Mometasone with olopatadine

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.