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==Administration==
*Type: [[Inhaled corticosteroid]]
*Dosage Forms: 100 mcg/5 mg/spray, 200 mcg/5 mcg/spray MDI
*Routes of Administration: Inhaled
*Common Trade Names: Dulera

==Adult Dosing==
*Prior medium dose inhaled steroid
**2 puffs (100 mcg/5 mcg/spray) inhaled BID
***Max: 4 puffs/day
***Taper to lowest effective dose. Use shortest effective treatment duration.
*Prior high dose inhaled steroid
**2 puffs (200 mcg/5 mcg/spray) inhaled BID
***Max: 4 puffs/day
***Taper to lowest effective dose. Use shortest effective treatment duration.

==Pediatric Dosing==
*12+ yo, prior medium dose inhaled steroid
**2 puffs (100 mcg/5 mcg/spray) inhaled BID
***Max: 4 puffs/day
***Taper to lowest effective dose. Use shortest effective treatment duration.
*12+ yo, prior high dose inhaled steroid
**2 puffs (200 mcg/5 mcg/spray) inhaled BID
***Max: 4 puffs/day
***Taper to lowest effective dose. Use shortest effective treatment duration.

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C; Possible risk of teratogenicity in animal data at 0.3-8x MRHD. Possible risk of delayed ossification at 80x MRHD.
*[[Lactation risk categories|Lactation risk]]: L3; Safety unknown

===Renal Dosing===
*Adult: Not defined
*Pediatric: Not defined

===Hepatic Dosing===
*Adult: Not defined. Caution in hepatic impairment.
*Pediatric: Not defined. Caution in hepatic impairment

==Contraindications==
*Allergy to class/drug
*[[Asthma]], acute
*Bronchospasm, acute

==Adverse Reactions==
===Serious===
*Bronchospasm, paradoxical
*[[Asthma]] exacerbation
*Death, asthma-related
*Hypersenstivity reaction
*[[Anaphylaxis]]
*Adrenal Suppression
*Hypercorticism
*Growth suppression in peds pts
*[[Hypertension]]
*[[Hypotension]]
*[[Angina]]
*[[Cardiac arrest]]
*[[Arrhythmia]]
*[[Hypokalemia]]
*[[Hyperglycemia]]
*[[Glaucoma]] in long-term use
*Cataracts in long-term use

===Common===
*Nasopharyngitis
*[[Headache]]
*[[Sinusitis]]
*[[Candidiasis]], oral
*[[Dysphonia]]

==Pharmacology==
*Half-life: Mometasone: 5 hr. Formoterol: 10 hr.
*Metabolism: Mometasone: Liver, CYP450: 3A4 substrate. Formoterol: Liver extensively, CYP450: 2A6, 2C9/19, 2D6 substrate.
*Excretion: Mometasone: Feces 74%, Urine 8%. Formoterol: Urine 59-62% (10% unchanged), feces 32-34%.

==Mechanism of Action==
*Mometasone: Exact mechanism of anti-inflammatory action unknown. Inhibits multiple inflammatory cytokines and produces multiple glucocorticoid and mineralcorticoid effects.
*Formoterol: Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle.

==Comments==
Black Box Warning: Long acting beta-2 adrenergic agonists (LABA) increase risk of asthma-related death. LABA use may increase risk of asthma-related hospitalization in pediatric and adolescent patients. Do not use corticosteroid/LABA combo if asthma adequately controlled on low-or medium-dose inhaled corticosteroids.

==See Also==

==References==
<references/>
[[Category:Pharmacology]]
[[Category:Pulmonology]]