Mometasone + Formoterol inhaler

Indications

Mometasone + Formoterol inhaler is used for: Asthma

Adult Dose

Inhalation/Respiratory Indicated in the regular treatment of asthma, where use of a combination (LABA + Inhaled Corticosteroid) has been found to be appropriate. Adult: Initial: 2 puffs of 100 mcg/5 mcg inhaled twice daily; may increase to higher dose after 2 wks if inadequate response. Severe asthma (initial) or inadequate response to lower dose (after 2 wk): 2 puffs of 200 mcg/5 mcg inhaled twice daily. Maximum daily dose: 800 mcg/20 mcg daily

Child Dose

Child: >12 yr Initial: 2 puffs of 100 mcg/5 mcg inhaled twice daily; may increase to higher dose after 2 wks if inadequate response. Severe asthma (initial) or inadequate response to lower dose (after 2 wk): 2 puffs of 200 mcg/5 mcg inhaled twice daily. Maximum daily dose: 800 mcg/20 mcg daily

Renal Dose

There are no data regarding the specific use of this combination in patients with renal impairment.

Administration

Oral Inhalation Preparation Priming Prime inhaler before first use or when inhaler is unused for >5 days Release 4 test puffs into air, away from face Remove cap; shake well for 5 sec before each test puff Instructions Check mouthpiece for objects before use Make sure canister is fully inserted Shake well before each use Oral Inhalation Administration For oral inhalation only Remove cap; place middle or index finger on canister top while placing thumb underneath mouthpiece Breathe out fully through your mouth, expelling as much air from lungs as possible; hold inhaler upright, placing the mouthpiece fully into the mouth, closing your lips around it While pushing firmly on canister top, continue breathing in slowly until lungs are full; avoid breathing out Hold breath as comfortably possible, up to 10 sec Remove inhaler from mouth; breathe through nose while keeping lips closed Repeating dose Wait at least 30 seconds prior preceding second puff Shake well prior to use; repeat steps (see under Oral Inhalation Administration) Replace the cap after use When finished administering 2 puffs, rinse mouth out with water (do not swallow water) Cleaning Wash and dry mouthpiece at least weekly When mouthpiece becomes blocked, wash mouthpiece thoroughly

Contra Indications

Hypersensitivity Primary treatment for acute bronchospasm, status asthmaticus, or exercise-induced bronchospasm

Precautions

Patient w/ severe asthma, risk factors for decreased BMD, CV disease (e.g. arrhythmia, coronary insufficiency, HTN, recent MI), DM, GI disease (e.g. diverticulitis, peptic ulcer, ulcerative colitis), myasthenia gravis, cataract/glaucoma, pheochromocytoma, seizure disorders, hypokalaemia, thyroid disease, bacterial (e.g. active or quiescent pulmonary TB), fungal, parasitic, and viral (e.g. chickenpox, measles, ocular herpes simplex) infections. Hepatic impairment. Childn. Pregnancy and lactation.

Pregnancy-Lactation

Pregnancy: There are no randomized clinical studies in pregnant women; there are clinical considerations with use in pregnant women In women with poorly or moderately controlled asthma, there is increased risk of several perinatal adverse outcomes such as preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate; pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control Lactation: There are no available data on the presence of mometasone furoate, or formoterol fumarate in human milk; the effects on the breastfed child, or the effects on milk production; The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

Interactions

Mometasone: Increased plasma concentration w/ strong CYP3A4 inhibitors (e.g. ketoconazole, ritonavir, cobicistat-containing products). Formoterol: Enhanced hypokalaemic effect w/ xanthine derivatives, or non-potassium sparing diuretics. May prolong QTc-interval and increase the risk of ventricular arrhythmias when used w/ quinidine, terfenadine, astemizole, macrolides, disopyramide, procainamide, phenothiazines, MAOIs, and TCA. Decreased therapeutic effect w/ β-adrenergic blockers. Increased risk of arrhythmias w/ halogenated hydrocarbons.

Adverse Effects

Side effects of Mometasone + Formoterol inhaler : 1-10% Nasopharyngitis (4.7%) Headache (2-4.5%) Sinusitis (2-3.3%) <1% Oral candidiasis

Mechanism of Action

Mometasone: Glucocorticoid; elicits local anti-inflammatory effects on respiratory tract with minimal systemic absorption Formoterol: Long-acting selective beta2-adrenergic agonist with rapid onset of action; acts locally as bronchodilator; stimulates intracellular adenyl cyclase, which results in increased cyclic adenosine monophosphate levels, causing relaxation of bronchial smooth muscle and inhibition of release of mast cell mediators