beclomethasone

Absorption: 20% absorbed following inhalation. Action is primarily local following inhalation.

Distribution: Crosses the placenta and enters breast milk in small amounts.

Metabolism/Excretion: Following inhalation, beclomethasone dipropionate is primarily converted to beclomethasone 17–monopropionate (active metabolite); primarily excreted in feces (<10% excreted in urine).

Half-Life: 2.8 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Inhalation	within 24 hr	1–4 wk*	unknown

*Improvement in pulmonary function; decreased airway responsiveness may take longer.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (product contains alcohol);
Acute attack of asthma/status asthmaticus.

Use Cautiously in:

Active untreated infections;
Diabetes or glaucoma;
Underlying immunosuppression (due to disease or concurrent therapy);
Systemic corticosteroid therapy (should not be abruptly discontinued when inhalable therapy is started; additional corticosteroids needed in stress or trauma);
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); prolonged or high-dose therapy may lead to complications.

Adv. Reactions/Side Effects ⬆ ⬇

EENT: cataracts, dysphonia, oropharyngeal fungal infections, pharyngitis, rhinitis, sinusitis

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

MS: ↓bone mineral density, back pain

Neuro: headache

Resp: bronchospasm, cough, wheezing

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

Drug-drug:

None known.

Route/Dosage ⬆ ⬇

Inhaln (Adults and Children ≥12 yr): Previously not on inhaled corticosteroid: 40–80 mcg twice daily; may ↑ dose after 2 wk if needed (not to exceed 320 mcg twice daily). Previously on inhaled corticosteroid: 40–320 mcg twice daily (based on strength of previous corticosteroid product) (not to exceed 320 mcg twice daily).
Inhaln (Children 4–11 yr): 40 mcg twice daily; may ↑ dose after 2 wk if needed (not to exceed 80 mcg twice daily).

Availability ⬆ ⬇

Inhalation aerosol: 40 mcg/metered inhalation in 10.6-g canister (delivers 120 metered inhalations); 80 mcg/metered inhalation in 10.6-g canister (delivers 120 metered inhalations)

Assessment ⬆ ⬇

Monitor respiratory status and lung sounds. Pulmonary function tests may be assessed periodically during and for several mo following a transfer from systemic to inhalation corticosteroids.
Assess patients changing from systemic corticosteroids to inhalation corticosteroids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. If these signs appear, notify health care professional immediately; condition may be life-threatening.
Monitor for withdrawal symptoms (joint or muscular pain, lassitude, depression) during withdrawal from oral corticosteroids.
Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication, treat with inhaled, short-acting bronchodilator, and notify health care professional immediately.
Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
Monitor for signs and symptoms of hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm). Discontinue beclomethasone if reactions occur.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at greatest risk for HPA suppression.
- May cause ↑ serum and urine glucose concentrations if significant absorption occurs.

Implementation ⬆ ⬇

After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount required to control symptoms. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
Inhaln: Allow at least 1 min between inhalations of aerosol medication.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication exactly as directed. 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 decrease is required.
Advise patients using inhalation corticosteroids and bronchodilator to use bronchodilator first and to allow 5 min to elapse before administering corticosteroid, unless otherwise directed by health care professional.
Advise patient that inhalation corticosteroids should not be used to treat an acute asthma attack but should be continued even if other inhalation agents are used. A rapid-acting inhaled beta-adrenergic bronchodilator should be used for relief of acute asthma attacks.
Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status.
Caution patient to avoid smoking, known allergens, and other respiratory irritants.
Advise patient to notify health care professional if sore throat or mouth occurs.
Instruct patient whose systemic corticosteroids have recently been reduced 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 increase risk for eye problems (glaucoma, cataracts, blurred vision).
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Metered-Dose Inhaler: Instruct patient in the proper use of the metered-dose inhaler. Canister must be primed prior to first use. Do this by releasing 2 actuations into air away from face. Canister will remain primed for 10 days. If not used for more than 10 days, reprime with 2 actuations. Shake inhaler well. Exhale completely and then close lips firmly around mouthpiece. While breathing in deeply and slowly, press down on canister. Hold breath for as long as possible to ensure deep instillation of medication. Remover inhaler from mouth and breathe out gently. Allow 1–2 min between inhalations. Rinse mouth with water or mouthwash after each use to minimize fungal infections, dry mouth, and hoarseness. Clean only the mouthpiece weekly with clean dry tissue or cloth. Do not place in water (see Medication Administration Techniques).

Evaluation/Desired Outcomes ⬆ ⬇

Decreased frequency and severity of asthma attacks.
Improvement in asthma symptoms.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0173- GlaxoSmithKline LLC
- 0173-0388- BECONASE AQ
  - 0173-0388-79- 180 SPRAY, SUSPENSION in 1 BOTTLE, PUMP (0173-0388-79)

50090- A-S Medication Solutions
- 50090-1342- QVAR
  - 50090-1342-0- 1 CANISTER in 1 BOX (50090-1342-0) > 120 AEROSOL, METERED in 1 CANISTER

50090- A-S Medication Solutions
- 50090-3033- QVAR
  - 50090-3033-0- 1 CANISTER in 1 BOX (50090-3033-0) > 120 AEROSOL, METERED in 1 CANISTER

59310- Teva Respiratory, LLC
- 59310-210- QNASL
  - 59310-210-12- 1 INHALER in 1 CARTON (59310-210-12) > 120 AEROSOL, METERED in 1 INHALER

59310- Teva Respiratory, LLC
- 59310-406- QNASL
  - 59310-406-06- 1 INHALER in 1 CARTON (59310-406-06) > 60 AEROSOL, METERED in 1 INHALER

59310- Teva Respiratory, LLC
- 59310-406- QNASL
  - 59310-406-08- 1 INHALER in 1 CARTON (59310-406-08) > 60 AEROSOL, METERED in 1 INHALER

59310- Teva Respiratory, LLC
- 59310-410- QNASL
  - 59310-410-12- 1 INHALER in 1 CARTON (59310-410-12) > 120 AEROSOL, METERED in 1 INHALER

59310- Teva Respiratory, LLC
- 59310-410- QNASL
  - 59310-410-13- 1 INHALER in 1 CARTON (59310-410-13) > 50 AEROSOL, METERED in 1 INHALER

68071- NuCare Pharmaceuticals,Inc.
- 68071-1691- QVAR
  - 68071-1691-8- 8.7 AEROSOL, METERED in 1 BOX (68071-1691-8)

68788- Preferred Pharmaceuticals Inc.
- 68788-7025- QVAR
  - 68788-7025-1- 1 CANISTER in 1 BOX (68788-7025-1) > 120 AEROSOL, METERED in 1 CANISTER

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