Usage
Beclometasone is prescribed for the prophylaxis and long-term control of asthma and allergic rhinitis (hay fever). It is also used to prevent the recurrence of nasal polyps after surgical removal. It can be administered via inhalation for respiratory conditions or intranasally for nasal conditions. Beclometasone is classified as a corticosteroid, specifically a glucocorticoid. It exerts its therapeutic effect by suppressing the inflammatory response in the airways or nasal passages.
Alternate Names
Beclometasone is also known as beclomethasone dipropionate. Brand names include QVAR, Beconase, Vancenase, Clenil Modulite, and others. Brand names may vary regionally.
How It Works
Pharmacodynamics: Beclometasone, a glucocorticoid, binds to glucocorticoid receptors in the cytoplasm of target cells. This complex then translocates to the nucleus, where it modulates gene transcription. This results in decreased production of inflammatory mediators like cytokines, prostaglandins, and leukotrienes, and an increase in anti-inflammatory proteins. Beclometasone also inhibits the recruitment of inflammatory cells to the site of inflammation.
Pharmacokinetics:
Inhaled beclometasone is absorbed through the lungs. After oral inhalation, approximately 20% of the dose reaches the lungs; the rest is swallowed and undergoes first-pass metabolism in the liver. Intranasal beclometasone is absorbed through the nasal mucosa. Beclometasone is metabolized in the liver primarily by CYP3A4 enzymes. Elimination occurs predominantly via fecal excretion, with a small amount excreted in the urine.
Dosage
Standard Dosage
Adults:
Inhalation (Asthma):
- Initial: 40 to 80 mcg twice daily, approximately 12 hours apart.
- Maintenance: Titrate to the lowest effective dose to maintain asthma control. The maximum dose is generally 320 mcg twice daily.
- Severe Asthma: Higher doses (up to 2 mg daily in divided doses) may be necessary in severe cases, under close medical supervision.
Intranasal (Allergic Rhinitis):
- Adults: 50 to 100 mcg into each nostril twice daily, or 50 mcg into each nostril 3 to 4 times daily. The maximum daily dose is usually 400 mcg.
Children:
Inhalation (Asthma):
- 4 to 11 years: 40 mcg twice daily, approximately 12 hours apart. The maximum dose is usually 80 mcg twice daily.
- Under 4 years: Dosage must be determined by a doctor.
Intranasal (Allergic Rhinitis):
- 6 years and older: Similar to adult dosing.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically needed, but start with the lowest effective dose and monitor closely.
- Patients with Renal Impairment: No specific dosage adjustments are typically needed.
- Patients with Hepatic Dysfunction: Use with caution. Close monitoring for adverse effects is recommended, and dose adjustments may be necessary.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, hypertension, osteoporosis, glaucoma, cataracts, or infections. Close monitoring and dose adjustments may be needed.
Clinical Use Cases
Beclometasone is not indicated for the primary treatment of status asthmaticus or other acute episodes of asthma requiring intensive measures. Its role is in long-term prevention and control. Therefore, it is not typically used in the context of intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations like status epilepticus or cardiac arrest. In these cases, short-acting rescue medications like salbutamol are preferred for rapid relief of acute symptoms.
Dosage Adjustments
Dosage adjustments may be needed based on individual patient response, disease severity, and the presence of comorbid conditions or drug interactions. Titrate to the lowest effective dose.
Side Effects
Common Side Effects:
- Inhalation: Oral candidiasis (thrush), hoarseness, cough, sore throat, headache.
- Intranasal: Nasal dryness and irritation, epistaxis (nosebleeds), sneezing, unpleasant taste or smell.
Rare but Serious Side Effects:
- Adrenal suppression (with prolonged high doses)
- Paradoxical bronchospasm (worsening of breathing after inhalation)
- Allergic reactions (rash, hives, swelling)
- Glaucoma, cataracts (with long-term use)
- Growth retardation in children (with long-term use)
- Immunosuppression
Long-Term Effects:
Osteoporosis, increased risk of infections, skin thinning, easy bruising, delayed wound healing, growth suppression in children.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), angioedema, adrenal crisis (with abrupt discontinuation of high doses).
Contraindications
- Hypersensitivity to beclometasone
- Active, untreated respiratory infections (e.g., tuberculosis, fungal infections)
- Status asthmaticus
Drug Interactions
- CYP3A4 Inhibitors: (e.g., ritonavir, ketoconazole, itraconazole) can increase beclometasone levels and the risk of adverse effects.
- CYP3A4 Inducers: (e.g., rifampicin, phenytoin, carbamazepine) can decrease beclometasone levels and efficacy.
Pregnancy and Breastfeeding
- Pregnancy: Beclometasone is generally considered safe during pregnancy. The benefits of controlling asthma usually outweigh the potential risks to the fetus.
- Breastfeeding: Beclometasone is likely safe during breastfeeding. The amount in breast milk is very small.
Drug Profile Summary
- Mechanism of Action: Glucocorticoid receptor agonist, suppresses inflammation.
- Side Effects: Oral candidiasis, hoarseness, cough, nasal irritation, adrenal suppression (with prolonged high doses).
- Contraindications: Hypersensitivity, active respiratory infections, status asthmaticus.
- Drug Interactions: CYP3A4 inhibitors and inducers.
- Pregnancy & Breastfeeding: Generally considered safe.
- Dosage: See detailed dosage section above.
- Monitoring Parameters: Lung function tests (for asthma), blood pressure, blood glucose (for long-term use), growth in children.
Popular Combinations
Beclometasone is often combined with long-acting beta-agonists (LABA) like salmeterol or formoterol for enhanced asthma control. The combination provides both anti-inflammatory and bronchodilator effects.
Precautions
- Rinse mouth after inhalation to reduce the risk of oral candidiasis.
- Monitor for signs of adrenal suppression with high doses or prolonged use.
- Use cautiously in patients with infections, diabetes, hypertension, osteoporosis, glaucoma, cataracts, or a history of seizures or psychiatric disorders.
FAQs (Frequently Asked Questions)
A: See detailed dosage guidelines above for adults, children, and specific conditions.
A: Advise patients to rinse their mouth with water and spit it out after each inhalation. If candidiasis develops, prescribe an appropriate antifungal treatment (e.g., nystatin, fluconazole).
A: Yes, generally considered safe. Benefits of asthma control outweigh potential risks.
Q4: What are the signs of adrenal suppression?
A: Fatigue, weakness, nausea, vomiting, low blood pressure, weight loss.
A: Osteoporosis, increased risk of infections, skin thinning, easy bruising, growth suppression in children (with high doses).
A: CYP3A4 inhibitors (e.g., ritonavir, ketoconazole) can increase beclometasone levels, and CYP3A4 inducers (e.g., rifampicin, phenytoin) can decrease levels.
A: No. Beclometasone is a preventer medication, not a rescue medication. Use short-acting beta-agonists like salbutamol for acute attacks.
A: No, especially with high doses or prolonged use. Taper the dose gradually to avoid adrenal insufficiency.
A: Follow the manufacturer’s instructions. Generally, wipe the mouthpiece with a clean, dry cloth regularly. Do not wash or immerse the inhaler in water.
