Generic Name: mometasone furoate
Dosage Form: cream
Momexin (mometasone furoate cream 0.1%)
DESCRIPTION: MomexinTM Mometasone Furoate Cream 0.1% contains mometasone furoate, USP for dermatologic use. Mometasone furoate
is a synthetic corticosteroid with antiinflammatory activity.
Chemically, mometasone furoate is 9a,21-Dichloro-11b,17- dihydroxy-16a-methylpregna-1, 4-diene-3,20-dione 17-(2-furoate), with the empirical formula
C27H30CI2O6, a molecular weight of 521.4 and the following structural formula:
Mometasone furoate is a white to off-white powder practically insoluble in water, slightly soluble in octanol, and moderately soluble in ethyl alcohol.
Each gram of Mometasone Furoate Cream 0.1% contains: 1 mg mometasone furoate, USP in a cream base of hexylene glycol,
phosphoric acid, propylene glycol stearate, stearyl alcohol and ceteareth-20, titanium dioxide, aluminum starch octenylsuccinate,
white wax, white petrolatum, and purified water.
Like other topical corticosteroids, mometasone furoate has anti-inflammatory, antipruritic, and vasoconstrictive properties. The mechanism of the anti-inflammatory
activity of the topical steroids, in general, is unclear. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called
lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their
common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.
The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle and the integrity of the epidermal barrier. Occlusive
dressings with hydrocortisone for up to 24 hours have not been demonstrated to increase penetration; however, occlusion of hydrocortisone for 96 hours markedly
enhances penetration.
Studies in humans indicate that approximately 0.4% of the applied dose of Mometasone Furoate Cream 0.1% enters the circulation after 8 hours of contact on normal skin without
occlusion. Inflammation and/or other disease processes in the skin may increase percutaneous absorption.
Studies performed with Mometasone Furoate Cream 0.1% indicate that it is in the medium range of potency as compared with other topical corticosteroids.
In a study evaluating the effects of mometasone furoate cream on the hypothalamic-pituitary-adrenal (HPA) axis, 15 grams were applied twice daily for 7 days to six adult patients with
psoriasis or atopic dermatitis. The cream was applied without occlusion to at least 30% of the body surface. The results show that the drug caused a slight lowering of adrenal corticosteroid
secretion.
In a pediatric trial, 24 atopic dermatitis patients, of which 19 patients were age 2 to 12 years, were treated with Mometasone Furoate Cream 0.1% once daily. The majority of patients cleared
within 3 weeks.
Ninety-seven pediatric patients ages 6 to 23 months, with atopic dermatitis, were enrolled in an open-label, hypothalamicpituitary- adrenal (HPA) axis safety study. Mometasone Furoate
Cream 0.1% was applied once daily for approximately 3 weeks over a mean body surface area of 41% (range 15% to 94%). In approximately 16% of patients who showed normal adrenal
function by Cortrosyn test before starting treatment, adrenal suppression was observed at the end of treatment with Mometasone Furoate Cream 0.1%. The criteria for suppression
were: basal cortisol level of ² 5 mcg/dL, 30-minute post-stimulation level of ² 18 mcg/dL, or an increase of less than 7 mcg/dL. Followup testing 2 to 4 weeks after stopping treatment, available for 5
of the patients, demonstrated suppressed HPA axis function inone patient, using these same criteria.
Mometasone Furoate Cream 0.1% is a medium potency corticosteroid indicated for the relief of the
inflammatory and pruritic manifestations of corticosteroidresponsive dermatoses.
Mometasone Furoate Cream 0.1% may be used in pediatric patients 2 years of age or older, although the safety and efficacy
of drug use for longer than 3 weeks have not been established (see PRECAUTIONS – Pediatric Use section). Since safety and
efficacy of Mometasone Furoate Cream 0.1% have not been established in pediatric patients below 2 years of age, its use in
this age group is not recommended.
Mometasone Furoate Cream 0.1% is contraindicated in those patients with a history of hypersensitivity to any of the components in the preparation.
Systemic absorption of topical corticosteroids can produce reversible hypothalamic-pituitary-adrenal
(HPA) axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of
treatment. Manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria can also be
produced in some patients by systemic absorption of topical corticosteroids while on treatment.
