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Mometasone (Mometasonum)

The drug interacts with intracellular glucocorticoid receptors, promoting the release of the receptor from connection with immunophilin and heat shock proteins 70 and 90. Penetration of the activated receptor into the nucleus, binding to glucocorticoid-sensitive regulatory elements of DNA - a specific effect on gene expression (activation and suppression). Interaction with other protein transcription factors, including NFκB and AP-1, which regulate the expression of many immune system proteins, resulting in suppression of the expression of genes encoding some cytokines, collagenase and stromelysins.

The anti-inflammatory effect of mometasone is due to several factors.

1. The drug induces the synthesis of lipocortin, which inhibits the activity of phospholipase A2. Inhibition of phospholipase A2-mediated hydrolysis of membrane phospholipids in damaged tissues prevents the formation of arachidonic acid. Impaired formation of arachidonic acid actually means inhibition of prostaglandin synthesis, since arachidonic acid is a substrate for further metabolism through the cyclooxygenase pathway, as well as through the lipoxygenase pathway with a corresponding inhibition of leukotriene synthesis.

2. The anti-inflammatory effect of glucocorticoids is potentiated by their ability to inhibit the expression of COX-2 genes, which also leads to a decrease in the synthesis of prostaglandins at the site of inflammation, including pro-inflammatory prostaglandins E2 and I2.

3. Mometasone inhibits the expression of intercellular adhesion molecules in the endothelium of blood vessels, disrupting the penetration of neutrophils and monocytes into the site of inflammation. After the administration of glucocorticoids, an increase in the concentration of neutrophils in the blood is noted (due to their receipt from the bone marrow and due to the restriction of migration from the blood vessels). This causes a decrease in the number of neutrophils at the site of inflammation.

Mometasone inhibits the transcription of genes for cytokines that stimulate the inflammatory and immune response (IL-1, IL-2, IL-6, IL-8), as well as tumor necrosis factor (and some others). Also noted is a decrease in the transcription rate and increased degradation of receptor genes for IL-1 and IL-2, inhibition of transcription of metalloproteinase genes (collagenase, elastase and others) involved in increasing the permeability of the vascular wall, in the processes of scarring and destruction of cartilage tissue in joint diseases.

The immunosuppressive effect is due to inhibition of transcription of DNA encoding the major histocompatibility complex, proinflammatory cytokines and inhibition of T-lymphocyte proliferation. Leads to a decrease in the number of T-lymphocytes and their influence on B-lymphocytes, inhibits the production of immunoglobulins. Reduces the formation and increases the breakdown of components of the complement system.

The antiallergic effect is associated with inhibition of the synthesis of allergy mediators, degranulation of mast cells and the release of allergy mediators, and therefore it is effective for immediate allergic reactions.

Mometasone Sandoz, 1 piece, 18 g, 50 mcg/dose, metered-dose nasal spray

As with any long-term treatment, patients using Mometasone Sandoz® Nasal Spray for several months or longer should be periodically examined by a doctor for possible changes in the nasal mucosa. It is necessary to monitor patients receiving intranasal corticosteroids for a long time.

Possible development of growth retardation in children. If growth retardation is detected in children, it is necessary to reduce the dose of intranasal corticosteroids to the lowest that allows for effective control of symptoms. In addition, the patient should be referred to a pediatrician for consultation.

If a local fungal infection of the nose or throat develops, it may be necessary to discontinue Mometasone Sandoz® nasal spray therapy and undergo special treatment. Irritation of the nasal and pharyngeal mucosa that persists for a long time may also serve as a reason to discontinue treatment with mometasone.

In placebo-controlled clinical trials in children, when a nasal spray containing mometasone was used at a daily dose of 100 mcg for a year, no growth retardation was observed in children. With long-term treatment with a nasal spray containing mometasone, no signs of suppression of the function of the hypothalamic-pituitary-adrenal axis were observed.

Patients who switch to treatment with Mometasone Sandoz® nasal spray after long-term treatment with systemic GCS require special attention. Withdrawal of systemic corticosteroids in such patients can lead to adrenal insufficiency, the subsequent recovery of which may take up to several months. If signs of adrenal insufficiency appear, systemic corticosteroids should be resumed and other necessary measures taken.

When using intranasal corticosteroids, systemic side effects may develop, especially with long-term use in high doses. The likelihood of developing these effects is much less than with the use of oral corticosteroids.

Systemic side effects may vary in individual patients and depending on the glucocorticosteroid drug used. Potential systemic effects include Cushing's syndrome, characteristic Cushingoid signs, adrenal suppression, growth retardation in children and adolescents, cataracts, glaucoma, and less commonly a number of psychological or behavioral effects including psychomotor hyperactivity, sleep disturbance, anxiety, depression, or aggression (especially in children).

During the transition from treatment with systemic corticosteroids to treatment with Mometasone Sandoz® nasal spray, some patients may experience initial withdrawal symptoms of systemic corticosteroids (for example, joint and/or muscle pain, fatigue and depression), despite a decrease in the severity of symptoms associated with damage to the nasal mucosa. Such patients must be specifically reassured of the advisability of continuing treatment with Mometasone Sandoz® nasal spray.

The transition from systemic to local GCS can also reveal allergic diseases such as allergic conjunctivitis and eczema that already existed but were masked by systemic GCS therapy.

Patients treated with glucocorticosteroids have a potentially reduced immune responsiveness and should be warned of their increased risk of infection if exposed to patients with certain infectious diseases (eg, chickenpox, measles), as well as the need for medical advice if such exposure occurs .

If signs of a significant bacterial infection appear (for example, fever, persistent or sharp pain on one side of the face or toothache, swelling in the orbital or periorbital area), immediate medical consultation is required.

When using a nasal spray containing mometasone, there are no signs of atrophy of the nasal mucosa for 12 months. In addition, mometasone furoate tends to help normalize the histological picture when examining biopsies of the nasal mucosa.

The effectiveness and safety of mometasone have not been studied in the treatment of unilateral polyps, polyps associated with cystic fibrosis, and polyps that completely occlude the nasal cavity. If unilateral polyps of an unusual or irregular shape are detected, especially those that are ulcerated or bleeding, additional medical examination is necessary.

The development of visual disturbances has been reported with the use of both systemic and local corticosteroids. If the patient experiences blurred vision or other visual disturbances, the patient should be referred to an ophthalmologist to determine possible causes, which may include the development of cataracts, glaucoma, or rarer diseases (eg, central serous chorioretinopathy) that have been reported with the use of systemic and topical corticosteroids .

Special precautions when disposing of unused medicinal product

The bottle must be discarded after the specified number of uses or 2 months from the date of first use.

Impact on the ability to drive vehicles and operate machinery

No studies have been conducted to study the effect of the drug on the ability to drive vehicles and operate machinery.

Mometasone Sandoz, 50 mcg/dose, 140 doses, metered-dose nasal spray, 18 g, 1 pc.

The transition from systemic to local GCS can also reveal allergic diseases such as allergic conjunctivitis and eczema that already existed but were masked by systemic GCS therapy.

Special precautions when disposing of unused medicinal product

The bottle must be discarded after the specified number of uses or 2 months from the date of first use.

Impact on the ability to drive vehicles and operate machinery

No studies have been conducted to study the effect of the drug on the ability to drive vehicles and operate machinery.