Qvar
Qvar®
Generic Name
Qvar®
Mechanism
- Receptor binding: Mometasone furoate is a synthetic glucocorticoid that selectively binds the cytoplasmic glucocorticoid receptor (GR) in nasal epithelial cells.
- Genomic effects: GR activation leads to altered transcription of < 300 target genes:
*↑ anti‑inflammatory proteins* (IL‑1ra, IL‑10, lipocortin‑1)
*↓ pro‑inflammatory mediators* (IL‑4, IL‑5, IL‑13, eotaxin, TNF‑α, histamine‑releasing factor).
• Non‑genomic effects: Rapid modulation of calcium flux and intracellular signaling pathways that blunt mast‑cell degranulation.
• Antiedema: Reduces capillary permeability → decreases mucosal swelling and congestion.
Result: Symptom relief (sneezing, itching, nasal congestion) with minimal systemic exposure.
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Pharmacokinetics
| Parameter | Data (intranasal) |
| Absorption | ~90 % local uptake; <1 % systemic bioavailability. |
| Distribution | Local high‑concentration at nasal mucosa; negligible plasma levels. |
| Metabolism | Hepatic CYP3A4/5 mediated; metabolite is inactive. |
| Elimination | Primarily fecal excretion (~70 %); renal (~20 %). |
| Half‑life | Intranasal tissue: 4–12 h; systemic plasma: 1–2 h. |
| Peak plasma concentration | <0.1 ng/mL (≤10 % of oral bioavailability). |
*Implication:* Systemic side‑effect profile is markedly lower than systemic corticosteroids.
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Indications
- Seasonal allergic rhinitis (SAR) – nasal congestion, rhinorrhea, pruritus.
- Perennial allergic rhinitis (PAR) – chronic nasal symptoms.
- Adjunctive therapy for patients inadequately controlled on antihistamines or intranasal antihistamine sprays.
*Not indicated for: Acute viral rhinitis, sinusitis, non‑allergic rhinitis, or systemic asthma.*
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Contraindications
| Category | Details |
| Contraindications | • Severe hypersensitivity to mometasone furoate or any component. |
| Warnings |
• Use with caution in pregnancy (Category C – limited data); weigh benefit vs risk. • Avoid in active local infections (e.g., severe viral rhinitis) until resolved to reduce risk of secondary infection. • Over‑use (>10 sprays/day per nostril) may increase systemic absorption and HPA‑suppressive risk. |
| Precautions |
• Children 6 yrs only. • Patients with a history of cataract or glaucoma: monitor ocular status. • Patients on CYP3A4 inhibitors/inducers: minor risk of altered systemic levels. |
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Dosing
| Population | Dosage | Frequency | Administration Tips |
| Adults & Children ≥6 yrs | 1 puff (35 µg) per nostril | Twice daily (morning & evening) | 1) Shake bottle gently before use.2) Tilt head slightly forward.3) Insert nozzle, close one nostril, spray and repeat. |
| Children 6–12 yrs | 1 puff per nostril | Twice daily | Same technique; consider lower dose if growth concerns. |
| Pediatric <6 yrs (off‑label) | 0.5 puff per nostril | Twice daily | Use with caution; monitor growth & systemic side‑effects. |
• Max daily dose: 10 puffs total (5 puffs per nostril).
• Tapering: No formal taper; discontinue abruptly if severe adverse reaction.
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Monitoring
| Parameter | Frequency | Rationale |
| Symptom control score | Monthly for first 4 weeks, then every 3 months | Assess efficacy; adjust dosage. |
| Growth velocity (children) | Every 3 months | Detect possible growth retardation. |
| Ocular assessment (visual acuity, intraocular pressure) | Annually or if symptoms | Prevent cataract/glaucoma progression. |
| Blood pressure & weight | Semi‑annual | Detect systemic cortisol effects. |
| Serum cortisol / ACTH | If adrenal suppression suspected | Evaluate HPA axis status. |
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Clinical Pearls
| Pearl | Explanation |
| “Qvar = 90 % local, 10 % systemic.” | The high local bioavailability minimizes risk of systemic side‑effects compared to oral steroids. |
| Potency vs. Side‑Effect: Qvar’s *persistence* in the nasal epithelium (half‑life ~12 h) provides sustained symptom control with a single daily dose in some patients. | |
| Pediatric use: While FDA‑approved for >6 yrs, many clinicians prescribe from 4 yrs onward, monitoring growth closely. | |
| Combination therapy: Pair Qvar with antihistamine nasal sprays (e.g., azelastine) for synergistic benefit; avoid simultaneous use of two intranasal steroids. | |
| Epistaxis check: After starting Qvar, evaluate for blood‑straw nasal bleeding; instruct patients to rinse gently if clot shows. | |
| Breathlessness in asthma: Qvar is *not* a rescue inhaler; use only for allergic rhinitis—using it for asthma can delay correct treatment. | |
| Pregnancy safety: Category C; still used in many obstetric settings due to minimal systemic exposure. | |
| Re‑exposure in case of allergic reaction: If a patient develops a rash or anaphylaxis, discontinue and refer for allergy testing; re‑challenge rarely used. |
> Bottom line: *Qvar* offers a high‑potency, low‑systemic‑exposure solution for allergic rhinitis with a favorable safety profile when used within the recommended dosing guidelines.