beclomethasone dipropionate

(be kloe meth' a sone)

Apo-Beclomethasone, Beclodisk (CAN), Becloforte Inhaler (CAN),
Beclovent Rotacaps (CAN), Beconase, Beconase AQ Nasal Spray,
Propaderm (CAN), QVAR, Vancenase, Vancenase AQ, Vancenase
Pockethaler

Pregnancy Category C

Drug classes
Corticosteroid
Glucocorticoid
Hormonal agent

Therapeutic actions
Anti-inflammatory effects; local administration into lower respiratory tract or nasal
passages maximizes beneficial effects on these tissues while decreasing the likelihood of
adverse corticosteroid effects from systemic absorption.

Indications
• Respiratory inhalant therapy: Control of bronchial asthma that requires
corticosteroids along with other therapy
• Intranasal use: Relief of symptoms of seasonal or perennial rhinitis that respond
poorly to other treatments; prevention of recurrence of nasal polyps following
surgical removal

Contraindications and cautions

• Respiratory inhalant therapy: Contraindicated with acute asthmatic attack, status
asthmaticus. Use caution with systemic fungal infections (may cause
excerbations), allergy to any ingredient, lactation
• Intranasal therapy: Use caution with untreated local infections (may cause
exacerbations); nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma
(interferes with healing); lactation

Available forms
Aerosol—40 mcg/actuation, 42 mcg/actuation, 80 mcg/actuation, 84 mcg/actuation; nasal
spray—0.042%, 0.084%

Dosages
Respiratory inhalant therapy
50 mcg released at the valve delivers 42 mcg to the patient.
ADULTS
Two inhalations (84–168 mcg) tid or qid. In severe asthma, start with 12 to 16 inhalations
per day, and adjust dosage downward. Do not exceed 20 inhalations (840 mcg/day). Do
not exceed 320 mcg bid QVAR.
PEDIATRIC PATIENTS
< 5 yr: Do not use.
5–11 yr: 1 or 2 inhalations tid or qid, not to exceed 10 inhalations (420 mcg/day) or
40 mcg bid QVAR; do not exceed 80 mcg bid.
Intranasal therapy
Each actuation of the inhaler delivers 42 or 84 mcg. Discontinue therapy after 3 wk if no
significant symptomatic improvement.
ADULTS
One inhalation (42–84 mcg) in each nostril bid–qid (total dose 168–336 mcg/day).
PEDIATRIC PATIENTS (6–11 YR)
One inhalation in each nostril bid–qid.

Pharmacokinetics
Route Onset Peak
Inhalation Rapid 1–2 wk

Metabolism: Lungs, GI, and liver; T1/2: 3–15 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Feces

Adverse effects
Respiratory inhalant use
• Endocrine: Cushing's syndrome with overdose, suppression of hypothalamic-
pituitary-adrenal (HPA) function due to systemic absorption
• Local: Oral, laryngeal, pharyngeal irritation, fungal infections
Intranasal use
• Local: Nasal irritation, fungal infections
• Respiratory: Epistaxis, rebound congestion, perforation of the nasal septum,
anosmia
• Other: Headache, nausea, urticaria

Nursing considerations
Assessment
• History: Acute asthmatic attack, status asthmaticus; systemic fungal infections;
allergy to any ingredient; lactation; untreated local infections, nasal septal ulcers,
recurrent epistaxis, nasal surgery or trauma
• Physical: Weight, T; P, BP, auscultation; R, adventitious sounds; chest x-ray
before respiratory inhalant therapy; exam of nares before intranasal therapy

Interventions
• Taper systemic steroids carefully during transfer to inhalational steroids; deaths
resulting from adrenal insufficiency have occurred during and after transfer from
systemic to aerosol steroids.
• Use decongestant nose drops to facilitate penetration of intranasal steroids if
edema, excessive secretions are present.

Teaching points
• This respiratory inhalant has been prescribed to prevent asthmatic attacks, not for
use during an attack.
 • Allow at least 1 min between puffs (respiratory inhalant); if you also are using an
inhalational bronchodilator (isoproterenol, metaproterenol, epinephrine), use it
several minutes before using the steroid aerosol.
• Rinse your mouth after using the respiratory inhalant aerosol.
• Use a decongestant before the intranasal steroid, and clear your nose of all
secretions if nasal passages are blocked; intranasal steroids may take several days
to produce full benefit.
• Use this product exactly as prescribed; do not take more than prescribed, and do
not stop taking the drug without consulting your health care provider. The drug
must not be stopped abruptly but must be slowly tapered.
• These side effects may occur: Local irritation (use the device correctly), headache
(consult your health care provider for treatment).
• Report sore throat or sore mouth.

Adverse effects in Italic are most common; those in Bold are life-threatening.