Mometasone

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Mometasone
Mometasone furoate.svg
Mometasone furoate ball-and-stick.png
Clinical data
Trade names Nasonex, Asmanex, Elocon, others[1]
Other names 9a,21-Dichloro-11�,17a-dihydroxy-16a-methylpregna-1,4-diene-3,20-dione
17a-(2-furoate)
AHFS/Drugs.com Monograph
Pregnancy
category
US: C (Risk not ruled out)
Routes of
administration Topical, inhalation (nasal spray)
Drug class Corticosteroid; Glucocorticoid
ATC code
D07AC13 (WHO) R01AD09 (WHO), R03BA07 (WHO)
Legal status
Legal status
US: ?-only
Pharmacokinetic data
Bioavailability Nasal spray is virtually undetectable in plasma; but systemic
availability is comparable to fluticasone[2]
Protein binding 98% to 99%
Metabolism Liver
Elimination half-life 5.8 hours
Identifiers
IUPAC name[show]
CAS Number
105102-22-5 ? 83919-23-7
PubChem CID
441336
ChemSpider
390091 ?
UNII
8HR4QJ6DW8
ChEBI
CHEBI:47564 ?
ChEMBL
ChEMBL1161 ?
CompTox Dashboard (EPA)
DTXSID4023333 Edit this at Wikidata
ECHA InfoCard 100.125.600 Edit this at Wikidata
Chemical and physical data
Formula C22H28Cl2O4 for mometasone
C27H30O6Cl2 as furoate
Molar mass 427.361 g/mol (mometasone)
521.4 g/mol (furoate)
3D model (JSmol)
Interactive image
SMILES[show]
InChI[show]
?? (what is this?) (verify)
Mometasone, also known as mometasone furoate, is a steroid medication used to treat
certain skin conditions, hay fever, and asthma.[3][4][5] Specifically it is used to
prevent rather than treat asthma attacks.[3] It can be applied to the skin,
inhaled, or used in the nose.[3][4][5]
Common side effects when used for asthma include headache, sore throat, and thrush.
[3] It is therefore recommended to rinse the mouth after use.[3] Long term use may
increase the risk for glaucoma and cataracts.[3] Common side effects when used in
the nose includes upper respiratory tract infections and nose bleeds.[5] Common
side effects when applied on the skin include acne, skin atrophy, and itchiness.[4]
It works by decreasing inflammation.[3]

Mometasone furoate was patented in 1981 and came into medical use in 1987.[6] It is
available as a generic medication.[7] A month supply of the inhaler in the United
Kingdom costs the NHS about �30 while the nasal spray is less than �2, as of 2019.
[7] In 2017, it was the 197th most commonly prescribed medication in the United
States, with more than two million prescriptions.[8][9]

Contents
1 Medical uses
1.1 Asthma
2 Contraindications
3 Side effects
4 Pharmacology
4.1 Pharmacodynamics
4.2 Pharmacokinetics
4.3 Mometasone
5 Society and culture
5.1 Brand names
5.2 Combinations
6 References
7 External links
Medical uses
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)[10][11] for patients unresponsive to less
potent corticosteroids, and penile phimosis.[12] In terms of steroid strength, it
is more potent than hydrocortisone, and less potent than dexamethasone.[13]

Some low-quality evidence suggests the use of mometasone for symptomatic

improvement in children with adenoid hypertrophy.[14]

Mometasone is used to alleviate inflammation and itchiness in skin conditions that

respond to treatment with glucocorticoids such as psoriasis and atopic dermatitis.
[15][16]

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.[17]

It is not useful for the common cold.[18]

Asthma
Mometasone furoate can be used with formoterol for the treatment of asthma, due to
its anti-inflammatory properties.[14][19]

Contraindications
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 3 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), washing foods, hand washing and calling a family doctor at the first sign
of a severe infection.

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

headache
Viral upper respiratory infections
sore throat
nose bleeds
cough
muscle and joint pain
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
Pharmacodynamics
Mometasone furoate reduces inflammation by causing several effects:[17][20][21]

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.[22]

Mechanism of action

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.[23]

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.[24] 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 immunosupressive drug because clincal 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
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 6�-
hydroxymometasone. In human hepatic microsomes, the formation of these metabolites
is regulated by CYP3A4.[17]

Mometasone
Mometasone by itself is a synthetic, steroidal glucocorticoid or corticosteroid
that was never marketed.[25][26][27] The C17a furoate ester of mometasone, is the
marketed medication.[25][26][27] Mometasone furoate acts as a prodrug of
mometasone.[28] In addition to its glucocorticoid activity, mometasone also has
very potent progestogenic activity and acts as a partial agonist of the
mineralocorticoid receptor.[22]

Society and culture

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

Mometasone and azelastine as Nasaflex

Mometasone and clotrimazole and gentamicin for veterinary use as Mometamax
Mometasone and florfenicol and terbinafine for veterinary use as Claro
Mometasone and formoterol as Dulera and Zenhale
Mometasone and fusidic acid as Momate-F
Mometasone and miconazole as Elica M and Sensicort-F
Mometasone and mupirocin as Sensicort-B
Mometasone and orbifloxacin and posaconazole for veterinary use as Posatex
Mometasone and salicylic acid as Belosalic, Cortimax-S, Elicasal, Elocom Plus,
Elosalic, Momate, Momesalic, Momtas, Monsalic, and Sensicort-S
Mometasone and tazarotene as Tazasone Forte
Mometasone and terbinafine as Cutizone-T
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