• Beclomethasone Dipropionate is a prodrug that is readily absorbed and metabolized when inhaled.
• Although the greatest effect might not be felt for three to four weeks, the commencement of action is roughly 24 hours.
• It acts as an anti-inflammatory and anti-allergic medicine.
• It is used for the maintenance and prophylactic treatment of Asthma in adults and children older than four years of age.
• Additionally, it is employed off-label to treat stable chronic obstructive pulmonary disease.

Beclomethasone Dosage (Inhalational) in adults:

Use in the treatment of Asthma:

Note:

Patients with mild to moderate asthma who develop an acute exacerbation of asthma may need to quadruple the dose.

The high dose regimen should be used for a maximum of two weeks.

• US labeling: Metered-dose inhaler (QVAR/ QVAR RediHaler):

  • Dose in patients not currently on inhaled corticosteroids:

    • 40 to 80 mcg two times a day initially to a maximum dose of 320 mcg two times a day.

  • Patients previously on inhaled corticosteroids:

    • 40 to 320 mcg two times a day to a maximum dose of 320 mcg two times a day.

• Canadian labeling: Metered-dose inhaler:

  • Mild asthma:

    • 50–100 mcg twice day, with a 100 mcg twice daily maximum dose.

  • Moderate asthma:

    • 100–250 mcg twice daily, with a maximum dose of 250 mcg twice daily.

  • Severe asthma:

    • 300–400 mcg twice daily, up to a maximum of 400 mcg twice daily.

Asthma Guidelines:

• The potency of inhalational beclomethasone according to the National Asthma Education and Prevention Program guidelines (NAEPP 2007) Metered-dose inhaler is as follows:

  • Low-dose therapy:

    • 80 to 240 mcg/day

  • Medium-dose therapy:

    • 240 to 480 mcg/day

  • High-dose therapy:

    • More than 480 mcg/day

• The Potency of Inhalational Beclomethasone according to the Global Initiative for Asthma guidelines (GINA 2018) Metered-dose inhaler is as follows:

  • Low-dose therapy:

    • 100 to 200 mcg/day

  • Medium-dose therapy:

    • 200 to 400 mcg/day

  • High-dose therapy:

    • More than 400 mcg/day

The dose of Beclomethasone inhaler as off label use in the treatment of stable Chronic obstructive pulmonary disease:

• • 50 to 400 mcg daily.
  • It should be used in combination with a long-acting bronchodilator such as formoterol.

Beclomethasone Dosage (Inhalational) in Children:

Use in the treatment of maintenance therapy of Asthma:

Qvar dosage as per the Manufacturer's labeling:

• Children 5 - 11 years:

  • 40 mcg two times a day initially to a maximum dose of 80 mcg two times a day.

• Children 12 years of age or older and Adolescents:

  • No recent history of inhaled corticosteroids use:

    • 40 - 80 mcg two times a day to a maximum dose of 320 mcg two times a day.

  • A recent history of inhaled corticosteroid use:

    • 40 - 160 mcg two times a day to a maximum dose of 320 mcg two times a day.

QVAR dosing as per NIH Asthma Guidelines (NAEPP 2007) (HFA formulation):

• Children 5 - 11 years:

  • Low dose: 80 to 160 mcg/day

    • 40 mcg/puff: 2 to 4 puffs/day or
    • 80 mcg/puff: 1 to 2 puffs/day

  • Medium dose: 160 to 320 mcg/day

    • 40 mcg/puff: 4 to 8 puffs/day or
    • 80 mcg/puff: 2 to 4 puffs/day)

  • High dose: Greater than 320 mcg/day

    • 40 mcg/puff: 8 puffs or more per day or
    • 80 mcg/puff: 4 puffs or more per day

• Children 12 years of age or older and Adolescents:

  • Low dose: 80 to 240 mcg/day

    • 40 mcg/puff: 2 to 6 puffs/day or
    • 80 mcg/puff: 1 to 3 puffs/day

  • Medium dose: 240 to 480 mcg/day

    • 40 mcg/puff: 6 to 12 puffs/day or
    • 80 mcg/puff: 3 to 6 puffs/day)

  • High dose: Greater than 480 mcg/day

    • 40 mcg/puff: 12 puffs or more per day or
    • 80 mcg/puff: 6 puffs per day

Beclomethasone dose in Asthma (Canadian labeling: Metered-dose inhaler):

• Children 5 - 11 years:

  • 50 mcg two times a day to a maximum dose of 100 mcg two times a day.

