Exhausting allergies, chronic sinusitis, polyps in the nasal cavity... It’s not a pleasant set. But even with it one can and must fight. Most often, the attending physician prescribes Nasonex spray. The drug has anti-inflammatory and antiallergic effects. It is based on mometasone furoate, which belongs to the group of glucocorticoids and is considered a synthetic drug.
an analogue of adrenal hormones, corticosteroids (GCS) for topical use.
Nasonex copes well with allergic rhinitis
Mometasone suppresses inflammatory and allergic reactions of various types when used in doses at which systemic effects do not develop. The therapeutic effect is observed 12 hours after the start of use.
Despite the fact that Nasonex is a hormonal drug, it does not affect other organs and systems except the nose.
A small dosage and use only in the nasal area ensures a very low concentration of mometasone in the blood. Also, it is worth noting that Nasonex is not addictive.
Indications
The main indications for the use of Nasonex spray are:
- allergic rhinitis (seasonal or year-round), which is accompanied by constant rhinorrhea and swelling of the nasal mucosa;
- exacerbation of chronic sinusitis (the drug is prescribed as an adjunct to antibiotic therapy) in adolescents and adults;
- polyps of the nasal cavity, which lead to disruption of full respiratory function.
Children are prescribed Nasonex allergy spray from the age of two. For the treatment of sinusitis in pediatrics, it is used in children over twelve years of age.
Nasonex drops can be taken by children from 2 years of age
Also, the spray is used to prevent moderate/severe seasonal allergic rhinitis. Nasonex must be used 2 weeks before the expected start of the dusting period.
Contraindications
Before starting to use the drug, be sure to carefully read the instructions. The spray, since it is a medicinal product, has contraindications for use:
- recent surgical interventions on the nasal cavity;
- open wound surfaces, bleeding scratches and cracks in the nasal cavity;
- increased individual sensitivity to the components of the drug;
- children's age (for seasonal and year-round allergic rhinitis - up to 2 years, for acute sinusitis or exacerbation of chronic sinusitis - up to 12 years, for polyposis - up to 18 years) - due to the lack of relevant data.
The drug is used with caution in the following conditions:
- tuberculosis in active or latent form;
- viral, bacterial or fungal processes;
- herpetic infection in the nose;
- infection of unknown origin.
Special instructions for the use of Nasonex
The use of the drug in young children should be carried out with the help of adults. Nasonex should not be used in the presence of local infection involving the nasal mucosa. Due to the fact that corticosteroids slow down wound healing, the drug should not be prescribed to patients who have recently undergone surgery or nasal trauma until the wounds have completely healed. Nasonex should be prescribed with caution or not at all to patients with active or latent tuberculosis infection, as well as untreated fungal, bacterial, systemic viral infections, and ophthalmic infections caused by the herpes simplex virus. After 12 months of treatment with Nasonex, there was no atrophy of the nasal mucosa; In addition, when using mometasone furoate, there was a tendency towards normalization of the histological picture when examining biopsy samples of the nasal mucosa. However, patients who use Nasonex for several months or longer should undergo periodic examination to identify possible changes in the nasal mucosa. If a local fungal infection of the nose or pharynx develops, it may be necessary to discontinue Nasonex therapy and carry out special therapy. Irritation of the mucous membrane of the nasal cavity and pharynx, which persists for a long time, may also be an indication to discontinue treatment with Nasonex. With long-term treatment with Nasonex, no signs of suppression of the hypothalamic-pituitary-adrenal system were noted. Patients who switch to treatment with Nasonex after prolonged systemic therapy with GCS should be under medical supervision. Withdrawal of systemic corticosteroids in such patients may lead to insufficiency of adrenal cortex function, which may require appropriate measures. During the transition from treatment with systemic corticosteroids to treatment with Nasonex, some patients may experience symptoms of corticosteroid withdrawal (arthralgia, myalgia, fatigue and depression). A change in therapy may also reveal allergic diseases that were previously masked by the use of systemic GCS therapy (allergic conjunctivitis, eczema, etc.). Patients receiving GCS therapy have a potentially reduced immunological