Patients applying a topical steroid to a large surface area or to areas under occlusion
should be evaluated periodically for evidence of HPA axis suppression. This may be done
by using the ACTH stimulation, A.M. plasma cortisol, and urinary free cortisol tests.
In a study evaluating the effects of mometasone furoate cream on the
hypothalamic-pituitary-adrenal (HPA) axis, 15 grams were applied twice daily for 7 days
to six adult patients with psoriasis or atopic dermatitis. The cream was applied without
occlusion to at least 30 percent of the body surface. The results show that the drug caused
a slight lowering of adrenal corticosteroidsecretion.
If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce
the frequency of application, or to substitute a less potent corticosteroid. Recovery of HPA axis
function is generally prompt upon discontinuation of topical corticosteroids. Infrequently,
signs and symptoms of glucocorticosteroid insufficiency may occur requiring supplemental systemic
corticosteroids. For information on systemic supplementation, see Prescribing Information for those products.
Pediatric patients may be more susceptible to systemic toxicity from equivalent doses due to their
larger skin surface to body mass ratios (see PRECAUTIONS - Pediatrics Use section).
If irritation develops, Mometasone Furoate Cream 0.1% should be discontinued and appropriate therapy instituted.
Allergic contact dermatitis with corticosteroids is usually diagnosed by observing a failure to heal rather than noting a clinical
exacerbation as with most topical products not containing corticosteroids. Such an observation should be corroborated with
appropriate diagnostic patch testing.
If concomitant skin infections are present or develop, an appropriate antifungal or antibacterial agent should be used. If a
favorable response does not occur promptly, use of Mometasone Furoate Cream 0.1% should be discontinued until
the infection has been adequately controlled.
Patients using topical corticosteroids should receive the following information and instructions:
1. This medication is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes.
2. This medication should not be used for any disorder other than that for which it was prescribed.
3. The treated skin area should not be bandaged or otherwise covered or wrapped so as to be occlusive, unless directed by
the physician.
4. Patients should report to their physician any signs of local adverse reactions.
5. Parents of pediatric patients should be advised not to use Mometasone Furoate Cream 0.1% in the treatment of diaper
dermatitis. Mometasone Furoate Cream 0.1% should not be applied in the diaper area as diapers or plastic pants may
constitute occlusive dressing (see DOSAGE AND ADMINISTRATION).
6. This medication should not be used on the face, underarm or groin areas unless directed by the physician.
7. As with other corticosteroids, therapy should be discontinued when control is achieved. If no improvement is
seen within 2 weeks, contact physicion.
8. Other corticosteroid-containing products should not be used with Mometasone Furoate Cream 0.01%
without first consulting with the physician.
The following tests may be helpful in evaluating patients for HPA axis suppression:
ACTH stimulation test
A.M. plasma cortisol test
Urinary free cortisol test
Long-term animal studies have not been performed to evaluate the carcinogenic potential of Mometasone Furoate Cream 0.1%.
Long-term carcinogenicity studies of mometasone furoate were conducted by the inhalation route in rats and mice. In a 2-year
carcinogenicity study in Sprague-Dawley rats, mometasone furoate demonstrated no statistically significant increase of
tumors at inhalation doses up to 67 mcg/kg (approximately 0.04 times the estimated maximum clinical topical dose from
Mometasone Furoate Cream 0.1% on a mcg/m2 basis). In a 19- month carcinogenicity study in Swiss CD-1 mice, mometasone
furoate demonstrated no statistically significant increase in the incidence of tumors at inhalation doses up to 160 mcg/kg
(approximately 0.05 times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on a mcg/m2
basis).
Mometasone furoate increased chromosomal aberrations in an in vitro Chinese hamster ovary cell assay, but did not increase
chromosomal aberrations in an in vitro Chinese hamster lung cell assay. Mometasone furoate was not mutagenic in the Ames
test or mouse lymphoma assay, and was not clastogenic in an in vivo mouse micronucleus assay, a rat bone marrow chromosomal
aberration assay, or a mouse male germ-cell chromosomal aberration assay. Mometasone furoate also did not induce
unscheduled DNA synthesis in vivo in rat hepatocytes.
In reproductive studies in rats, impairment of fertility was not produced in male or female rats by subcutaneous doses up to
15 mcg/kg (approximately 0.01 times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on
a mcg/m2 basis).
