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Topical / inhaled corticosteroid Pregnancy: §4.6 of the Asmanex Twisthaler SPC: 'There are no or limited amount of data from the use of mometasone furoate in pregnant women. Studies in animals with mometasone furoate, like other glucocorticoids, have shown reproductive toxicity. As with other inhaled corticosteroid preparations, mometasone furoate is not to be used during pregnancy unless the potential benefit to the mother justifies the potential risk to the mother, fetus or infant. Infants born of mothers who received corticosteroids during pregnancy are to be observed carefully for hypoadrenalism.' Breast-feeding: it is unknown whether mometasone furoate/metabolites are excreted in human milk; animal data have shown excretion in milk; a decision must be made whether to discontinue breast-feeding or to discontinue/abstain from mometasone furoate therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. Fertility: in reproductive studies in rats there was no effect on fertility.

Mometasone furoate

Brand names: Asmanex, Nasonex, Elocon

Mometasone furoate is a potent synthetic corticosteroid available as an inhaler, intranasal spray and topical preparation, used for maintenance treatment of asthma, allergic rhinitis and inflammatory skin conditions depending on formulation.

Adult dose

Dose: SCOPE — INHALED ROUTE (ASTHMA MAINTENANCE) ONLY. Everything below is from the UK SPC for Asmanex Twisthaler 200 micrograms Inhalation Powder and applies to inhaled mometasone furoate for asthma in adults and adolescents 12 years and over. The nasal-spray and topical-cream routes this page also names are NOT covered by this source and no figure for them is published here. Persistent MILD TO MODERATE asthma: the recommended starting dose for most patients is 400 micrograms once daily; data suggest better asthma control is achieved if once-daily dosing is given in the evening. Some patients may be more adequately controlled on 400 micrograms daily given in two divided doses (200 micrograms twice daily). Dose reduction to 200 micrograms once daily given in the evening may be an effective maintenance dose for some patients. SEVERE asthma: the recommended starting dose is 400 micrograms twice daily, which is the maximum recommended dose; when symptoms are controlled, titrate to the lowest effective dose. In every case the dose 'should be individualised and titrated to the lowest dose at which effective control of asthma is maintained'.
Route: Oral inhalation only, via the Asmanex Twisthaler dry-powder inhaler. §4.2: the product 'should be administered by oral inhalation only' and 'is for inhalation use only'. The patient should be upright when inhaling, should close the lips around the mouthpiece and breathe in rapidly and deeply, then hold the breath for about 10 seconds or as long as is comfortable, and must not breathe out through the inhaler. After each dose, patients should be advised to rinse their mouth with water and spit out the contents without swallowing, which helps reduce the risk of candidiasis.
Frequency: Once daily (preferably in the evening) in persistent mild to moderate asthma, or twice daily; twice daily in severe asthma. Must be taken regularly to maintain therapeutic benefit even when the patient is asymptomatic.
Max: 400 micrograms twice daily. §4.2 states of the severe-asthma regimen: 'The recommended starting dose is 400 micrograms twice daily, which is the maximum recommended dose.'
It said the bundle contained no UK SPC and no inhaled source, only a US dermatological cream label. The inhaled/asthma dose above therefore rests on UK labelling for the right product. WHAT IS STILL NOT SOURCED: this page is a three-route umbrella (Asmanex inhaler, Nasonex nasal spray, Elocon cream). No UK SPC for the aqueous nasal spray and none for the topical cream is present in the bundle, so no intranasal and no topical dose is published, and route-specific safety for those routes (epistaxis and nasal septal perforation intranasally; skin atrophy topically) is absent from this record. The bundle's second provider is US labelling for Mometasone Furoate Cream USP 0.1% (Glenmark Pharmaceuticals, label date 2019-07-09); it was NOT used for any figure on this page. NOT INTENDED AS A RELIEVER: §4.2 — 'the patient should be instructed that Asmanex Twisthaler 200 micrograms Inhalation Powder is not intended to be used "on demand" as a reliever medication to treat acute symptoms'. TRANSFER FROM ORAL CORTICOSTEROIDS: in patients with severe asthma previously receiving oral corticosteroids, Asmanex is initiated concurrently with the patient's usual maintenance dose of systemic corticosteroid; after approximately one week gradual withdrawal of the systemic corticosteroid can be initiated by reducing the daily or alternate-daily dose, with the next reduction after an interval of one to two weeks depending on response. 'Generally, these decrements are not to exceed 2.5 mg of prednisone daily, or its equivalent' — that 2.5 mg is a PREDNISONE withdrawal step, NOT a mometasone dose. A slow rate of withdrawal is strongly recommended. ELDERLY: 'Elderly patients older than 65 years of age — No dosage adjustment is necessary.' PAEDIATRIC: 'The safety and efficacy of Asmanex Twisthaler 200 mcg in children less than 12 years of age have not been established. No data are available.' DEVICE: the digital display indicates when the last dose has been delivered; after dose 01 the counter reads 00 and the cap locks, at which time the unit must be discarded. Do not wash the inhaler; avoid contact with water. RENAL/HEPATIC: no renal or hepatic dose adjustment is stated anywhere in the fetched sections of this SPC. Some sections of the product information we used were incomplete — check the full SPC.

