General
Adjust dosage carefully according to individual requirements and response.  
After a satisfactory response is obtained, decrease dosage gradually to the lowest dosage that maintains an adequate clinical response.   Achieve the lowest effective dosage, particularly in children, since inhaled corticosteroids have the potential to affect growth.   (See Pediatric Use under Cautions.)
Base initial and maximum dosages in adults and children ≥12 years of age on previous asthma therapy.  
Conversion to Orally Inhaled Therapy in Patients Receiving Systemic Corticosteroids
When switching from systemic corticosteroids to orally inhaled corticosteroids, including mometasone, asthma should be reasonably stable before initiating oral inhalation treatment. 
Initially, administer oral inhalation concurrently with the maintenance dosage of the systemic corticosteroid.  After at least 1 week, gradually withdraw the systemic corticosteroid. 
Decrements of the systemic corticosteroid usually should not exceed 2.5 mg daily of prednisone (or its equivalent) each week in patients receiving an orally inhaled corticosteroid. Once oral corticosteroids are discontinued and symptoms of asthma have been controlled, titrate dosage of the orally inhaled drug to the lowest effective level. 
Death has occurred in some individuals in whom systemic corticosteroids were withdrawn too rapidly.   (See Withdrawal of Systemic Corticosteroids under Cautions.)
Administration
Oral Inhalation
Mometasone (Asmanex Twisthaler): Administer by oral inhalation as an oral inhalation powder using the Twisthaler breath-actuated dry powder inhalation device. 
Mometasone (Asmanex HFA): Administer by oral inhalation as an oral inhalation suspension using metered-dose aerosol inhaler with hydrofluoroalkane (HFA; non-chlorofluorocarbon) propellant.
Mometasone/formoterol fixed combination (Dulera): Administer by oral inhalation as an oral inhalation suspension using metered-dose aerosol inhaler with HFA propellant. 
Following each mometasone or mometasone/formoterol dose, rinse the mouth thoroughly with water without swallowing.  
Oral Inhalation Powder
Administer as a single oral inhalation once or twice daily. When administered once daily, use at the same time each day, preferably in the evening for optimal efficacy.
Removal of the cap from the Twisthaler device (by twisting in a counterclockwise direction) releases a single dose of drug from the drug storage unit into the inhalation channel, making the dose available for administration via oral inhalation through the mouthpiece. The dose counter will decrease by 1 each time the cap is removed. Remove the Twisthaler cap with the inhaler in an upright position. Before inhaling the dose, exhale as completely as possible, but not into the Twisthaler device. Place the mouthpiece of the inhaler between the lips and inhale quickly and deeply through the inhaler. Do not cover the ventilation holes on either side of the inhaler while inhaling the dose. Remove the inhaler from the mouth, hold breath for about 10 seconds, then exhale slowly.
Wipe mouthpiece dry with a dry cloth or tissue. Close and reload the Twisthaler device for the next dose by twisting the cap in a clockwise direction until a click is heard. Do not wash the inhaler; store in a dry place. Discard the inhaler when every inhalation is used (when the dose indicator reads “00”) or 45 days after removal from its foil overwrap pouch, whichever comes first.
Oral Inhalation Aerosol
Administer as 2 oral inhalations twice daily (morning and evening).
Use only with actuator supplied with the product.
Mometasone (Asmanex HFA): Test spray 4 times into the air (away from the face) before first use or if not used for >5 days; shake well before each test spray and each inhalation. Remove the cap from the mouthpiece of the actuator before use. Do not wash inhaler in water; clean the mouthpiece using a dry wipe every 7 days.
Mometasone/formoterol fixed combination (Dulera): Test spray 4 times into the air (away from the face) before first use or if not used for >5 days; shake well before each test spray and each inhalation. Clean inhaler every 7 days by wiping mouthpiece with a dry cloth; do not wash inhaler in water.
Dosage
Available as mometasone furoate; dosage expressed in terms of the salt. 
Also available as fixed combination containing mometasone furoate and formoterol fumarate dihydrate (mometasone/formoterol); dosage of mometasone component expressed in terms of the salt and dosage of formoterol component expressed in terms of hydrated salt.
Strength and dosage of mometasone furoate administered as an oral inhalation powder (Asmanex Twisthaler) is expressed as the nominal (labeled) dose contained in the Twisthaler device. Amount of drug delivered to the lungs depends on several factors, such as the patient’s inspiratory flow. Each actuation of the Twisthaler device contains 110 or 220 mcg of mometasone furoate oral inhalation powder and delivers approximately 100 or 200 mcg of mometasone furoate from the mouthpiece, depending on preparation used.
Each actuation of the oral aerosol inhaler containing mometasone furoate (Asmanex HFA) delivers 115 or 225 mcg of mometasone furoate from the valve and 100 or 200 mcg of mometasone furoate from the actuator, depending on preparation used. Strength and dosage of the preparation expressed in terms of drug delivered from mouthpiece of the actuator. Actual amount of drug delivered to the lungs depends on several factors, such as coordination between actuation of the device and patient’s inspiratory flow. Asmanex HFA aerosol inhaler delivers 120 actuations per 13-g canister.