reactivity and should be warned about the increased risk of infection in case of contact with patients with certain infectious diseases (for example, chicken pox, measles), as well as the need to consult a doctor if such contact has occurred. Patients should be warned to seek immediate medical attention if signs or symptoms of a severe bacterial infection occur, such as fever, severe unilateral facial or toothache, orbital or periorbital swelling/edema, or worsening after initial improvement. Children. In placebo-controlled clinical studies in children in whom Nasonex was used at a daily dose of 100 mcg for 1 year, no growth retardation was observed. The safety and effectiveness of Nasonex in the treatment of nasal polyps in children and adolescents under 18 years of age, symptoms of rhinosinusitis in children under 12 years of age, and seasonal or year-round allergic rhinitis in children under 2 years of age have not been studied. Use during pregnancy and lactation. Special studies of the effect of the drug during pregnancy have not been conducted. After intranasal administration of the drug at the maximum therapeutic dose, mometasone is not detected in the blood plasma even at the minimum concentration. Therefore, it can be expected that the effect of the drug on the fetus will be insignificant, and the potential toxicity regarding reproductive function will be very low. However, like other corticosteroids for intranasal use, Nasonex should be prescribed during pregnancy or lactation only if the expected benefits of its use justify the potential risk to the mother, fetus or infant. Children whose mothers received corticosteroids during pregnancy should be examined to identify possible adrenal hypofunction.
Side effects
When prescribing the drug, the following adverse reactions may occur:
- pharyngitis;
- headache;
- nosebleeds (bleeding may be obvious or blood may be present in the mucus released from the nose);
- irritation of the mucous membrane in the nasal cavity;
- burning sensation in the nose.
One of the side effects of Nasonex may be headache.
In children receiving Nasonex for the treatment of allergic rhinitis, the following was observed:
- nosebleeds;
- irritation of the nasal mucosa;
- headache;
- sneezing;
- very rarely: bronchospasm, shortness of breath, anaphylaxis, angioedema, disturbances of taste and smell, perforation of the nasal septum and increased intraocular pressure.
How to take Nasonex
The drug is intended for intranasal administration of the suspension contained in the bottle through a dosing nozzle. The dose of the drug sprayed into the nasal cavity is determined by the doctor depending on the severity of the disease.
Before using the spray for the first time, it is “calibrated” by pressing the applicator 6-7 times. This action allows you to establish the delivery of the drug into the nasal cavity in a therapeutic dose of 100 mg.
Taking Nasonex
Before each use, the bottle must be shaken vigorously.
For direct use, the end of the dispensing nozzle must be inserted into the nasal passage and pressed on the applicator (1 press = 1 spray). The head and bottle with the drug must be kept strictly vertical.
If Nasonex has not been used for 14 days or more, it is necessary to re-calibrate by pressing the applicator 2 times. It is also important to clean the dispensing nozzle regularly to prevent it from malfunctioning.
Release form
- Dosed spray Nasonex Sinus. Polyethylene bottles 10 g, packaging No. 1. Each bottle is equipped with a protective cap and a spray nozzle. The contents of the bottle are designed for 60 doses, each of which contains 50 mcg of active substance.
- Nasonex metered spray. Polyethylene bottles 18 g, packaging No. 1. Each bottle is equipped with a protective cap and a spray nozzle. The contents of the bottle are designed for 140 doses, each of which contains 50 mcg of active substance.
The contents of the bottle are an opaque suspension of almost white or off-white color.
Nasonex during pregnancy
Due to the fact that there are no clinically proven studies of the effect of the active substance - mometasone furoate - on the body of a pregnant woman, the fetus and during lactation, the drug is prescribed with caution starting from the second trimester, and only when the expected effect of therapy justifies the potential risk to the fetus/newborn .
Nasonex during pregnancy
When using the drug during pregnancy, newborns should be carefully monitored for adrenal hypofunction.
Nasonex for children
According to the instructions for use, Nasonex spray can be used by children from 2 years of age. The prescription of the drug depends not only on the age of the child, but also on the disease being diagnosed.
