most desirable [4:<1% following oral inhalation of a single 440-mcg dose. 1 2 Onset 1 2 weeks of continuous therapy required to achieve optimum symptomatic relief. 1 Duration When corticosteroids are discontinued, asthma control remains stable for several days or longer. 1 Distribution Extent Not known whether mometasone is distributed into milk; 1 however, other corticosteroids are distributed into milk. 1 Does not accumulate in red blood cells. 1 Plasma Protein Binding 98 99%. 1 Elimination Metabolism Extensively metabolized in the liver principally by CYP3A4 isoenzyme. 1 2 Elimination Route Excreted principally in feces and to a lesser extent in urine. 1 2 Half-life Following IV administration, approximately 5 hours. 1 Special Populations In patients with hepatic impairment, plasma concentrations of the drug may be increased. 1 Stability Storage Oral Inhalation Powder 25 C (may be exposed to 15 30 C) in a dry place. 1 Discard the inhaler 45 days after opening the foil pouch or when dose counter reads 00 , whichever comes first. 1 Actions Reduces the inflammatory asthmatic response by inhibiting multiple cell types (e.g., mast cells, eosinophils, lymphocytes, neutrophils, macrophages). 1 Inhibits mediator production or secretion (e.g., eicosanoids, leukotrienes, cytokines, histamine) involved in the asthmatic response. 1 Improves lung function (e.g., forced expiratory volume in 1 second [FEV 1 ], morning and evening peak expiratory flow rate). 1 3 4 Advice to Patients Importance of providing the patient a copy of the manufacturer's patient information. 1 Importance of adequate understanding of proper storage, preparation, and inhalation techniques, including use of the Twisthaler device. 1 8 Importance of pediatric patients receiving oral inhalation therapy under adult supervision. 8 Importance of rinsing the mouth after oral inhalation. 1 2 8 Importance of advising patients that mometasone furoate oral inhalation must be used at regular intervals to be therapeutically effective. 1 8 Importance of adherence to prescribed dosage regimen; do not increase the frequency of administration without consulting a clinician. 8 Importance of advising patients that at least 1 2 weeks of continuous therapy may be required for optimum effects to be achieved. 1 8 Importance of contacting a clinician if asthma symptoms do not improve in such a time frame. 1 8 Importance of advising patients that orally inhaled mometasone should not be used as a bronchodilator and that the drug is not indicated for emergency use (e.g., relief of acute bronchospasm). 1 8 Importance of availability and use of a short-acting β 2 -adrenergic agonist for relief of acute asthma symptoms. 1 8 12 Importance of contacting a clinician immediately if asthmatic attacks that are not controlled by bronchodilator therapy occur. 1 Importance of gradual withdrawal from systemic corticosteroids during transfer to orally inhaled mometasone and of monitoring by a clinician during such transfer of therapy. 8 (See Conversion to Orally Inhaled Therapy in Patients Receiving Systemic Corticosteroids under Dosage and Administration.) Importance of advising patients being transferred from systemic corticosteroid to mometasone oral inhalation therapy to carry special identification (e.g., card, bracelet) indicating the need for supplementary systemic corticosteroids during periods of stress or severe exacerbation of asthma. 1 Importance of advising patients to immediately resume therapy with large doses 1 of systemic corticosteroids and contact their clinician for further instructions during stressful periods (e.g., stress, severe asthmatic attack, surgery, trauma, infection). 1 8 Importance of informing patients that corticosteroids may decrease bone mineral density. 1 8 (See Musculoskeletal Effects under Cautions.) Risk of localized candidal infections of mouth and pharynx. 1 8 (See Infections under Cautions.) Risk of systemic corticosteroid effects (e.g., hypercorticism, potentially life-threatening adrenal suppression). 1 Importance of informing a clinician of fatigue, weakness, nausea, vomiting, dizziness, or fainting. 1 8 (See Systemic Corticosteroid Effects under Cautions.) Risk of reduction in growth velocity with orally inhaled corticosteroids. 1 (See Pediatric Use under Cautions.) Importance of informing patients that long-term use of inhaled corticosteroids may increase the risk for development of some eye problems (e.g., cataracts, glaucoma). 1 (See Ocular Effects under Cautions.) Importance of immunosuppressed patients avoiding exposure to chickenpox or measles, and, if exposed, of immediately consulting a clinician. 1 8 (See Immunosuppressed Patients under Cautions.) Importance of advising immunosuppressed patients of potential worsening of existing tuberculosis, fungal, bacterial, parasitic, or viral infections, or ocular herpes simplex. 1 Importance of immunosuppressed patients informing clinician of a history of infections. 8 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., infections). 1 8 Importance of informing patients of other important precautionary information. 1 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Mometasone Furoate Routes Dosage Forms Strengths Brand Names Manufacturer Oral Inhalation Powder for inhalation 110 mcg/inhalation (delivers 100 mcg/inhalation) Asmanex Twisthaler Schering 220 mcg/inhalation (delivers 200 mcg/inhalation) Asmanex Twisthaler Schering AHFS DI Essentials. Copyright 2017, Selected Revisions February 15, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References 1. Schering Corporation. Asmanex Twisthaler (mometasone furoate) inhalation powder prescribing information. Kenilworth, NJ; 2008 Jan. 2. Sharpe M, Jarvis B. Inhaled mometasone furoate: a review of its uses in adults and adolescents with persistent asthma. Drugs . 2001; 61:1325-50. [PubMed 11511026] 3. Nayak AS, Banov C, Corren J et al. Once-daily mometasone furoate dry powder inhaler in the treatment of patients with persistent asthma. Ann Allergy Asthma Immunol . 2000; 84:417-24. [PubMed 10795650] 4. Kemp JP, Berkowitz RB, Miller SD et al. Mometasone furoate administered once daily is as effective as twice-daily administration for treatment of mild-to-moderate persistent asthma. J Allergy Clin Immunol . 2000; 106:485-92. [PubMed 10984368] 5. Noonan M, Karpel JP, Bensch GW et al. Comparison of once-daily to twice-daily treatment with mometasone furoate dry powder inhaler. Ann Allergy Asthma Immunol . 2001; 86:36-43. [PubMed 11206236] 6. Fish JE, Karpel JP, Craig TJ et al. Inhaled mometasone furoate reduces oral prednisone requirements while improving respiratory function and health-related quality of life in patients with severe persistent asthma. J Allergy Clin Immunol . 2000; 106:852-60. [PubMed 11080706] 7. Bernstein DI, Berkowitz RB, Chervinsky P et al. Dose-ranging study of new steroid for asthma: mometasone furoate dry powder inhaler. Respir Med . 1999; 93:603-12. [PubMed 10542973] 8. Schering Corporation. Asmanex Twisthaler (mometasone furoate) inhalation powder patient instructions for use. Kenilworth, NJ; 2008 Jan. 10. National Institutes of Health, National Heart, Lung, and Blood Institute. Global initiative for asthma: global strategy for asthma management and prevention NHLBI/WHO Workshop Report. Bethesda, MD: National Institutes of Health. 2005 Oct. NIH/NHLBI Publication No. 02-3659. Available from website. Accessed Jan. 5, 2006. 11. Berger WE, Milgrom H, Chervinsky P et al. Effects of treatment with mometasone furoate dry powder in children with persistent asthma. Ann Allergy Asthma Immunol . 2006; 97:672-80. [PubMed 17165278] 12. National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health, National Heart, Lung and Blood Institute. Aug 28. 2007. Available from website. 13. IVAX Laboratories. Qvar (beclomethasone dipropronate) HFA inhalation aerosol prescribing information. Miami, FL; 2005 Nov. 14. Schering Plough, Kenilworth, NJ: Personal communication. 15. National Institutes of Health, National Heart, Lung, and Blood Institute. Global initiative for asthma: global strategy for asthma management and prevention. Bethesda, MD: National Institutes of Health. 2009 Dec. Available from: NIH website. Accessed 2010 Sep 23. Next Interactions Print this page Add to My Med List More about Asmanex Twisthaler (mometasone) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group Pricing & Coupons 13 Reviews Add your own review/rating Drug class: inhaled corticosteroids Consumer resources Asmanex ... +8 more Professional resources Asmanex (FDA) Mometasone Furoate (AHFS Monograph) Other brands: Asmanex HFA Related treatment guides Asthma, Maintenance> ]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Manufacturer Merck & Co., Inc. 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