Mometasone furoate

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Mometasone furoate
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rabin Bista, M.B.B.S. [2]

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Overview

Mometasone furoate is a corticosteroid that is FDA approved for the treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses in patients ≥ 2 years of age. Common adverse reactions include burning, pruritus, and skin atrophy.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

  • Mometasone Furoate Cream USP, 0.1% is a corticosteroid indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses in patients 2 years of age or older.

Dosage

  • Apply a thin film of Mometasone Furoate Cream to the affected skin areas once daily. Mometasone Furoate Cream may be used in pediatric patients 2 years of age or older. Since safety and efficacy of Mometasone Furoate Cream have not been established in pediatric patients below 2 years of age; use in this age group is not recommended.
  • Therapy should be discontinued when control is achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary. Safety and efficacy of Mometasone Furoate Cream in pediatric patients for more than 3 weeks of use have not been established.
  • Mometasone Furoate Cream should not be used with occlusive dressings unless directed by a physician. Mometasone Furoate Cream should not be applied in the diaper area if the child still requires diapers or plastic pants, as these garments may constitute occlusive dressing.
  • Mometasone Furoate Cream is for topical use only. It is not for oral, ophthalmic, or intravaginal use.
  • Avoid use on the face, groin, or axillae.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Mometasone furoate cream in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mometasone furoate cream in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding FDA-Labeled Use of Mometasone furoate in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Mometasone furoate in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Mometasone furoate in pediatric patients.

Contraindications

  • None

Warnings

Effects on Endocrine System
Allergic Contact Dermatitis
  • If irritation develops, Mometasone Furoate Cream should be discontinued and appropriate therapy instituted. Allergic contact dermatitis with corticosteroids is usually diagnosed by observing a failure to heal rather than noting a clinical exacerbation as with most topical products not containing corticosteroids. Such an observation should be corroborated with appropriate diagnostic patch testing.
Concomitant Skin Infections
  • If concomitant skin infections are present or develop, an appropriate antifungal or antibacterial agent should be used. If a favorable response does not occur promptly, use of Mometasone Furoate Cream should be discontinued until the infection has been adequately controlled.

Adverse Reactions

Clinical Trials Experience

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Mometasone furoate in the drug label.

Drug Interactions

  • No drug-drug interaction studies have been conducted with Mometasone Furoate Cream.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C

  • There are no adequate and well-controlled studies in pregnant women. Therefore, Mometasone Furoate Cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Some corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.
  • When administered to pregnant rats, rabbits, and mice, mometasone furoate increased fetal malformations. The doses that produced malformations also decreased fetal growth, as measured by lower fetal weights and/or delayed ossification. Mometasone furoate also caused dystocia and related complications when administered to rats during the end of pregnancy.
  • In mice, mometasone furoate caused cleft palate at subcutaneous doses of 60 mcg/kg and above. Fetal survival was reduced at 180 mcg/kg. No toxicity was observed at 20 mcg/kg. (Doses of 20, 60, and 180 mcg/kg in the mouse are approximately 0.01, 0.02, and 0.05 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis.)
  • In rats, mometasone furoate produced umbilical hernias at topical doses of 600 mcg/kg and above. A dose of 300 mcg/kg produced delays in ossification, but no malformations. (Doses of 300 and 600 mcg/kg in the rat are approximately 0.2 and 0.4 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis.)
  • In rabbits, mometasone furoate caused multiple malformations (e.g., flexed front paws, gallbladder agenesis, umbilical hernia, hydrocephaly) at topical doses of 150 mcg/kg and above (approximately 0.2 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis). In an oral study, mometasone furoate increased resorptions and caused cleft palate and/or head malformations (hydrocephaly and domed head) at 700 mcg/kg. At 2800 mcg/kg most litters were aborted or resorbed. No toxicity was observed at 140 mcg/kg. (Doses at 140, 700, and 2800 mcg/kg in the rabbit are approximately 0.2, 0.9, and 3.6 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis.)
  • When rats received subcutaneous doses of mometasone furoate throughout pregnancy or during the later stages of pregnancy, 15 mcg/kg caused prolonged and difficult labor and reduced the number of live births, birth weight, and early pup survival. Similar effects were not observed at 7.5 mcg/kg. (Doses of 7.5 and 15 mcg/kg in the rat are approximately 0.005 and 0.01 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis.)


Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Mometasone furoate in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Mometasone furoate during labor and delivery.

Nursing Mothers

  • Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk. Because many drugs are excreted in human milk, caution should be exercised when Mometasone Furoate Cream is administered to a nursing woman.

