Mometasone: lowest systemic exposure of the INCS; OTC since 2022.
BP ByBestAllergyNasalSprays Editorial Team — Clinical Pharmacy, Editorial Pool BI Reviewed byBestAllergyNasalSprays Editorial Team — Adult Allergy & Immunology, Editorial Pool
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Evidence reviewed
First published
Literature review current through
Mometasone furoate has very low systemic bioavailability (under 1% per the current Nasonex prescribing information), among the lowest of the intranasal corticosteroidsExpertMometasone furoate has greater glucocorticoid-receptor binding affinity than fluticasone propionate (Flonase) and triamcinolone acetonide (Nasacort), supporting its higher relative potency among the older OTC intranasal corticosteroids; fluticasone furoate (Flonase Sensimist) has comparable receptor affinityExpertNasonex is the only OTC nasal spray with FDA approval for treatment of chronic rhinosinusitis with nasal polyps in adults 18 and older (per FDA prescribing information; Nasonex 24HR went OTC in 2022). Allergic-rhinitis indication remains ages 12 and older.ExpertNasonex 24HR Allergy (mometasone furoate 50 mcg/spray) became available OTC in June 2022 and is FDA-labeled for adults and children 2 years of age and olderExpertMometasone has not been associated with an increased risk of birth defects in available pregnancy studies, and expert reviews consider intranasal mometasone acceptable at recommended doses; data are more limited than for budesonide, which has been the most extensively studied intranasal corticosteroid in pregnancy (Alhussien 2018)ExpertPer LactMed, intranasal mometasone has not been directly studied during breastfeeding, but the amounts absorbed systemically are likely too small to affect a breastfed infant; expert opinion considers nasal corticosteroids acceptable during lactationExpert
Context & alternatives
For eligible patients 13+ with multi-symptom, year-round, or failed-OTC rhinitis, Allermi is our #1 overall pick: a compounded telehealth Rx that pairs an intranasal steroid with azelastine, ipratropium, and micro-dosed oxymetazoline, personalized by a board-certified allergist. Not sure if you qualify? Check eligibility in 60 seconds.
Best fit for Nasonex: users who want the highest-potency OTC intranasal corticosteroid with the lowest systemic absorption among the older OTC INCS options — particularly older adults on polypharmacy, patients with glaucoma/cataract concerns (ophthalmology clearance is needed before starting any INCS regardless), patients 18+ with a history of nasal polyps, or those already plateaued on Flonase or Nasacort. In pregnancy, Rhinocort (budesonide) is still first-line; Nasonex is a reasonable alternative if cleared by your OB. For chronic nasal congestion, Nasonex is one of the most effective OTC picks.