• Children 12 years of age or more and Adolescents:

  • Mild asthma:

    • 50 to 100 mcg two times a day to a maximum dose of 100 mcg two times a day.

  • Moderate asthma:

    • 100 to 250 mcg two times a day to a maximum dose of 250 mcg two times a day.

  • Severe asthma:

    • 300 to 400 mcg two times a day to a maximum dose of 400 mcg two times a day.

Switching from oral systemic corticosteroid to orally inhaled corticosteroid:

• • Inhalational therapy should be initiated when the patients' symptoms are well controlled on oral corticosteroids.
  • Seven days after initiating inhalational corticosteroids, oral corticosteroids may be tapered off gradually.
  • According to the US guidelines, oral prednisone should not be reduced by more than 5 mg/day or equivalent every 1 - 2 weeks in adolescents and adults.
  • Patients who develop the clinical features of adrenal insufficiency should be restarted on the previous dose and a more gradual tapering should be done.
  • Furthermore, additional need for oral systemic corticosteroids may be required in times of stress and during exacerbations.

Side Effects Of Beclomethasone Dipropionate:

• Central Nervous System:

  • Headache
  • Pain
  • Voice Disorder

• Gastrointestinal:

  • Oral Candidiasis
  • Vomiting
  • Diarrhea
  • Nausea

• Genitourinary:

  • Dysmenorrhea
  • Viral Gastroenteritis

• Infection:

  • Influenza

• Neuromuscular & Skeletal:

  • Back Pain
  • Myalgia

• Otic:

  • Otitis

• Respiratory:

  • Pharyngitis
  • Nasopharyngitis
  • Upper Respiratory Tract Infection
  • Cough
  • Viral Upper Respiratory Tract Infection
  • Oropharyngeal Pain
  • Sinusitis
  • Allergic Rhinitis

• Miscellaneous:

  • Fever

Monitoring parameters while on Beclomethasone:

• Monitor FEV, peak flow, and other pulmonary function tests
• Bone mineral density
• Growth
• Observe for the clinical features of HPA axis suppression and adrenal insufficiency
• Observe for the development of oral candidiasis
• Monitor for cataracts and glaucoma
• Monitor the patient for improvement or worsening of asthma symptoms.

How to administer Beclomethasone dipropionate?

• Oral inhalation: Metered-dose inhaler:

  • The inhaler should not be shaken or sprayed on the nose, eyes, or face.
  • After the dose, oral rinses should be done.
  • The inhaler should not be put in water or washed.
  • Clean the mouthpiece with a dry tissue or a cloth.
  • When the counter displays '0', discard the inhaler.

• QVAR inhaler use:

  • Prime the canister twice into the air if it has not been used for more than ten days.
  • When used with a spacer device, delayed inspiration should be avoided as it may reduce the total amount of drug delivered.

• QVAR RediHaler:

  • The Redihaler device is breath-actuated and it does not require priming before use.
  • When it is not used, it should be properly capped.
  • After using it and after each inhalation, it should be closed with the white cap.
  • If the white cap has been opened for more than two minutes, close the white cap first to prepare the inhaler and check the dose counter to make sure the inhaler is not empty.
  • Never breathe out into the inhaler mouthpiece.
  • Do not use it with a spacer or volume-holding chamber.

Beclomethasone dipropionate Brand Names (International):

• AeroBec
• Aerocort
• Aerovent
• Asmabec Clickhaler
• Beclasone
• Beclate Aquanase
• Beclazone
• Beclo-Asma
• Beclod
• Becloforte
• Beclohale
• Beclomet
• Beclomin
• Beclone
• Beclophar
• Beclosone Forte
• Beclotis
• Beconase
• Becotide
• Beklofort Evohaler
• Bekotid Evohaler
• Bemedrex
• Bronconox
• Bronconox
• Forte
• Clenil
• Clenil Forte
• Destap FS
• Eclosynt
• Ecobec
• Ibicar
• Meclonate
• Propavent
• Qvar
• Respocort
• Steradin HFA
• Ventolair

Beclomethasone Dipropionate Brand Names in Pakistan: