Intranasal corticosteroid + antihistamine Pregnancy: There are no or limited data on mometasone furoate and on intranasal olopatadine in pregnant women, and animal studies have shown reproductive toxicity. Should not be used in pregnancy unless the potential benefit to the mother justifies any potential risk to the mother, foetus or infant; infants born to mothers who received corticosteroids during pregnancy should be observed carefully for hypoadrenalism. Breast-feeding: a decision must be made whether to discontinue breast-feeding or to discontinue/abstain from therapy (§4.6).

Mometasone with olopatadine

Brand names: Ryaltris

This combination nasal spray delivers the intranasal corticosteroid mometasone furoate together with the topical antihistamine olopatadine, used for moderate-to-severe allergic rhinitis when a single agent gives inadequate control.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Two actuations in each nostril (product: 25 micrograms mometasone furoate + 600 micrograms olopatadine per actuation)

Route: Intranasal (nasal spray, suspension) — nasal use only

Frequency: Twice daily (morning and evening)

Adults and adolescents 12 years and older: the usual recommended dose is two actuations in each nostril twice daily, morning and evening (§4.2). Not recommended in children below 12 years of age as safety and efficacy have not been established. No dose adjustment required in the elderly. Administration: shake the container well and prime the pump with 6 actuations before the first dose (until a uniform spray is obtained); re-prime with 2 actuations if the pump has not been used for 14 days or longer; shake for a minimum of 10 seconds before each use; wipe the nozzle after use; discard the bottle after the labelled number of actuations or within 2 months of first use. Source product: Ryaltris 25 micrograms/actuation + 600 micrograms/actuation Nasal Spray, suspension (UK SPC) — the exact fixed combination on this page. The openFDA label in this bundle is mometasone furoate 0.1% CREAM (topical dermatological, once daily) — a different product and route; it was not used for any field here. §4.8 frequency columns could not be reliably mapped from the source table, so frequency categories are not asserted for the individual reactions below (other than the SPC's own 'most commonly reported' statement).

Dose adjustments

Renal

There are no data in patients with renal or hepatic impairment; however, no dose adjustment is expected to be required in these populations (§4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients (§4.3)
Presence of untreated localised infection involving the nasal mucosa, such as herpes simplex (§4.3)
Recent nasal surgery or trauma — a nasal corticosteroid should not be used until healing has occurred, because of the inhibitory effect of corticosteroids on wound healing (§4.3)

Side effects

Most commonly reported: dysgeusia (a substance-specific unpleasant taste), epistaxis and nasal discomfort (§4.8)
Nasal dryness, nasal inflammation, nasal mucosal disorder, sneezing, throat irritation, oropharyngeal pain (§4.8)
Headache, dizziness, somnolence, lethargy, migraine (§4.8)
Dry mouth, abdominal pain, nausea, constipation, sore tongue (§4.8)
Blurred vision, dry eye, eye discomfort; cataracts, glaucoma and increased intraocular pressure (reported with corticosteroid use) (§4.8)
Nasal septum perforation (reported with corticosteroid use); hypersensitivity including anaphylactic reactions, angioedema, bronchospasm and dyspnoea (§4.8)

Clinical monograph

How it works

Mometasone is a topical glucocorticoid that broadly suppresses nasal mucosal inflammation and oedema, while olopatadine is a selective histamine H1-receptor antagonist that rapidly blocks histamine-mediated sneezing, itch and rhinorrhoea; the two provide complementary control.

Prescribing in practice

As with single-agent intranasal steroids, correct technique aiming away from the septum limits epistaxis and the small risk of septal damage with prolonged use, while the antihistamine component can cause a bitter taste and occasional drowsiness.
It should be used regularly for sustained benefit, and the steroid component contributes to cumulative corticosteroid exposure if other steroids are used.
A bitter taste after dosing is common and can be reduced by keeping the head upright and avoiding sniffing hard.

Monitoring

Review symptom control and technique periodically, inspect for nasal irritation or bleeding, and remain alert to any sedation from the antihistamine component.

Counselling the patient

Use it regularly rather than only when symptoms flare.
A short-lived bitter taste is common; keeping your head upright and not sniffing hard afterwards helps.
Stop driving if you feel drowsy, and report persistent nosebleeds or crusting.

Evidence & guidelines

Fixed-combination intranasal mometasone with olopatadine is supported by trials in moderate-to-severe allergic rhinitis showing faster and greater symptom relief than either component alone, as set out in the SPC.

Reference: BSACI rhinitis guideline; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Fluticasone with azelastine · Intranasal corticosteroid + antihistamine

Pathways