Nasonex


mometasone (nasal)

(moe-met-a-sone) mometasone,

Nasonex

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Treatment of nasal symptoms of seasonal and perennial allergic rhinitis.Prophylaxis of nasal symptoms of seasonal allergic rhinitis.Treatment of nasal polyps.

Action

Potent, locally acting anti-inflammatory and immune modifier.

Therapeutic effects

Decrease in symptoms of allergic rhinitis and nasal polyps.

Pharmacokinetics

Absorption: Negligible absorption; action is primarily local following nasal use.Distribution: Crosses the placenta and enters breast milk in small amounts.Metabolism and Excretion: Rapidly and extensively metabolized by the liver; primarily excreted in bile.Half-life: 5.8 hr.

Time/action profile (improvement in symptoms)

ROUTEONSETPEAKDURATION
Intranasal within 2 days 1–2 wk unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to mometasone.Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (resulting from disease or concurrent therapy); Systemic glucocorticoid therapy (should not be abruptly discontinued when intranasal therapy is started); Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <2 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Adverse Reactions/Side Effects

Central nervous system

  • headache (most frequent)

Ear, Eye, Nose, Throat

  • pharyngitis (most frequent)
  • epistaxis
  • nasal burning
  • nasal irritation
  • nasopharyngeal fungal infection
  • sinusitis

Gastrointestinal

  • vomiting

Genitourinary

  • dysmenorrhea

Endocrinologic

  • adrenal suppression (↑ dose, long-term therapy only)
  • ↓ growth (children)

Musculoskeletal

  • pain

Respiratory

  • cough

Interactions

Drug-Drug interaction

None known.

Route/Dosage

Treatment of Season and Perennial Allergic Rhinitis

Intranasal (Adults and Children ≥12 yr) 2 sprays in each nostril once daily (not to exceed 2 sprays in each nostril once daily).Intranasal (Children 2–11 yr) 1 spray in each nostril once daily.

Prophylaxis of Seasonal Allergic Rhinitis

Intranasal (Adults and Children ≥12 yr) 2 sprays in each nostril once daily initiated 2–4 wk prior to beginning of pollen season.

Treatment of Nasal Polyps

Intranasal (Adults ≥18 yr) 2 sprays in each nostril 1–2 times daily (not to exceed 2 sprays in each nostril twice daily).

Availability

Nasal spray: 50 mcg/metered spray in 17-g bottle (delivers 120 sprays)

Nursing implications

Nursing assessment

  • Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
    • Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
    • Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
  • Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
  • Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before glucocorticoid nasal spray.

Patient/Family Teaching

  • Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
  • Instruct patient in correct technique for administering nasal spray (see ). Shake well before use. Before first-time use, prime unit by spraying 10 times or until fine spray appears. If not used for at least 7 days, reprime by spraying 2 times or until fine spray appears. Prior to administering dose, gently blow nose to clear nostrils. Close 1 nostril. Tilt head forward slightly and insert nasal applicator into other nostril. Spray and breathe inward through nostril. Breathe out through mouth. Repeat procedure in other nostril. Warn patient that temporary nasal stinging may occur.
  • Instruct patient to notify health care professional if symptoms do not improve within 2 wk, or if symptoms worsen.

Evaluation/Desired Outcomes

  • Resolution or prevention of nasal stuffiness, discharge, and sneezing in seasonal or perennial allergic rhinitis or nasal polyps.

Nasonex

(nā′zə-nĕks′) A trademark for a preparation of the drug mometasone furoate.