Morris Nejat MD NY Allergist Specializing in Allergy and Allergy Triggers is a Board Certified Pediatrician and an NY Allergist in New York and Midtown and Downtown New York with information on allergy asthma and triggers Morris Nejat for NY allergy, NYC Allergist and Manhattan Allergy treatment and therapy in NYC new york city. NY allergist asthma ny allergy ny allergy dust mites cockroach pollen grass weed count sinus nasal polyps testing skin shots allergyshots NYC new york city allergist asthma ny allergist allergy nyc  allergy dust mites cockroach pollen grass weed count sinus nasal polyps testing skin shots allergyshots Morris Nejat MD Allergist in Allergy Testing, Specializing in Allergy and Allergy Triggers is a Board Certified Pediatrician Allergist in New York and Midtown and Downtown New York with information on allergy asthma sinus and triggers Morris Nejat Arthur Lubitz Feingold Finegold Gregory Pollack Cliff Bassett. Health Insurance Medicare Medicaid Aetna USHC Allmerica Financial AmeriChoice of NJ AmeriHealth Administrators Anthem Healthcare of NY BC/BS BC/BS HMO Beech Street Network Center Care Chickering Claims Administrators Child Health Plus Cigna First Health Network GHI Great West Healthsource HIP Home Care Industry Horizon of NJ Horizon of NY Insurance Design Administrators (IDA) Local Insurances Magnacare MasterCare Medicaid w/Medicare Medicare Multiplan New England Financial NY Government Employee One Health Care Network Oxford PHCS Network PHS Network Pomco Prudential Select Pro Unicare United Healtcare 1199 32-BJ. All insurance accepted. Medication therapy flonase advair claritine clarityne claritin patanol and allergy medication from board certified allergist clarinex clarinext allegra zyrtec glaxo nasonex nasanex.

Mometasone furoate is a corticosteroid demonstrating anti-inflammatory properties. The precise mechanism of corticosteroid action on allergic rhinitis is not known. Corticosteroids have been shown to have a wide range of effects on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, and lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, and cytokines) involved in inflammation.

Mometasone furoate demonstrated no mineralocorticoid, androgenic, antiandrogenic, or estrogenic activity in preclinical studies. After administration of a single intranasal dose of mometasone furoate to adult male rats, the highest drug levels were seen in the esophagus, trachea, nasal passage, and mouth.

In two clinical studies utilizing nasal antigen challenge, mometasone furoate decreased some markers of the early- and late-phase allergic response. These observations included decreases (vs. placebo) in histamine and eosinophil cationic protein levels, and reductions (vs. baseline) in eosinophils, neutrophils, and epithelial cell adhesion proteins. The clinical significance of these findings is not known.

The effect of mometasone furoate on nasal mucosa following 12 months of treatment was examined in 46 patients with allergic rhinitis. There was no evidence of atrophy and there was a marked reduction in intraepithelial eosinophilia and inflammatory cell infiltration (e.g., eosinophils, lymphocytes, monocytes, neutrophils, and plasma cells).

Absorption: Mometasone furoate monohydrate administered as a nasal spray is virtually undetectable in plasma despite the use of a sensitive assay with a lower quantitation limit (LOQ) of 50 pcg/ml.

Metabolism: Studies have shown that any portion of a mometasone furoate dose which is swallowed and absorbed undergoes extensive metabolism to multiple metabolites.

Excretion: Following intravenous administration, the effective plasma elimination half-life of mometasone furoate is 5.8 hours. Any absorbed drug is excreted as metabolites mostly via the bile, and to a limited extent, into the urine.

The effects of renal impairment, hepatic impairment, age, or gender on mometasone furoate pharmacokinetics have not been adequately investigated.

Three clinical pharmacology studies have been conducted in humans to assess the effect of mometasone furoate at various doses on adrenal function. In one study, daily doses of 200 and 400 mug of mometasone furoate and 10 mg of prednisone were compared to placebo in 64 patients with allergic rhinitis. Adrenal function before and after 36 consecutive days of treatment was assessed by measuring plasma cortisol levels following a 6-hour Cortrosyn (ACTH) infusion and by measuring 24-hour urinary-free cortisol levels. Mometasone furoate, at both the 200 and 400 mug dose, was not associated with a statistically significant decrease in mean plasma cortisol levels post-Cortrosyn infusion or a statistically significant decrease in the 24-hour urinary-free cortisol levels compared to placebo. A statistically significant decrease in the mean plasma cortisol levels post-Cortrosyn infusion and 24-hour urinary-free cortisol levels was detected in the prednisone treatment group compared to placebo.

A second study assessed adrenal response to mometasone furoate (400 and 1600 mug/day), prednisone (10 mg/day), and placebo, administered for 29 days in 48 male volunteers. The 24-hour plasma cortisol area under the curve (AUC_0-24), during and after an 8-hour Cortrosyn infusion and 24-hour urinary-free cortisol levels were determined at baseline and after 29 days of treatment. No statistically significant differences of adrenal function were observed with mometasone furoate compared to placebo.