- seasonal and year-round allergic rhinitis - for children from 2 years of age;
- acute sinusitis or exacerbation of chronic sinusitis - from 12 years of age;
- acute rhinosinusitis with mild and moderate symptoms without signs of severe bacterial infection - from 12 years of age;
- preventive treatment of moderate and severe seasonal allergic rhinitis - from 12 years of age (recommended two to four weeks before the expected start of the dust season);
- Nasal polyposis, accompanied by impaired nasal breathing and sense of smell, is not prescribed for children.
The effectiveness of the drug Nasonex in the treatment of patients with chronic polyposis rhinosinusitis
It has been proven that the drug Nasonex facilitates nasal breathing, reduces hypersecretion of the mucous membrane and thereby improves the quality of life of patients with chronic polypous rhinosinusitis. In some cases, the drug allows one to refrain from performing surgery on the structures of the nasal cavity in such patients.
Table. Dynamics of complaints in patients with chronic polypous rhinosinusitis before and after four weeks of use of the drug Nasonex
Rice. 1. Dynamics of air patency of the nasal cavity before and after use of the drug Nasonex in patients with chronic polypous rhinosinusitis
Rice. 2. Microendoscopic picture of the nasal mucosa in patients with chronic polypous rhinosinusitis. Stained with methylene blue. Magnification × 60
Rice. 3. Microendoscopic picture of the nasal mucosa in patients with chronic polypous rhinosinusitis after four weeks of Nasonex use. Stained with methylene blue. Magnification × 60
Introduction
Chronic polypous rhinosinusitis is a polyetiological disease with a relapsing nature, which significantly reduces the quality of life of patients.
In the general population, nasal polyps occur in 2.7% of the population, usually in men, people over 60 years of age and patients with bronchial asthma. These data were obtained based on endoscopy of the nasal cavity [1].
Despite the existence of many theories of the occurrence of polypous rhinosinusitis, none of them can clearly and reliably explain the mechanisms of its formation. It has been revealed that nasal polyps are present in 40% of patients with cystic fibrosis [1]. Positive skin allergy tests in patients with polyps are observed in 50–84% of cases. Moreover, more than 60% of patients have a polyvalent allergy [2, 3]. 7% of patients with bronchial asthma and 36–96% of patients with aspirin intolerance have nasal polyps [1].
It is generally accepted that polyps are formed as a result of disruption of biological processes in the body and exposure to unfavorable environmental factors. As a result, vascular permeability increases, leading to edema and maintaining progressive nasal congestion [4].
Surgical intervention in patients with chronic polypous rhinosinusitis is considered only when all conservative treatment methods have been exhausted. The relapse rate after surgery in such patients is quite high [5]. Revision surgery of the nasal cavity and paranasal sinuses is required in 3.6% of cases 12 months after surgery and in 11.8% after 36 months [6].
A traditional and clinically proven drug treatment for chronic polypous rhinosinusitis is the use of glucocorticosteroid (GCS) therapy, either in the form of short courses using systemic drugs, or in the form of long courses of topical therapy with intranasal GCS [7].
Intranasal GCS Nasonex inhibits the release of inflammatory mediators, increases the production of lipomodulin - an inhibitor of phospholipase A. Phospholipase A causes a decrease in the release of arachidonic acid and, accordingly, inhibition of the synthesis of arachidonic acid metabolic products - cyclic endoperoxides, prostaglandins. Nasonex prevents the marginal accumulation of neutrophils, which reduces the formation of inflammatory exudate and the production of lymphokines, inhibits the migration of macrophages, and reduces the processes of infiltration and granulation. The drug reduces inflammation by reducing the formation of a chemotaxis substance (impact on late allergy reactions), inhibits the development of an immediate allergic reaction (due to inhibition of the production of arachidonic acid metabolites and a decrease in the release of inflammatory mediators from mast cells).
Clinical observation
From patients who applied to the otorhinolaryngology clinic for consultation and further surgical treatment, a homogeneous group of 42 patients with chronic polypous rhinosinusitis was formed. All patients had an increased level of total immunoglobulin E in the blood. The patients had never undergone surgery for nasal polyps. For this group of patients, nasal topical corticosteroid Nasonex was recommended as preoperative preparation at a dose of 100 mcg in each half of the nose twice a day. Patients were re-examined after four weeks to assess the dynamics of the condition of the nasal cavity and plan surgical treatment tactics.