Pediatric Use

  • Mometasone Furoate Cream may be used with caution in pediatric patients 2 years of age or older, although the safety and efficacy of drug use for longer than 3 weeks have not been established. Since safety and efficacy of Mometasone Furoate Cream have not been established in pediatric patients below 2 years of age, its use in this age group is not recommended.
  • In a pediatric trial, 24 atopic dermatitis subjects, of whom 19 subjects were age 2 to 12 years, were treated with Mometasone Furoate Cream once daily. The majority of subjects cleared within 3 weeks. Mometasone Furoate Cream caused HPA axis suppression in approximately 16% of pediatric subjects ages 6 to 23 months, who showed normal adrenal function by Cortrosyn test before starting treatment, and were treated for approximately 3 weeks over a mean body surface area of 41% (range 15%-94%). The criteria for suppression were: basal cortisol level of ≤5 mcg/dL, 30-minute post-stimulation level of ≤18 mcg/dL, or an increase of <7 mcg/dL. Follow-up testing 2 to 4 weeks after trial completion, available for 5 of the subjects, demonstrated suppressed HPA axis function in 1 subject, using these same criteria. Long-term use of topical corticosteroids has not been studied in this population.
  • Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of HPA axis suppression and Cushing’s syndrome when they are treated with topical corticosteroids. They are, therefore, also at greater risk of adrenal insufficiency during and/or after withdrawal of treatment. Pediatric patients may be more susceptible than adults to skin atrophy, including striae, when they are treated with topical corticosteroids. Pediatric patients applying topical corticosteroids to greater than 20% of body surface are at higher risk of HPA axis suppression.
  • HPA axis suppression, Cushing’s syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension have been reported in pediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in children include low plasma cortisol levels and an absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.

Mometasone Furoate Cream should not be used in the treatment of diaper dermatitis.

Geriatic Use

  • Clinical studies of Mometasone Furoate Cream included 190 subjects who were 65 years of age and over and 39 subjects who were 75 years of age and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, greater sensitivity of some older individuals cannot be ruled out.

Gender

There is no FDA guidance on the use of Mometasone furoate with respect to specific gender populations.

Race

There is no FDA guidance on the use of Mometasone furoate with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Mometasone furoate in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Mometasone furoate in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Mometasone furoate in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Mometasone furoate in patients who are immunocompromised.

Administration and Monitoring

Administration

  • topical

Monitoring

There is limited information regarding Monitoring of Mometasone furoate in the drug label.

IV Compatibility

There is limited information regarding IV Compatibility of Mometasone furoate in the drug label.

Overdosage

  • Topically applied Mometasone Furoate Cream can be absorbed in sufficient amounts to produce systemic effects

Pharmacology

Mometasone Wiki Structure.png
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Mometasone furoate
Systematic (IUPAC) name
(11β,16α)-9,21-dichloro-11-hydroxy-16-methyl-3,20-dioxopregna-1,4-dien-17-yl 2-furoate
Identifiers
CAS number 105102-22-5
83919-23-7
ATC code D07AC13 R01AD09 (WHO), R03BA07 (WHO)
PubChem 441336
DrugBank DB00764
Chemical data
Formula C22H28Cl2O4 for Mometasone
C27H30O6Cl2 as Furoate
Mol. mass 427.361 g/mol (Mometasone)
521.4 g/mol (Furoate)
SMILES eMolecules & PubChem
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
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
Excretion ?
Therapeutic considerations
Pregnancy cat.

C(US)

Legal status

Rx Only (US)

Routes topical, inhalation

Mechanism of Action

Structure

  • Chemically, mometasone furoate is 9α, 21-dichloro-11β,17-dihydroxy-16α-methylpregna-1,4-diene-3,20-dione 17-(2-furoate), with the empirical formula C27H30Cl2O6, a molecular weight of 521.4 and the following structural formula:
This image is provided by the National Library of Medicine.

Pharmacodynamics

  • Studies performed with Mometasone Furoate Cream indicate that it is in the medium range of potency as compared with other topical corticosteroids.
  • In a study evaluating the effects of Mometasone Furoate Cream on the HPA axis, 15 grams were applied twice daily for 7 days to six adult subjects with psoriasis or atopic dermatitis. The cream was applied without occlusion to at least 30% of the body surface. The results showed that the drug caused a slight lowering of adrenal corticosteroid secretion.
  • Ninety-seven pediatric subjects ages 6 to 23 months with atopic dermatitis were enrolled in an open-label HPA axis safety study. Mometasone Furoate Cream was applied once daily for approximately 3 weeks over a mean body surface area of 41% (range 15%-94%). In approximately 16% of subjects who showed normal adrenal function by Cortrosyn test before starting treatment, adrenal suppression was observed at the end of treatment with Mometasone Furoate Cream. The criteria for suppression were: basal cortisol level of ≤5 mcg/dL, 30-minute post-stimulation level of ≤18 mcg/dL, or an increase of <7 mcg/dL. Follow-up testing 2 to 4 weeks after stopping treatment, available for 5 of the subjects, demonstrated suppressed HPA axis function in one subject, using these same criteria