A third study evaluated single, rising doses of mometasone furoate (1000, 2000, and 4000 mug/day), orally administered mometasone furoate (2000, 4000, and 8000 mug/day), orally administered dexamethasone (200, 400, and 800 mug/day), and placebo (administered at the end of each series of doses) in 24 male volunteers. Dose administrations were separated by at least 72 hours. Determination of serial plasma cortisol levels at 8 AM and for the 24-hour period following each treatment were used to calculate the plasma cortisol area under the curve (AUC_0-24). In addition, 24-hour urinary-free cortisol levels were collected prior to initial treatment administration and during the period immediately following each dose. No statistically significant decreases in the plasma cortisol AUC, 8 AM cortisol levels, or 24-hour urinary-free cortisol levels were observed in volunteers treated with either mometasone furoate or oral mometasone, as compared with placebo treatment. Conversely, nearly all volunteers treated with the 3 doses of dexamethasone demonstrated abnormal 8 AM cortisol levels (defined as a cortisol level <10 mug/dl), reduced 24-hour plasma AUC values, and decreased 24-hour urinary-free cortisol levels, as compared to placebo treatment.

The efficacy and safety of mometasone furoate in the prophylaxis and treatment of seasonal allergic rhinitis and the treatment of perennial allergic rhinitis have been evaluated in 18 controlled trials, and one uncontrolled clinical trial, in approximately 3000 adults (age 17-85) and adolescents (age 12-16). This included 1757 males and 1453 females, including a total of 283 adolescents (182 boys and 101 girls) with seasonal allergic or perennial allergic rhinitis, treated with mometasone furoate at doses ranging from 50 to 800 mug/day. The majority of patients were treated with 200 mug/day. These trials evaluated the total nasal symptom scores that included stuffiness, rhinorrhea, itching, and sneezing. Patients treated with mometasone furoate 200 mug/day had a significant decrease in total nasal symptom scores compared to placebo-treated patients. No additional benefit was observed for mometasone furoate doses greater than 200 mug/day. A total of 350 patients have been treated with mometasone furoate for 1 year or longer.

In patients with seasonal allergic rhinitis, mometasone furoate demonstrated improvement in nasal symptoms (vs. placebo) within 2 days after the first dose. Maximum benefit is usually achieved within 1 to 2 weeks after initiation of dosing.

Prophylaxis of seasonal allergic rhinitis for patients 12 years of age and older with mometasone furoate, given at a dose of 200 mug/day, was evaluated in two clinical studies in 284 patients. These studies were designed such that patients received 4 weeks of prophylaxis with mometasone furoate prior to the anticipated onset of the pollen season, however, some patients received only 2 to 3 weeks of prophylaxis. Patients receiving 2 to 4 weeks of prophylaxis with mometasone furoate demonstrated a statistically significantly smaller mean increase in total nasal symptom scores with onset of the pollen season as compared to placebo patients.

Mometasone furoate is indicated for the prophylaxis and treatment of the nasal symptoms of seasonal allergic rhinitis and the treatment of the nasal symptoms of perennial allergic rhinitis, in adults and children 12 years of age and older. In patients with a known seasonal allergen that precipitates nasal symptoms of seasonal allergic rhinitis, initiation of prophylaxis with mometasone furoate is recommended 2 to 4 weeks prior to the anticipated start of the pollen season.

Hypersensitivity to any of the ingredients of this preparation contraindicates its use.

The replacement of a systemic corticosteroid with a topical corticosteroid can be accompanied by signs of adrenal insufficiency and, in addition, some patients may experience symptoms of withdrawal (i.e., joint and/or muscular pain, lassitude, and depression). Careful attention must be given when patients previously treated for prolonged periods with systemic corticosteroids are transferred to topical corticosteroids, with careful monitoring for acute adrenal insufficiency in response to stress. This is particularly important in those patients who have associated asthma or other clinical conditions where too rapid a decrease in systemic corticosteroid dosing may cause a severe exacerbation of their symptoms.

If recommended doses of intranasal corticosteroids are exceeded or if individuals are particularly sensitive or predisposed by virtue of recent systemic steroid therapy, symptoms of hypercorticism may occur, including very rare cases of menstrual irregularities, acneiform lesions, and cushingoid features. If such changes occur, topical corticosteroids should be discontinued slowly, consistent with accepted procedures for discontinuing oral steroid therapy.

Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chickenpox and measles, for example, can have a more serious or even fatal course in nonimmune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. How the dose, route, and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If exposed to chickenpox, prophylaxis with varicella zoster immune globin (VZIG) may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated. (See the respective package inserts for complete VZIG and IG prescribing information.) If chickenpox develops, treatment with antiviral agents may be considered.

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