Teratogenic Effects: Pregnancy Category C: Corticosteroids have been shown to be teratogenic in laboratory
animals when administered systemically at relatively low dosage levels. Some corticosteroids have been shown to be teratogenic
after dermal application in laboratory animals.
When administered to pregnant rats, rabbits, and mice, mometasone furoate increased fetal malformations. The doses
that produced malformations also decreased fetal growth, as measured by lower fetal weights and/or delayed ossification.
Mometasone furoate also caused dystocia and related complicationswhen administered to rats during the end of pregnancy.
In mice, mometasone furoate caused cleft palate at subcutaneous doses of 60 mcg/kg and above. Fetal survival was
reduced at 180 mcg/kg. No toxicity was observed at 20 mcg/kg. (Doses of 20, 60, and 180 mcg/kg in the mouse are approximately
0.01, 0.02, and 0.05 times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on a
mcg/m2 basis.)
In rats, mometasone furoate produced umbilical hernias at topical doses of 600 mcg/kg and above. A dose of 300 mcg/kg
produced delays in ossification, but no malformations. (Doses of 300 and 600 mcg/kg in the rat are approximately 0.2 and 0.4
times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on a mcg/m2 basis.)
In rabbits, mometasone furoate caused multiple malformations (eg, flexed front paws, gallbladder agenesis, umbilical hernia,
hydrocephaly) at topical doses of 150 mcg/kg and above (approximately 0.2 times the estimated maximum clinical topical
dose from Mometasone Furoate Cream 0.1% on a mcg/m2 basis). In an oral study, mometasone furoate increased resorptions
and caused cleft palate and/or head malformations (hydrocephaly and domed head) at 700 mcg/kg. At 2800 mcg/kg most
litters were aborted or resorbed. No toxicity was observed at 140 mcg/kg. (Doses at 140, 700, and 2800 mcg/kg in the rabbit are
approximately 0.2, 0.9, and 3.6 times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on
a mcg/m2 basis.)
When rats received subcutaneous doses of mometasone furoate throughout pregnancy or during the later stages of pregnancy,
15 mcg/kg caused prolonged and difficult labor and reduced the number of live births, birth weight, and early pup
survival. Similar effects were not observed at 7.5 mcg/kg. (Doses of 7.5 and 15 mcg/kg in the rat are approximately 0.005
and 0.01 times the estimated maximum clinical topical dose from Mometasone Furoate Cream 0.1% on a mcg/m2 basis.)
There are no adequate and well-controlled studies of teratogenic effects from topically applied corticosteroids in pregnant
women. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk
to the fetus.
Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with
endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids
could result in sufficient systemic absorption to produce detectable quantities in human milk. Because many
drugs are excreted in human milk, caution should be exercised when Mometasone Furoate Cream 0.1% is administered to a
nursing woman. Mometasone Furoate Cream 0.1% may be used with caution in pediatric patients 2 years of age or older,
although the safety and efficacy of drug use for longer than 3 weeks have not been established. Use of Mometasone Furoate
Cream 0.1% is supported by results from adequate and wellcontrolled studies in pediatric patients with corticosteroidresponsive
dermatoses. Since safety and efficacy of Mometasone Furoate Cream 0.1% have not been established in
pediatric patients below 2 years of age, its use in this age group is not recommended.
Mometasone Furoate Cream 0.1% caused HPA axis suppression in approximately 16% of pediatric patients ages 6 to 23
months, who showed normal adrenal function by Cortrosyn test before starting treatment, and were treated for approximately 3
weeks over a mean body surface area of 41% (range 15% to 94%). The criteria for suppression were: basal cortisol level of
less than or equal to 5 mcg/dL, 30-minute post-stimulation level of less than 18 mcg/dL, or an increase of less than or equal
to 7 mcg/dL. Follow-up testing 2 to 4 weeks after study completion, available for 5 of the patients, demonstrated suppressed
HPA axis function in one patient, using these same criteria. Long-term use of topical corticosteroids has not been studied
in this population (see CLINICAL PHARMACOLOGY - Pharmacokinetics section)
Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of HPA axis
suppression and Cushing’s syndrome when they are treated with topical corticosteroids. They are, therefore, also at greater risk of
adrenal insufficiency during and/or after withdrawal of treatment. Pediatric patients may be more susceptible than adults to
skin atrophy, including striae, when they are treated with topical corticosteroids. Pediatric patients applying topical corticosteroids
to greater than 20% of body surface are at higher risk of HPA axis suppression.