Dose adjustments

Renal

Not stated in the fetched sections of the Asmanex Twisthaler SPC.

Hepatic

Not stated in the fetched sections of the Asmanex Twisthaler SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3 of the Asmanex Twisthaler SPC — this is the only contraindication the SPC lists)
  • SCOPE NOTE: this is the contraindication list of the INHALED product only. No UK nasal-spray and no UK topical-cream label was fetched, so contraindications specific to those routes are not represented here

Side effects

  • Oral candidiasis — very common (>10%) in the 400 micrograms twice daily treatment group in placebo-controlled trials; may require antifungal therapy and in some patients discontinuation (§4.4, §4.8)
  • Pharyngitis, headache and dysphonia — common (1-10%), treatment-related (§4.8)
  • In patients dependent on oral corticosteroids treated with 400 micrograms twice daily for 12 weeks, oral candidiasis occurred in 20% and dysphonia in 7% (§4.8)
  • Uncommonly reported: dry mouth and throat, dyspepsia, weight increase, palpitations (§4.8)
  • Bronchospasm — as with other inhalation therapy, may occur; treat immediately with a fast-acting inhaled bronchodilator, discontinue Asmanex immediately, assess the patient and institute alternative therapy if necessary (§4.8)
  • Asthma aggravation including cough, dyspnoea, wheezing and bronchospasm — frequency not known (§4.8)
  • Hypersensitivity reactions including rash, pruritus, angioedema and anaphylactic reaction — frequency not known (§4.8)
  • Psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression — frequency not known, particularly in children (§4.4, §4.8)
  • Systemic effects of inhaled corticosteroids, particularly at high doses for prolonged periods: Cushing's syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, decrease in bone mineral density, cataracts, glaucoma (§4.4, §4.8)
  • Blurred vision and other visual disturbance; rare cases of glaucoma, increased intraocular pressure and/or cataracts (§4.4, §4.8)
  • SCOPE NOTE: these are the INHALED product's reactions. The nasal route's characteristic effects (epistaxis) and the topical route's (skin atrophy) are not covered by the fetched source.
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • Titrate to the lowest dose at which effective control of asthma is maintained — §4.4 states this explicitly as the way to limit systemic corticosteroid effects
  • During withdrawal of oral corticosteroids, monitor carefully for signs of unstable asthma, including objective measures of airway function, and for adrenal insufficiency (§4.2, §4.4)
  • Particular care in patients transferred from systemically active corticosteroids — deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer to less systemically available inhaled corticosteroids; after withdrawal from systemic corticosteroids a number of months are required for recovery of HPA axis function (§4.4)
  • Watch for symptoms of systemic corticosteroid withdrawal during dose reduction (joint and/or muscular pain, lassitude, depression) despite maintenance or improvement in pulmonary function (§4.4)
  • Growth in children and adolescents — growth retardation is a listed possible systemic effect (§4.4)
  • Refer for ophthalmological evaluation if blurred vision or other visual disturbance occurs, to assess for cataract, glaucoma or central serous chorioretinopathy (§4.4)
  • Inspect for oropharyngeal candidiasis; reinforce rinsing the mouth with water and spitting out after each dose (§4.2, §4.4)

Clinical monograph

How it works

It binds glucocorticoid receptors to suppress the transcription of multiple pro-inflammatory mediators, reducing mucosal and airway inflammation.

Prescribing in practice

  • Inhaled and intranasal corticosteroids are for regular preventive use and do not relieve acute symptoms; abrupt high-dose or prolonged use carries a risk of systemic corticosteroid effects including adrenal suppression.
  • Advise rinsing the mouth after inhaled use to reduce the risk of oral candidiasis and dysphonia.
  • Use the lowest effective dose and review inhaler technique and adherence regularly.

Monitoring

Monitor symptom control and, with prolonged or high-dose use, watch for local candidiasis and signs of systemic corticosteroid exposure, including growth in children.

Counselling the patient

  • Use this every day as a preventer even when you feel well; it will not give instant relief.
  • Rinse your mouth and spit out after each inhaled dose.
  • Do not stop suddenly after long-term use without medical advice.

Evidence & guidelines

Inhaled corticosteroids are an established cornerstone of asthma maintenance therapy in NICE and national asthma guidance.

Reference: BTS/SIGN; NICE NG80/NG222; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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