In all patients, before prescribing Nasonex, the severity of the disease was assessed using a visual analogue scale (mild - 0–3, moderate > 3–7, severe > 7–10), the degree of air patency of the nasal cavity was analyzed and contact endoscopy of the nasal mucosa was performed . Similar studies were carried out in all patients after four weeks of using Nasonex at a follow-up visit.
The five main complaints presented by all patients with chronic polypous rhinosinusitis at the first visit to varying degrees were analyzed over time. Patients rated each symptom on a three-point scale (see table):
- 0 points – no sign;
- 1 point – weak sign;
- 2 points – strong sign;
- 3 points – pronounced symptom.
All patients, after using Nasonex at a dose of 100 mcg in each half of the nose for four weeks, noted clinical improvement. Complaints of difficulty in nasal breathing completely disappeared in 16.7% of patients, and hypersecretion phenomena disappeared in 28.6%. Not a single patient assessed the phenomena of hypersecretion and sneezing attacks as 3 points after conservative treatment.
Patients were asked to rate on a visual analogue scale how bothersome they were by symptoms of rhinosinusitis. Before using the drug Nasonex, the severity of the disease was assessed as average – 7 points. At the second visit after treatment, this indicator was 3 points.
Despite the fact that the severity of the disease in patients with polypous rhinosinusitis before and after conservative treatment was assessed as moderate, there was a clear trend towards a decrease in the severity of the disease.
To assess the air patency of the nasal cavity, we used a computer rhinospirometry technique modified at the Department of Otorhinolaryngology of PSPbSMU named after. acad. I.P. Pavlova software for recording the flow-volume curve (rationalization proposal No. 1411 dated December 24, 2002).
The dynamics of nasal breathing were assessed by the absolute increase in volume-velocity parameters. Parameters that most accurately reflect the respiratory function of the nose and allow one to judge the effectiveness of the treatment: forced expiratory volume through the nose in the first second (FEV1(n)), peak volumetric flow rate through the nose (POSmax(n)) and average volumetric flow rate through the nose (SOS25 –75(n)). The dynamics of these parameters were most indicative of improvement in nasal breathing [8].
An increase in speed and volume parameters of nasal breathing was found according to average values in patients with chronic polypous rhinosinusitis after four weeks of use of the drug Nasonex at a dose of 100 mcg in each half of the nose twice a day (Fig. 1).
To conduct microendoscopy of the nasal mucosa, a contact endoscope with a diameter of 4.0 mm of anterolateral vision with a viewing angle of 30° with a 60-fold magnification was used at the Azimut Research and Production Company (St. Petersburg, Russia). For better visualization of the various components of the epithelium, the mucous membrane of the inferior turbinates was stained with a 1% aqueous solution of methylene blue according to the method of M.A. Khorolskaya [9].
The uniformity of epithelial coloring, the shape of the nuclei, the arrangement of cellular elements, and mucus production were assessed. Normally, the surface layer of the mucous membrane is represented by epithelial cells, evenly spaced and uniformly colored. The kernels are round in shape and medium in size [9].
Heterogeneous coloring of the nasal mucosa with the presence of areas that do not respond to staining with methylene blue are methylene-resistant fields. Such fields are formed by a cluster of goblet cells in the secretion stage. The number of fields is used to judge the intensity of secretion formation in the mucous membrane of the nasal cavity [9].
When performing contact endoscopy of the mucous membrane of the inferior turbinates in patients with chronic polypous rhinosinusitis before using the drug Nasonex, uneven coloring of the epithelium, an increased amount of colored nasal secretion, and the location of cell fields in clusters were visualized. This indicated pronounced secretion. In places, transitions of the epithelium into dark blue stripes were detected, which was regarded as folding of the mucous membrane during swelling in the nasal cavity (Fig. 2).
When repeated contact endoscopy after four weeks of use of the drug Nasonex at a dose of 100 mcg in each half of the nose twice a day, positive dynamics were noted in relation to methylene-resistant fields. The microendoscopic picture demonstrated uniform coloring of the epithelium and uniform arrangement of cellular elements, which indicated a decrease in folding of the mucous membrane, edema and secretion (Fig. 3).