Each actuation of the oral aerosol inhaler containing the mometasone/formoterol fixed combination (Dulera) delivers 115 or 225 mcg of mometasone furoate and 5.5 mcg of formoterol fumarate dihydrate from the valve and delivers 100 or 200 mcg of mometasone furoate and 5 mcg of formoterol fumarate dihydrate from the actuator, depending on preparation used. Strength and dosage of the preparation expressed in terms of drug delivered from mouthpiece of the actuator. Actual amount of drug delivered to the lungs depends on several factors, such as coordination between actuation of the device and patient’s inspiratory flow. Dulera aerosol inhaler delivers 60 or 120 metered sprays per 8.8- or 13-g canister, respectively.
Pediatric Patients
Asthma
Mometasone
Children 4–11 years of age: Initial and maximum dosage is 110 mcg once daily in the evening, regardless of prior therapy.
Adolescents ≥12 years of age previously receiving bronchodilators alone or inhaled corticosteroids: Initially, 220 mcg once daily in the evening. If control of asthma inadequate after 2 weeks of therapy at initial dosage, a higher dosage may provide additional asthma control. If required, dosage may be increased to a maximum 440 mcg daily (440 mcg once daily or 220 mcg twice daily).
Adolescents ≥12 years of age previously receiving oral corticosteroids: Initial and maximum dosage is 440 mcg twice daily.
Adolescents ≥12 years of age previously receiving inhaled medium-dose corticosteroids: 200 mcg (2 inhalations of preparation containing 100 mcg) twice daily.
Adolescents ≥12 years of age previously receiving inhaled high-dose corticosteroids or oral corticosteroids: 400 mcg (2 inhalations of preparation containing 200 mcg) twice daily.
If control of asthma inadequate after 2 weeks at lower dosage, consider switching to the higher strength preparation, initiating therapy with an oral corticosteroid, or initiating oral inhalation therapy with a fixed combination containing a corticosteroid and a long-acting β2-agonist.
Mometasone/Formoterol Fixed Combination
Adolescents ≥12 years of age: 200 or 400 mcg of mometasone furoate and 10 mcg of formoterol fumarate dihydrate (2 inhalations of preparation containing 100 or 200 mcg of mometasone furoate/5 mcg of formoterol fumarate dihydrate) twice daily. Select initial dosage based on asthma severity, previous asthma therapy (including previous inhaled corticosteroid dosage), current control of asthma symptoms, and risk of future asthma exacerbations.
If control of asthma inadequate after 2 weeks at lower dosage, switching to higher strength preparation of the fixed combination (higher strengths contain higher dosages of mometasone only) may provide additional asthma control.
Adults
Asthma
Mometasone
Previously receiving bronchodilators alone or inhaled corticosteroids: Initially, 220 mcg once daily in the evening. If control of asthma inadequate after 2 weeks of therapy at initial dosage, a higher dosage may provide additional asthma control. If required, dosage may be increased to a maximum of 440 mcg daily (440 mcg once daily or 220 mcg twice daily).
Previously receiving oral corticosteroids: Initial and maximum dosage is 440 mcg twice daily.
Previously receiving inhaled medium-dose corticosteroids: 200 mcg (2 inhalations of preparation containing 100 mcg) twice daily.
Previously receiving inhaled high-dose corticosteroids or oral corticosteroids: 400 mcg (2 inhalations of preparation containing 200 mcg) twice daily.
If control of asthma inadequate after 2 weeks of therapy at lower dosage, consider switching to the higher strength preparation, initiating therapy with an oral corticosteroid, or initiating oral inhalation therapy with a fixed combination containing a corticosteroid and a long-acting β2-agonist.
Mometasone/Formoterol Fixed Combination
200 or 400 mcg of mometasone furoate and 10 mcg of formoterol fumarate dihydrate (2 inhalations of preparation containing 100 or 200 mcg of mometasone furoate/5 mcg of formoterol fumarate dihydrate) twice daily. Select initial dosage based on asthma severity, previous asthma therapy (including previous inhaled corticosteroid dosage), current control of asthma symptoms, and risk of future exacerbations.
If control of asthma inadequate after 2 weeks of therapy at lower dosage, switching to higher strength preparation of the fixed combination (higher strengths contain higher dosages of mometasone only) may provide additional asthma control.
Prescribing Limits
Pediatric Patients
Asthma
Mometasone
Children 4–11 years of age: Maximum 110 mcg daily.
Adolescents ≥12 years of age previously receiving bronchodilators alone or inhaled corticosteroids: Maximum 440 mcg daily.
Adolescents ≥12 years of age previously receiving oral corticosteroids: Maximum 880 mcg daily.
Adolescents ≥12 years of age: Maximum 800 mcg daily.
Mometasone/Formoterol Fixed Combination
Adolescents ≥12 years of age: Maximum 800 mcg of mometasone furoate and 20 mcg of formoterol fumarate dihydrate daily.
Adults
Asthma
Mometasone
Previously receiving bronchodilators alone or inhaled corticosteroids: Maximum 440 mcg daily.
Previously receiving oral corticosteroids: Maximum 880 mcg daily.
Maximum 800 mcg daily.
Mometasone/Formoterol Fixed Combination
Maximum 800 mcg of mometasone furoate and 20 mcg of formoterol fumarate dihydrate daily.
Special Populations
Hepatic Impairment
Monitor patients for signs of increased drug exposure.  
Renal Impairment
No specific dosage recommendations at this time.  
 Detailed Mometasone dosage information
