beclomethasone (nasal)

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

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

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 or 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 by nasal corticosteroids);
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: adrenal suppression (increased dose, long-term therapy only), ↓growth (children)

GI: nausea

Neuro: dizziness, headache

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

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

Availability ⬆ ⬇

Nasal spray: 40 mcg/metered spray in 4.9-g bottles (delivers 60 metered sprays) and 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 stuffiness, amount and color of nasal discharge, and frequency of sneezing.
- Monitor for signs of adverse effects on nasal mucosa (nasal discomfort, epistaxis, nasal ulceration, Candida albicans infection, nasal septal perforation, impaired wound healing) periodically during therapy. Avoid use in patients with recent nasal ulcers, nasal surgery, or nasal trauma.
- Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
- 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 (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Implementation ⬆ ⬇

After desired clinical effect is obtained, decrease dose to lowest effective amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before corticosteroid nasal spray.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Before first-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 (QNASL) and rinse nasal applicator with cold water periodically to clean. Warn patient that temporary nasal stinging may occur.
Advise patient that nasal decongestant or oral antihistamine may be needed until effects of beclomethasone become apparent.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
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.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