Names and pronunciation
(moe-met′a-sone) Asmanex, Asmanex HFA, Propel, Sinuva
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Drug reference
(moe-met′a-sone) Asmanex, Asmanex HFA, Propel, Sinuva
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Func. class.: Antiinflammatory
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Chem. class.: Corticosteroid
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ACTION: May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins)
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USES: Inhalation: Maintenance treat- ment of asthma as prophylactic therapy in those ≥4 yr of age; allergic rhinitis, nasal congestion
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SIDE EFFECTS CNS: Headache, fatigue, depression GI: Oral candidiasis, abdominal pain, dyspepsia, nausea, vomiting, anorexia, gastroenteritis MS: MS pain, arthralgia RESP: Sinusitis, allergic rhinitis, URI, pharyngitis GU: Dysmenorrhea, UTI
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INTERACTIONS Increase: adverse reactions—CYP3A4 inhibitors, use cautiously NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Asthma Adult/child ≥12 yr: Oral inhalation: Asmanex HFA: Metered-dose inhaler: Patients with no prior treatment with inhaled corticosteroid: Mometasone 100 mcg: Initial: 200 mcg twice daily; max 400 mcg twice daily (800 mcg/day); those who previously received oral cor- ticosteroids: Mometasone 200 mcg: Ini- tial: 400 mcg twice daily; max 400 mcg twice daily (800 mcg/day); Asmanex Twisthaler: Dry powder inhaler: Those who previously received bronchodila- tors alone: Initial: 220 mcg once daily in the evening; max 440 mcg/day; those who previously received inhaled corti- costeroids: Initial: 220 mcg once daily in the evening; maximum dose: 440 mcg/ day; those who previously received oral corticosteroids: Initial: 440 mcg twice daily; max 880 mcg/day Allergic rhinitis (seasonal and perennial) Adult: Intranasal: 2 sprays (100 mcg) in each nostril once daily (total daily dose: 200 mcg) Nasal congestion associated with seasonal rhinitis Adult/child ≥12 yr: Intranasal: 2 sprays (100 mcg) in each nostril once daily (total daily dose: 200 mcg) Nasal polyps Adult: Intranasal: 2 sprays (100 mcg) in each nostril twice daily (total daily dose: 400 mcg); 2 sprays (100 mcg) in each nostril once daily may be effective in some patients Seasonal allergic rhinitis (prophy- laxis) Adult/child ≥12 yr: Intranasal: 2 sprays (100 mcg) in each nostril once daily (total daily dose: 200 mcg); treatment M should begin 2-4 wk before the antici- pated start of pollen season
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Available forms: Inhalation aerosol 100 mcg, 200 mcg/actuation; inhalation powder 110 mcg, 220 mcg/actuation, cream 0.1%, lotion 0.1%, ointment 0.1%, nasal spray 50 mcg/spray
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Administer: Nasal route: • Spray: For intranasal administration only • Prime pump (press 10 times or until fine spray appears) before first use • If 7 or more days have elapsed since last use, reprime pump with 2 sprays or until a fine mist appears • Shake before using. Blow nose • Insert applicator into nostril, tilt head slightly forward keeping bottle upright, and close off the other nostril. Breathe in through nose • While inhaling, press pump, exhale through mouth • After each use, wipe tip with a tissue and replace cap • Avoid spraying directly into nasal sep- tum, eyes, mouth, face • Discard after 120 medicated sprays have been used, even if not completely empty
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Assess: • Asthma: Monitor signs, symptoms of asthma, not to be used for acute asthma attacks, wean from corticosteroids (sys- temic) • Cushing symptoms: Assess for ex- cess sweating, excessive hairiness, exces- sive hunger, fatigue, flushing, high blood pressure, osteoporosis, abnormal pad of fat between the shoulder blades, acne, darkening of the skin, stretch marks, or thinning, muscle weakness or loss of muscle, anxiety, depression, easy bruis- ing, hair loss, headache, infertility, in- somnia, irritability, pot belly, round face from gradual swelling, swelling in ex- tremities, or weight gain
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Evaluate: • Therapeutic response: Decrease symptoms of asthma or seasonal/peren- nial rhinitis
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Patient and caregiver information: • Teach patient how to use inhalation or nasal spray • If only using once/day use before bed- time • Not to be used for acute asthma attack
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PHARMACOKINETICS Nasal: Onset, peak, duration unknown Inhalation: Onset, duration unknown, peak 1-2½ hr
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