Beclomethasone (Systemic, Oral Inhalation) (Monograph)

Brand name: QVAR
Drug class: Adrenals
Molecular formula: C₂₈H₃₇ClO₇
CAS number: 5534-09-8

Medically reviewed by Drugs.com on Feb 5, 2025. Written by ASHP.

Introduction

Synthetic corticosteroid;² ¹⁴⁹ minimal mineralocorticoid activity.¹⁴⁹ ^a

Uses for Beclomethasone (Systemic, Oral Inhalation)

Asthma

Used for the long-term prevention of bronchospasm in patients with asthma.¹ ² ⁸ ²¹ ²⁴ ²⁵ ²⁶ ¹⁰³ ¹¹² ¹¹³ ¹¹⁶ ¹⁴⁴ ¹⁴⁹ ¹⁵²

Should not be used in the treatment of nonasthmatic bronchitis.¹ ²⁸ ¹¹² ¹¹³ ¹⁴⁴

Chronic Obstructive Pulmonary Disease

Efficacy in patients with chronic obstructive pulmonary disease (e.g., bronchitis)^{† [off-label]} who are stabilized with oral corticosteroids³³ ³⁴ ³⁷ ¹¹⁷ or whose disease is corticosteroid responsive¹¹⁷ ¹¹⁸ remains to be fully evaluated.

Inflammatory Conditions of the GI Tract

Has been used as an oral solution³⁵ or rectal suspension³⁶ (these dosage forms not commercially available in the US) in the management of inflammatory diseases of the GI tract^{† [off-label]} (e.g., inflammatory bowel disease^{† [off-label]}, eosinophilic gastroenteritis^{† [off-label]}).³⁵ ³⁶ However, the role of beclomethasone dipropionate in the management of inflammatory conditions of the GI tract remains to be established.³⁵ ³⁶

Beclomethasone (Systemic, Oral Inhalation) Dosage and Administration

General

Adjust dosage carefully according to individual requirements and response.¹ ² ⁶¹ ⁸³ ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹
After a satisfactory response is obtained, decrease dosage gradually to the lowest dosage that maintains an adequate clinical response.¹⁴⁹ ¹⁵⁰ Achieve the lowest effective dosage, particularly in children, since inhaled corticosteroids have the potential to affect growth.¹⁴⁹ ¹⁵⁰ (See Pediatric Use under Cautions.)

Conversion to Orally Inhaled Therapy in Patients Receiving Systemic Corticosteroids

When switching from systemic corticosteroids to orally inhaled beclomethasone dipropionate, asthma should be reasonably stable before initiating treatment with the oral inhalation.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹
Initially, administer the aerosol concurrently with the maintenance dosage of the systemic corticosteroid.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ After about 1 week, gradually withdraw the systemic corticosteroid.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹
Death has occurred in some individuals in whom systemic corticosteroids were withdrawn too rapidly.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ (See Withdrawal of Systemic Corticosteroid Therapy under Warnings.)
If exacerbations of asthma occur after transfer to oral inhalation therapy, administer short courses of systemic corticosteroids, then taper dosage as symptoms subside.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹

Administration

Oral Inhalation

Administer by oral inhalation using an oral aerosol inhaler.¹⁴⁹

Test-spray inhalation aerosol (2 times) before first use or whenever the aerosol not used for prolonged periods (>10 days).¹⁴⁹ ^b

Oral inhalation aerosol is formulated as a solution, which does not require shaking.¹⁴⁹

Exhale slowly and completely and place the mouthpiece of the inhaler well into the mouth with the lips closed firmly around it; keep the tongue below the mouthpiece.^b Inhale slowly and deeply through the mouth while actuating the inhaler.^b Hold the breath for as long as possible (about 5–10 seconds), withdraw the mouthpiece, and exhale gently.^b If additional inhalations are required, repeat the procedure.^b

Rinse the mouth thoroughly with water to remove drug deposited in the oropharyngeal area.³³ ⁴⁸ ⁴⁹ ⁵² ⁵⁹ ¹⁴⁹ ^b

Clean the mouthpiece weekly^b using a clean, dry tissue or cloth.^b Do not wash or place any part of the inhaler canister in water.^b

Dosage

Available as beclomethasone dipropionate; dosage expressed in terms of the salt.^b ¹⁴⁹

Oral inhalation aerosol releases 50 or 100 mcg of beclomethasone dipropionate, and delivers 40 or 80 mcg, respectively, from the actuator (mouthpiece) per metered spray.¹⁴⁹

Pediatric Patients

Asthma

Oral Inhalation

Children 5–11 years of age receiving bronchodilators alone or inhaled corticosteroids previously: Initially, 40 mcg twice daily.¹⁴⁹ If required, dosage may be increased to a maximum 80 mcg twice daily.¹⁴⁹

Children ≥12 years of age receiving bronchodilators alone previously: Initially, 40–80 mcg twice daily.¹⁴⁹ If required, dosage may be increased to a maximum 320 mcg twice daily.¹⁴⁹

Children ≥12 years of age receiving inhaled corticosteroids previously: Initially, 40–160 mcg twice daily. If required, dosage may be increased to a maximum 320 mcg twice daily.