At a follow-up visit four weeks after using Nasonex 100 mcg twice daily, seven (16.7%) of 42 patients decided to refrain from surgery due to improvement in nasal breathing.
Conclusion
The drug Nasonex has a positive clinical effect on the nasal cavity in patients with chronic polypous rhinosinusitis, facilitates nasal breathing and reduces hypersecretion of the mucous membrane, which certainly improves the quality of life. In some cases, the drug Nasonex allows one to refrain from surgical intervention on the structures of the nasal cavity in patients with chronic polypous rhinosinusitis.
Nasonex for allergies
Nasonex is used to treat seasonal or year-round allergic rhinitis in adults and adolescents over 12 years of age. The recommended preventive and therapeutic dose of the drug is 2 inhalations (50 mcg each) into each nasal passage once (total daily dose of mometasone - 200 mcg/day). Clinical improvement after the first use of Nasonex is observed within 12 hours.
After achieving the desired therapeutic effect and to maintain it, the dose is reduced to 100 mcg/day. (one inhalation into each nostril once).
If the symptoms of the disease do not decrease, then, in agreement with the attending physician, it is possible to increase the daily dose to 400 mcg/day. When the patient's condition improves, the dose of the drug must be reduced.
For children aged 2-11 years with allergies, it is recommended to take one inhalation in each nasal passage once. The total dose is 100 mcg/day.
Indications for use of the drug Nasonex
- seasonal or perennial allergic rhinitis in adults and children aged ≥2 years;
- as an adjuvant therapeutic agent in antibiotic therapy for acute episodes of sinusitis in adults (including elderly patients) and in children aged ≥12 years;
- treatment of acute rhinosinusitis without signs of severe bacterial infection in adults and children aged ≥12 years;
- Treatment of nasal polyps in patients aged ≥18 years and associated symptoms (including nasal congestion and loss of smell).
Nasonex for adenoids
Enlarged adenoids are a fairly common complication of allergic rhinitis. Nasonex relieves swelling and often prevents the need for surgery.
A similar effect is achieved by suppressing lymphoid tissue. But it should be borne in mind that in case of severe inflammation, Nasonex is ineffective. Also, the hormonal nature of the drug suppresses the immune system to some extent, so after discontinuation of the drug, inflammation in the adenoids may resume (especially in children). To relieve this condition, it is recommended to undergo a course of anti-inflammatory treatment of adenoid vegetations. And also strengthen your immune system, eat right, walk in the fresh air, play sports and have as little contact with household chemicals and dust as possible.
Nasonex spray: instructions for use
General recommendations
The drug is intended for intranasal administration (used in the form of inhalations) of the suspension contained in the bottle. The procedure is carried out using a dosing nozzle, which is supplied with each bottle of Nasonex.
Before using the spray for the first time, it is “calibrated” by pressing the dosing device 6-7 times. “Calibration” allows you to establish a stereotypical supply of medicine. In this case, each press of the dosing device ensures the release of 100 mg of suspension into the nasal cavity, which contains 50 mcg of a chemically pure active substance.
Before use, the bottle must be shaken vigorously each time.
Instructions for use of Nasonex/Nasonex Sinus for allergic rhinitis
The standard prophylactic/therapeutic dose for adolescents over the age of twelve and adult patients (including the elderly) is two inhalations into each nasal passage as a single dose (200 mcg of mometasone per day).
After achieving the desired therapeutic effect, the dose is reduced to 100 mcg/day. (one inhalation in each nasal passage once).
If it was not possible to achieve the desired effect when using a therapeutic dose, the dose can be increased to 400 mcg/day. That is, the patient should take up to four inhalations once in each nasal passage. Reducing the severity of symptoms of allergic rhinitis is an indication for dose reduction.
Clinical improvement after the first use of mometasone is usually noticeable within 12 hours after the first inhalation.
For children under 11 years of age, it is recommended to take one inhalation into each nasal passage once for allergies. The total dose is 100 mcg/day.
Since Nasonex is not a nasal drop, but a spray, when inhaling, you should keep your head straight, without throwing it back.
