receptor.[28]

Society and culture

Brand names

As of 2016, mometasone furoate is 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.[35] It was available 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, Rinocort, Sensicort, Septopic, Silkaren, Soneta, Suavicort, Suqi, Synaller, Tabunex, Topcort, Topison, Uniclar, Uniderm, Vizomet, Yperod, Zalconex, and Zynovate.[35]

Combinations

The following combination medications are available as of 2022:[36]

Notes and References

  1. Web site: Mometasone Use During Pregnancy . Drugs.com . 14 February 2020 . 1 April 2020 . 26 October 2020 . https://web.archive.org/web/20201026164628/https://www.drugs.com/pregnancy/mometasone.html . live .
  2. Web site: Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017 . Therapeutic Goods Administration (TGA) . 21 June 2022 . 30 March 2024.
  3. Web site: Nasonex- mometasone furoate spray, metered . DailyMed . 26 January 2011 . 19 June 2022 . 5 November 2022 . https://web.archive.org/web/20221105121337/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a06f66a9-ca36-48c6-a00d-4f614b539cdf . live .
  4. Web site: Nasonex- mometasone furoate spray . DailyMed . 15 December 2022 . 17 April 2023 . 17 April 2023 . https://web.archive.org/web/20230417075216/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13696a8b-366a-4a5e-adea-d5b7bff9e46f . live .
  5. Web site: List of nationally authorised medicinal products. European Medicines Agency. 6 March 2023. 7 March 2023. https://web.archive.org/web/20230307081706/https://www.ema.europa.eu/en/documents/psusa/mometasone-list-nationally-authorised-medicinal-products-psusa/00002085/202005_en.pdf. live.
  6. Tayab ZR, Fardon TC, Lee DK, Haggart K, McFarlane LC, Lipworth BJ, Hochhaus G . Pharmacokinetic/pharmacodynamic evaluation of urinary cortisol suppression after inhalation of fluticasone propionate and mometasone furoate . British Journal of Clinical Pharmacology . 64 . 5 . 698–705 . November 2007 . 17509041 . 2203259 . 10.1111/j.1365-2125.2007.02919.x .
  7. Web site: Mometasone Furoate Monograph for Professionals . Drugs.com . American Society of Health-System Pharmacists . 11 March 2019 . en . 7 October 2016 . https://web.archive.org/web/20161007221939/https://www.drugs.com/monograph/mometasone-furoate.html . live .
  8. Web site: Mometasone Furoate topical Monograph for Professionals . Drugs.com . American Society of Health-System Pharmacists . 11 March 2019 . en . 5 August 2020 . https://web.archive.org/web/20200805054336/https://www.drugs.com/monograph/mometasone-furoate-topical.html . live .
  9. Web site: Mometasone Furoate eent Monograph for Professionals . Drugs.com . American Society of Health-System Pharmacists . 11 March 2019 . 30 April 2016 . https://web.archive.org/web/20160430104859/http://www.drugs.com/monograph/mometasone-furoate-eent.html . live .
  10. Web site: Mometasone . DrugBank . 30 April 2020 . 29 June 2019 . https://web.archive.org/web/20190629134414/https://www.drugbank.ca/drugs/DB00764 . live .
  11. Book: Fischer J, Ganellin CR . Analogue-based Drug Discovery . 2006 . John Wiley & Sons . 9783527607495 . 488 .
  12. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 22nd list (2021) . 2021 . 10665/345533 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2021.02 . free .
  13. Web site: Competitive Generic Therapy Approvals . U.S. Food and Drug Administration (FDA) . 29 June 2023 . 29 June 2023 . 29 June 2023 . https://web.archive.org/web/20230629233651/https://www.fda.gov/drugs/generic-drugs/competitive-generic-therapy-approvals . live .
  14. Book: British national formulary : BNF 76. 2018. Pharmaceutical Press. 9780857113382. 265. 76.
  15. Web site: The Top 300 of 2021 . ClinCalc . 14 January 2024 . 15 January 2024 . https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx . live .
  16. Web site: Mometasone - Drug Usage Statistics . ClinCalc . 14 January 2024.
  17. 6 . Lax SJ, Harvey J, Axon E, Howells L, Santer M, Ridd MJ, Lawton S, Langan S, Roberts A, Ahmed A, Muller I, Ming LC, Panda S, Chernyshov P, Carter B, Williams HC, Thomas KS, Chalmers JR . March 2022 . Strategies for using topical corticosteroids in children and adults with eczema . The Cochrane Database of Systematic Reviews . 2022 . 3 . CD013356 . 10.1002/14651858.CD013356.pub2 . 8916090 . 35275399 . Cochrane Skin Group.