HPA axis suppression, Cushing’s syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension
have been reported in pediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in children
include low plasma cortisol levels, and an absence of response to ACTH stimulation. Manifestations of intracranial hypertension
include bulging fontanelles, headaches, and bilateral papilledema. Mometasone Furoate Cream 0.1% should not be used in the
treatment of diaper dermatitis.
Clinical studies of Mometasone Furoate Cream 0.1% included 190 subjects who were 65 years of age and over
and 39 subjects who were 75 years of age and over. No overall differences in safety or effectiveness were observed between
these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between
the elderly and younger patients. However, greater sensitivity of some older individuals cannot be ruled out. In controlled clinical studies involving 319 patients, the incidence of adverse reactions associated with the use of Mometasone Furoate Cream 0.1% was 1.6%.
Reported reactions included burning, pruritus, and skin atrophy. Reports of rosacea associated with the use of Mometasone
Furoate Cream 0.1% have also been received. In controlled clinical studies (n=74) involving pediatric patients 2 to 12 years of age,
the incidence of adverse experiences associated with the use of Mometasone Furoate Cream 0.1% was approximately 7%.
Reported reactions included stinging, pruritus, and furunculosis.
The following adverse reactions were reported to be possibly or probably related to treatment with Mometasone Furoate
Cream 0.1% during clinical studies in 4% of 182 pediatric patients 6 months to 2 years of age: decreased glucocorticoid
levels, 2; paresthesia, 2; folliculitis, 1; moniliasis, 1; bacterial infection, 1; skin depigmentation, 1. The following signs of skin
atrophy were also observed among 97 patients treated with Mometasone Furoate Cream 0.1% in a clinical study: shininess
4; telangiectasia 1, loss of elasticity 4, loss of normal skin markings 4, thinness 1, and bruising 1. Striae were not observed in
this study.
The following additional local adverse reactions have been reported infrequently with topical corticosteroids, but may occur
more frequently with the use of occlusive dressings. These reactions are listed in an approximate decreasing order of occurrence:
irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact
dermatitis, secondary infection, striae, and miliaria.
Topically applied Mometasone Furoate Cream 0.1% can be absorbed in sufficient amounts to produce systemic
effects (see PRECAUTIONS Sectoin).
Apply a thin film of Mometasone Furoate Cream 0.1% to the affected skin areas
once daily. Mometasone Furoate Cream 0.1% may be used in pediatric patients 2 years of age or older. Since
safety and efficacy of Mometasone Furoate Cream 0.1% have not been adequately established in pediatric
patients below 2 years of age, its use in this age group is not
recommended (see PRECAUTIONS - Pediatric Use Section).
As with other corticosteroids, therapy should be discontinued when control is achieved. If no improvement
is seen within 2 weeks, reassessment of diagnosis may be necessary. Safety and efficacy of Mometasone
Furoate Cream 0.1% in pediatric patients for more than 3 weeks of use have not been established. Mometasone
Furoate Cream 0.1% should not be used with occlusive dressings unless directed by a physician. Mometasone
Furoate Cream 0.1% should not be applied in the diaper area if the child still requires diapers or plastic pants
as these garments may constitute occlusive dressing.
Momexin™ is supplied in the following:
(NDC 68712-032-01) one 45 g tube of mometasone furoate
cream 0.1% packaged with one 4 oz can of ammonium lactate mousse 12%
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)
[See USP Controlled Room Temperature]
Manufactured by:
G and W Labroatories, Inc.
South Plainfiled, NJ 07080
Manufactured for:
JSJ Pharmaceuticals
Charleston SC 29401
800-499-4468
www.jsjpharm.com
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| Marketing Information | |||
| Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
| ANDA | ANDA077447 | 05/01/2009 | |
| Labeler - JSJPharmaceuticals (615074866) |
More Momexin resources
- Momexin Use in Pregnancy & Breastfeeding
- Momexin Drug Interactions
- Momexin Support Group
- 21 Reviews for Momexin - Add your own review/rating
- Momexin Cream MedFacts Consumer Leaflet (Wolters Kluwer)
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