Adults

Asthma

Oral Inhalation

In adults receiving bronchodilators alone previously: Initially, 40–80 mcg twice daily.¹⁴⁹ If required, dosage may be increased to a maximum 320 mcg twice daily.¹⁴⁹

Adults receiving inhaled corticosteroids: Initially, 40–160 mcg twice daily. If required, dosage may be increased to a maximum of 320 mcg twice daily.

Prescribing Limits

Pediatric Patients

Asthma

Oral Inhalation

Children 5–11 years of age: Maximum 80 mcg twice daily.¹⁴⁹

Children ≥12 years of age: Maximum 320 mcg twice daily.¹⁴⁹

Adults

Asthma

Oral Inhalation

Maximum 320 mcg twice daily.¹⁴⁹

Special Populations

Geriatric Patients

Consider initial dosages at the lower end of the usual range due to possible age-related decrease in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.¹⁴⁹

Cautions for Beclomethasone (Systemic, Oral Inhalation)

Contraindications

Primary treatment of severe acute asthmatic attacks or status asthmaticus when intensive measures¹ ² ²⁹ ¹¹² ¹¹³ ¹⁴⁹ (e.g., oxygen, parenteral bronchodilators, IV corticosteroids)¹⁴⁷ are required.
Known hypersensitivity to the drug or any ingredient in the formulation.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹

Warnings/Precautions

Warnings

Withdrawal Of Systemic Corticosteroid Therapy

Possible corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression);¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ acute adrenal insufficiency;¹ ² ¹¹² ¹¹³ ¹⁴⁴ life-threatening exacerbation of asthma;¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ pulmonary infiltrates with eosinophilia;¹ ¹¹² ¹¹³ or symptomatic exacerbation of allergic conditions¹ ² ²⁷ ⁴⁴ ⁵² ⁵⁸ ⁷⁰ ¹¹² ¹¹³ ¹⁴⁴ if prolonged systemic corticosteroid therapy is replaced with oral inhalation corticosteroid therapy.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ Such symptoms may be observed especially in patients maintained on ≥20 mg of prednisone (or its equivalent) daily and particularly during the later part of the transfer.¹⁴⁹

In general, the greater the dosage and duration of systemic corticosteroid therapy, the greater the time required for withdrawal of systemic corticosteroids and replacement by orally inhaled corticosteroids.⁷³

Taper the dosage of the systemic corticosteroid, and carefully monitor patients during dosage reduction for objective signs of adrenal insufficiency (e.g., hypotension, weight loss).¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹

Immunosuppressed Patients

Increased susceptibility to infections in patients who are taking immunosuppressant drugs compared with healthy individuals.¹¹³ ¹³⁴ ¹³⁵ ¹³⁶ ¹³⁷ ¹³⁸ ¹³⁹ ¹⁴⁰ ¹⁴¹ ¹⁴² ¹⁴³ ¹⁴⁴ Certain infections (e.g., varicella [chickenpox], measles) can have a more serious or even fatal outcome in such patients, particularly in children.¹¹³ ¹³⁴ ¹³⁵ ¹³⁶ ¹³⁷ ¹³⁸ ¹³⁹ ¹⁴⁰ ¹⁴¹ ¹⁴² ¹⁴³ ¹⁴⁴

Exposure to varicella and measles should be avoided in previously unexposed patients.^b If exposure to varicella (chickenpox) or measles occurs in susceptible patients, consider administering varicella zoster immune globulin (VZIG) or immune globulin (IG), respectively.^b Consider treatment with an antiviral agent if varicella develops.^b

Concomitant Therapy

Use with caution in patients receiving systemic prednisone for any disease.⁴⁵ ⁴⁷ Concomitant use with prednisone in an alternate-day or daily dosing regimen could increase the likelihood of HPA-axis suppression compared with therapeutic dosages of either drug alone.⁴⁵ ⁴⁷

Resume systemic corticosteroids during periods of stress (e.g., infection, trauma, surgery) or a severe asthma exacerbation in patients who were attempting a switch from systemic to orally inhaled corticosteroid therapy.¹⁴⁹

Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression

Avoid higher than recommended dosages of the drug, since suppression of HPA function may occur.¹⁴⁹ If higher than recommended dosages are used, carefully consider the relative risks of adrenal suppression and potential therapeutic benefits.¹⁴⁹ Recommended dosages of orally inhaled drug provide less than normal physiologic amounts of glucocorticoid systemically and do not provide mineralocorticoid activity.¹⁴⁹ Orally inhaled drug will not compensate for insufficient endogenous cortisol production caused by previous systemic corticosteroid therapy.¹⁴⁹

Respiratory Effects

Bronchospasm,¹ ² ⁵⁷ ¹¹² ¹¹³ ¹³³ ¹⁴⁹ cough,²⁰ ²⁵ ⁵⁸ ¹³¹ ¹³² ¹⁴⁹ and/or wheezing⁵⁷ ⁵⁸ ¹³¹ ¹³² ¹³³ ¹⁴⁹ may occur, especially in asthmatic patients with hyperactive airways.²⁰ ²⁵ ