Asmanex
[mometasone furoate inhalation powder]
WHAT IS Asmanex? The Asmanex Twisthaler 220 mcg ( Mometasone
furoate inhalation powder )  delivers anti-inflammatory medication for
asthma through a dry powder delivery system. Asmanex is a
cap-activated inhalation-driven multi-dose dry powder inhaler
containing mometasone furoate and anhydrous lactose (which contains
milk proteins). Each actuation of the Asmanex Twisthaler 220 mcg
inhaler provides a measured dose of 1.5 mg mometasone furoate
inhalation powder, containing 220 mcg of mometasone
furoate.Asmanex(R) Twisthaler(R) 220mcg is for the first-line
maintenance treatment of asthma as preventive therapy in patients 12
years of age and older.

HOW DOES ASMANEX WORK? The active ingredient in Asmanex is
mometasone furoate. Mometasone furoate is a corticosteroid
demonstrating potent anti-inflammatory activity. Inflammation is an
important factor for asthma. The binding affinity of mometasone furoate
for the human glucocorticoid receptor is about 12 times that of
dexamethasone, 7 times that of triamcinolone acetonide and 5 times
that of budesonide.

Asmanex helps manage symptoms. Clinical studies with Asmanex have
shown improvement in lung function, decreased use of rescue
medication, decreased incidence of nighttime awakenings and
improvements in daytime symptoms such as coughing and wheezing.

STATISTICS ABOUT ASMANEX Genetics, environment, and immune
system factors can all contribute. Asthma triggers can include tobacco
smoke and allergens such as dust mites, animal dander, and
cockroaches. Currently, about 20 million people suffer from asthma.

ASMANEX SIDE-EFFECTS The most common side effects of Asmanex
include: headache, allergic rhinitis, pharyngitis, upper respiratory
infection, sinusitis, oral candidiasis, dysmenorrhea, musculoskeletal
pain, back pain, dyspepsia, myalgia, abdominal pain, and nausea.

RECENT CLINICAL FINDINGS ON ASMANEX (Mometasone furoate
inhalation powder)

BIOAVAILABILITY (ABSORPTION)
Fluticasone propionate  and mometasone furoate have similar and very
low systemic bioavailability when administered intranasally using a
high-dose regimen [of Asmanex]. [B1]

Mometasone furoate (MF) and fluticasone propionate (FP) are high
potency inhaled corticosteroids. The systemic bioavailability of MF is
claimed to be negligible, leading to a minimal potential for systemic
adverse effects. [B2]

CONTRAINDICATIONS
Asmanex Twisthaler therapy is contraindicated in the primary treatment
of status asthmaticus or other acute episodes of asthma where
intensive measures are required.

SAFETY AND EFFECTIVENESS OF ASMANEX
Mometasone furoate microemulsion is a safe and effective therapy in
the treatment of symptomatic erosive-ulcerative oral lichen planus [B3].

Mometasone furoate does not affect mucociliary clearance in patients
with perennial allergic rhinitis. [B4]

Mometasone furoate DPI, 400 microg every evening, provided
comparable efficacy as fluticasone propionate MDI, two 125-microg
puffs twice daily, in subjects with moderate persistent asthma
previously treated with fluticasone propionate. [B5]

TASTE Compared with fluticasone propionate and mometasone
furoate, triamcinolone acetonide aqueous was associated with
significantly less odor, less taste, less dryness of nose/throat, less
aftertaste, and greater overall liking. [B6]

ABOUT ASTHMA
As many as 20 million Americans have asthma, leading to 2 million
emergeny room visits and more than 5000 deaths annually. [1]

NEWS
The FDA is planning to restrict use of Glaxo's Advair (another asthma treatment) as
Advair may make some asthma episodes more severe and shouldn't be used as
a first-choice treatment.  Advair, a combo of Serevent and a steroid, is sold as
Seretide in some markets. Thus, Merck's Singulair and Schering-Plough's
Asmanex may takes its market share. [2]

References for Asmanex Twisthaler :

Once-Daily Asthma Medicine Approved, WebMD Medical News, March 31, 2005 -
Asmanex Twisthaler Once-Daily Asthma Inhaler Approved Forbes.com. March
31, 2005 Product label, April 3, 2005 - Asmanex Twisthaler [1] Once-Daily
Asthma Inhaler Approved, womenshealth.gov Online Publication, November 25,
2005. [2] Glaxo Shares Fall on U.S. Plan to Restrict Advair Use (Update 5)
Bloomberg.com, Nov 21, 2005 S1 FDA Staff Recommends Updated Warning For
Asmanex > SGP   wsj.com  JUNE 19, 2009, 10:18 A.M. ET
[B1] Daley-Yates et al, Eur
J Clin Pharmacol. 2004 Jun;60(4):265-8. Epub 2004 Apr 28 [B2] Fardon TC et al, Adrenal
suppression with dry powder formulations of fluticasone propionate and mometasone furoate,
Am J Respir Crit Care Med. 2004 Nov 1;170(9):960-6. Epub 2004 Jun 7. [B3] Aguirre JM,
Efficacy of mometasone furoate microemulsion in the treatment of erosive-ulcerative oral
lichen planus: pilot study. J Oral Pathol Med. 2004 Aug;33(7):381-5. [B4] Pata YS et al, The
effect of mometasone furoate on mucociliary clearance in patients with perennial allergic
rhinitis, Kulak Burun Bogaz Ihtis Derg. 2003 Oct;11(4):97-9.[B5] Wardlaw A Efficacy and safety
of mometasone furoate dry powder inhaler vs fluticasone propionate metered-dose inhaler in
asthma subjects previously using fluticasone propionate. Ann Allergy Asthma Immunol. 2004
Jul;93(1):49-55 [B6] Stokes M et al, Evaluation of patients' preferences for triamcinolone
acetonide aqueous, fluticasone propionate, and mometasone furoate nasal sprays in patients
with allergic rhinitis. Otolaryngol Head Neck Surg. 2004 Sep;131(3):225-31
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Vitamin World
In a memo posted to FDA's Web site July 3, 2009, agency staff said
a review of Asmanex adverse event reports didn't identify events
"unique to the pediatric population." However, FDA staff recommended
that the warnings section of Asmanex' label be expanded to discuss
"immediate hypersensitivity events", or allergic reactions. The memo
noted that such a warning is included for other asthma drugs including
GlaxoSmithKline's (GSK) Advair and AstraZeneca's (AZN) Symbicort.
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