Instructions for Nasonex Sinus and Nasonex for exacerbation of sinusitis
For patients over twelve years of age, including the elderly, the recommended therapeutic dose is two inhalations into each nostril, 2 times a day. The total dose is 400 mcg/day.
The drug is used as an adjuvant, complementing the main treatment.
If clinical improvement cannot be achieved using the drug at a standard dosage, the dose may be increased to 800 mcg/day. (four inhalations into each nasal passage, 2 times a day). After the severity of symptoms decreases, the dose should be reduced.
After 12 months of use of Nasonex, there were no signs of atrophy of the nasal mucosa; in addition, mometasone tended to improve the histological picture when examining a tissue sample of the nasal mucosa.
Nasonex for adenoids
Enlarged adenoids are a fairly common complication of allergic rhinitis in young children. Prescribing Nasonex to children with adenoids can relieve swelling and often prevent the need for surgical intervention.
Reviews of Nasonex for adenoids indicate that the effect is achieved by suppressing lymphoid tissue, but it takes quite a long time to achieve it. In addition, in cases of severe inflammation, the drug is not very effective.
As a hormonal agent, the spray also additionally suppresses local immunity, and therefore, after its discontinuation, inflammation in the adenoids may resume. External manifestations of inflammation are the appearance of mucus flowing down the back wall of the throat.
To relieve this condition, doctors recommend taking a course of anti-inflammatory treatment for adenoid vegetations . In this case, inhalations through a nebulizer with Cycloferon , supplemented by rinsing the nasopharynx using the nasopharyngeal shower method, which are carried out in an ENT office, may be effective.
Dr. Komarovsky recommends, as an addition to the treatment of adenoids, to reconsider the organization of the child’s lifestyle. Since one of the causes of enlarged adenoids is decreased immunity, it is very important that the immune system functions as well as possible.
To minimize the risk of an increase in the size of the pharyngeal tonsils , the child should eat properly, walk in the fresh air, harden, play sports and have as little contact as possible with household chemicals and dust.
After the inflammation disappears, it is usually not necessary to repeat the course of intranasal GCS.
Analogs of the drug Nasonex
Synonyms for Nasonex spray with the same active ingredient are: Desrinit, Rizonel, Asmanex Twistheiler, Momat Rino and Nosephrine.
Nasonex spray analogues
Analogues of Nasonex with a similar therapeutic effect (dosage form: spray): Flutinex, Avamis, Flixonase, Beclonazal, Beclomethasone, Fluticasone, Tafen, Rinoklenil, Polydexa, Nasobek, Nazarel, Budoster, Aldecin.
Nasal drops with GCS: Benacap, Benarin.
Before replacing Nasonex, you should definitely consult with your doctor regarding contraindications, dosage and duration of therapy.
Nasonex or Avamis?
Nasonex and Avamis have similar therapeutic effects, routes of administration and indications. The active component of Avamis spray is fluticasone furoate, Nasonex is mometasone furoate. Both substances are characterized by a very high degree of affinity for GCS receptors and exceptional local activity. However, among all existing corticosteroids for intranasal administration, mometasone has the lowest bioavailability and the fastest development of the therapeutic effect. In addition, Nasonex based on mometasone is approved for use in children from the age of two, while Avamis in pediatric practice is used only for the treatment of children over six years of age. Mometasone furoate has a more gentle effect on the body and does not have a negative effect.
But Avamis has fewer contraindications than Nasonex spray.
Do not forget that, despite the similarity of these two medications, only the attending physician can prescribe or replace one drug with another.
Nasonex or Desrinit?
The main differences between Nasonex and Dezrinit are price and manufacturer. Nasonex is an original drug produced in Belgium. And Dezrinit is a generic produced in Israel. The original drug always contains components of a higher degree of purification. Therefore, its effectiveness is higher and its tolerability is better. The active substance of the drugs is identical - mometasone. The composition contains minor differences in auxiliary components that do not affect the overall therapeutic effect.
Nasonex is more often used for children, because the drug has less side effects than its analogue.
Remember that even if the composition is the same, taking medications must be coordinated with your doctor, who will suggest the optimal solution for a specific disease.
