Metamist Nasal Spray

• Allergic rhinitis (seasonal and perennial) - treatment and prophylaxis
• Nasal polyps
• Asthma prophylaxis (inhalation)

Adult Dose (Nasal Spray):

• Allergic rhinitis: 100 mcg (2 sprays) in each nostril once daily; may increase to 200 mcg; Maintenance: 50 mcg
• Seasonal allergy prophylaxis: Start 2-4 weeks prior to pollen season
• Nasal polyps: 100 mcg once daily; may increase to twice daily after 5-6 weeks

Inhalation (Asthma):

• Mild-moderate: 400 mcg once daily in the evening; Maintenance: 200 mcg 1-2 times
• Severe: 400 mcg twice daily; titrate to lowest effective dose once controlled

Pediatric Dose (Nasal): 2-11 years: 50 mcg (1 spray) daily; >12 years: 100 mcg

Pediatric Dose (Inhalation): 400 mcg once daily (mild-moderate); 400 mcg twice daily (severe)

Common Side Effects (>10%):

• Headache (26%)
• Viral infection (14%)
• Pharyngitis (12%)
• Epistaxis (11%)

Uncommon (1-10%):

• Cough (7%)
• Upper respiratory tract infection (6%)
• Dysmenorrhea (5%)

Rare: Loss of taste, Muscle soreness

Use in Pregnancy: Mometasone may be unsafe during pregnancy (Category C); animal studies show evidence of fetal harm. Use only if clearly needed.

• Caution in respiratory tract tuberculosis, untreated fungal/bacterial/viral/parasitic infections
• Caution in ocular herpes simplex, nasal septum perforation, epistaxis, cataracts, glaucoma, increased intraocular pressure
• Risk of serious chickenpox and measles in susceptible individuals; avoid use in unvaccinated persons
• Deaths from adrenal insufficiency after abrupt withdrawal of oral steroids; taper gradually
• May retard growth in children
• Infections (including Candida albicans) in immunocompromised patients
• Excessive use may suppress HPA axis function
• Long-term use reduces bone mineral density