beclomethasone (nasal)

Absorption: 27–44% absorbed following intranasal administration; action is primarily local following intranasal use.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Primarily converted to beclomethasone 17-monopropionate (active metabolite); 60% excreted in feces, 12% in urine.

Half-Life: 2.7 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Intranasal	1–3 days‡	up to 2 wk	unknown

‡Up to 2 wk in some patients.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (product contains alcohol).

Use Cautiously in:

Active untreated infections;
Diabetes;
Glaucoma;
Underlying immunosuppression (due to disease or concurrent therapy);
Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started);
Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired);
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <4 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

EENT: epistaxis, nasal irritation, nasal stuffiness, rhinorrhea, sneezing, tearing eyes

Endo: ↓growth (children), adrenal suppression (↑ dose, long-term therapy only)

GI: nausea

Neuro: dizziness, headache

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

Intranasal (Adults and Children ≥12 yr): 2 sprays in each nostril once daily.
Intranasal (Children 4–11 yr): 1 spray in each nostril once daily .

Availability ⬆ ⬇

Nasal spray: 40 mcg/metered spray in 6.8-g bottles (delivers 60 metered sprays); 80 mcg/metered spray in 10.6-g bottles (delivers 120 metered sprays)

Assessment ⬆ ⬇

Monitor degree of nasal congestion, amount and color of discharge, and frequency of sneezing.Assess patient changing from systemic corticosteroid to nasal preparation for signs/symptoms of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. If signs/symptoms of adrenal suppression occur with higher than recommended dose of nasal preparation, discontinue slowly, consistent with accepted process for discontinuing oral therapy.
- Monitor for signs/symptoms of local nasal adverse effects (pain, epistaxis, ulcer, Candida albicansinfection, septal perforation, impaired wound healing) periodically during therapy. If adverse reaction occurs, discontinue beclomethasone.
- Monitor growth rate in children receiving chronic therapy; use lowest possible dose.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk .

Implementation ⬆ ⬇

After desired clinical effect is obtained, ↓ dose to lowest required to control symptoms. Gradually ↓ dose every 2–4 wk as long as desired effect is maintained.
Intranasal: If also using a nasal decongestant, give decongestant 5–15 min before using beclomethasone.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to take missed doses as soon as remembered unless almost time for next dose. Advise patient not to discontinue medication without consulting health care professional; gradual ↓ is required.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Before 1st-time use, prime pump by pressing down and releasing pump 6 times or until fine spray appears. If not used for >7 days, reprime pump until fine spray appears. Prior to administering dose, gently blow nose to clear nostrils. Close 1 nostril. Tilt head forward slightly and insert nasal applicator into other nostril. Spray and breathe inward through nostril. Breathe out through mouth. Repeat procedure in other nostril. Wipe nasal applicator and rinse nasal applicator with cold water periodically to clean. Warn patient that temporary nasal stinging may occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient that nasal decongestant or oral antihistamine may be needed until effects of beclomethasone become apparent.
Advise patient to immediately notify health care professional and discontinue beclomethasone if urticaria, angioedema, rash, or paradoxical bronchospasm occurs.
Instruct patient to notify health care professional if symptoms do not improve within 3 wk, if symptoms worsen, or if sneezing or nasal irritation occurs.
Instruct patient whose systemic corticosteroids have recently been ↓ or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators.
Advise patient to have regular eye exams. May ↑ risk for eye disorders (glaucoma, cataracts, blurred vision).
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