Pharmacokinetics

  • The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle and the integrity of the epidermal barrier. Studies in humans indicate that approximately 0.4% of the applied dose of Mometasone Furoate Cream enters the circulation after 8 hours of contact on normal skin without occlusion. Inflammation and/or other disease processes in the skin may increase percutaneous absorption.

Nonclinical Toxicology

Carcinogenesis & Mutagenesis & Impairment of Fertiity

  • Long-term animal studies have not been performed to evaluate the carcinogenic potential of Mometasone Furoate Cream. Long-term carcinogenicity studies of mometasone furoate were conducted by the inhalation route in rats and mice. In a 2-year carcinogenicity study in Sprague Dawley rats, mometasone furoate demonstrated no statistically significant increase of tumors at inhalation doses up to 67 mcg/kg (approximately 0.04 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis). In a 19-month carcinogenicity study in Swiss CD-1 mice, mometasone furoate demonstrated no statistically significant increase in the incidence of tumors at inhalation doses up to 160 mcg/kg (approximately 0.05 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis).
  • Mometasone furoate increased chromosomal aberrations in an in vitro Chinese hamster ovary cell assay, but did not increase chromosomal aberrations in an in vitro Chinese hamster lung cell assay. Mometasone furoate was not mutagenic in the Ames test or mouse lymphoma assay, and was not clastogenic in an in vivo mouse micronucleus assay, a rat bone marrow chromosomal aberration assay, or a mouse male germ-cell chromosomal aberration assay. Mometasone furoate also did not induce unscheduled DNA synthesis in vivo in rat hepatocytes.
  • In reproductive studies in rats, impairment of fertility was not produced in male or female rats by subcutaneous doses up to 15 mcg/kg (approximately 0.01 times the estimated maximum clinical topical dose from Mometasone Furoate Cream on a mcg/m2 basis).

Clinical Studies

  • The safety and efficacy of the Mometasone Furoate Cream for the treatment of corticosteroid-responsive dermatoses were evaluated in two randomized, double-blind, vehicle-controlled clinical trials, one in psoriasis and one in atopic dermatitis. A total 366 subjects (12-81 years of age), of whom 177 received Mometasone Furoate Cream and 181 subjects received vehicle cream, were evaluated in these trials. Mometasone Furoate Cream or the vehicle cream were applied once daily for 21 days.
  • The two trials showed Mometasone Furoate Cream is effective in the treatment of psoriasis and atopic dermatitis.

How Supplied

  • Mometasone Furoate Cream USP, 0.1% is white to off-white in color and supplied in 15-gram (NDC 0115-1470-52) and 45 gram (NDC 0115-1470-46) tubes.

Storage

  • Store at 20°-25°C (68°-77°F); excursions permitted to 15°-30°C (59°-86°F).
  • Avoid excessive heat.

Images

Drug Images

Package and Label Display Panel

Package Label.Principal Display Panel

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Ingredients and Appearance

Mometasone Ingredients and App.png

Patient Counseling Information

  • Use Mometasone Furoate Cream as directed by the physician. It is for external use only.
  • Avoid contact with the eyes.
  • Do not use Mometasone Furoate Cream on the face, underarms, or groin areas unless directed by the physician.
  • Do not use Mometasone Furoate Cream for any disorder other than that for which it was prescribed.
  • The treated skin area should not be bandaged or otherwise covered or wrapped so as to be occlusive, unless directed by the physician.
  • Report any signs of local adverse reactions to the physician.
  • Advise patients not to use Mometasone Furoate Cream in the treatment of diaper dermatitis. Do not apply Mometasone Furoate Cream in the diaper area, as diapers or plastic pants may constitute occlusive dressing.
  • Discontinue therapy when control is achieved. If no improvement is seen within 2 weeks, contact the physician.
  • Do not use other corticosteroid-containing products with Mometasone Furoate Cream without first consulting with the physician.

Precautions with Alcohol

  • Alcohol-Mometasonefuroate interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

There is limited information regarding Mometasone furoate Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  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. "Mometasone furoate".

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