  18. Tan RA, Corren J . Mometasone furoate in the management of asthma: a review . Therapeutics and Clinical Risk Management . 4 . 6 . 1201–8 . December 2008 . 19337427 . 2643101 . 10.2147/TCRM.S3261 . free .
  19. Bousquet J . 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 . May 2009 . 19392928 . 10.1111/j.1742-1241.2009.02003.x . 2040993 .
  20. Khope S . Topical mometasone furoate for phimosis . Indian Pediatrics . 47 . 3 . 282 . March 2010 . 20371899 .
  21. Williams DM . What does potency actually mean for inhaled corticosteroids? . The Journal of Asthma . 42 . 6 . 409–17 . 2005 . 16293535 . 10.1081/jas-57878 . 43138631 .
  22. Passali D, Spinosi MC, Crisanti A, Bellussi LM . Mometasone furoate nasal spray: a systematic review . Multidisciplinary Respiratory Medicine . 11 . 18 . 2 May 2016 . 27141307 . 4852427 . 10.1186/s40248-016-0054-3 . free .
  23. Green C, Colquitt JL, Kirby J, Davidson P, Payne E. November 2004. Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation. Health Technology Assessment. 8. 47. iii, iv, 1–120. 10.3310/hta8470. 15527669. free.
  24. Prakash A, Benfield P . Topical mometasone. A review of its pharmacological properties and therapeutic use in the treatment of dermatological disorders . Drugs . 55 . 1 . 145–63 . January 1998 . 9463794 . 10.2165/00003495-199855010-00009 . 46976211 .
  25. Web site: Mometasone Nasal Spray: MedlinePlus Drug Information . MedlinePlus . 19 March 2020 . 19 March 2020 . 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. . 20 March 2020 . https://web.archive.org/web/20200320040028/https://medlineplus.gov/druginfo/meds/a602024.html . live .
  26. Book: Nurse's Drug Handbook 2010 . 677 . 15 July 2009 . 978-0-7637-7900-9 . Jones & Bartlett Learning .
  27. Book: Diagnosis and Management of Asthma . Kavuru MS . Chapter 9: Anti-inflammatory agents . 2007 . Professional Communications . 978-1-932610-38-3 .
  28. Austin RJ, Maschera B, Walker A, Fairbairn L, Meldrum E, Farrow SN, Uings IJ . Mometasone furoate is a less specific glucocorticoid than fluticasone propionate . The European Respiratory Journal . 20 . 6 . 1386–92 . December 2002 . 12503693 . 10.1183/09031936.02.02472001 . free .
  29. Walsky RL, Gaman EA, Obach RS . Examination of 209 drugs for inhibition of cytochrome P450 2C8 . Journal of Clinical Pharmacology . 45 . 1 . 68–78 . January 2005 . 15601807 . 10.1177/0091270004270642 . 670198 .
  30. Blaiss MS . Safety update regarding intranasal corticosteroids for the treatment of allergic rhinitis . Allergy and Asthma Proceedings . 32 . 6 . 413–8 . 2011 . 22221434 . 10.2500/aap.2011.32.3473 .
  31. Book: Elks H . The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. 14 November 2014. Springer. 978-1-4757-2085-3. 834–. 11 March 2019. 10 January 2023. https://web.archive.org/web/20230110195428/https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA834. live.
  32. Book: Index Nominum 2000: International Drug Directory. January 2000. Taylor & Francis. 978-3-88763-075-1. 701–.
  33. Book: Morton IK, Hall JM . Concise Dictionary of Pharmacological Agents: Properties and Synonyms. 31 October 1999. Springer Science & Business Media. 978-0-7514-0499-9. 185–. 11 March 2019. 10 January 2023. https://web.archive.org/web/20230110195429/https://books.google.com/books?id=mqaOMOtk61IC&pg=PA185. live.
  34. Book: Vardanyan R, Hruby V . Steroid Hormones . Synthesis of Best-Seller Drugs. https://books.google.com/books?id=A8oHBgAAQBAJ&pg=PA463. 7 January 2016. Elsevier Science. 978-0-12-411524-8. 463–.
  35. Web site: International brands for Mometasone. Drugs.com. 17 November 2016. 17 November 2016. https://web.archive.org/web/20161117213757/https://www.drugs.com/international/mometasone.html. live.
  36. Web site: Mometasone . 17 November 2016 . 17 November 2016 . https://web.archive.org/web/20161117213757/https://www.drugs.com/international/mometasone.html . live .
  37. Web site: Mometamax Ultra: Pending EC decision . European Medicines Agency . 7 October 2022 . 7 October 2022 . 8 October 2022 . https://web.archive.org/web/20221008025148/https://www.ema.europa.eu/en/medicines/veterinary/summaries-opinion/mometamax-ultra . live .
  38. Web site: European Medicines Agency . Mometamax Ultra EPAR . 7 October 2022 . 9 February 2024.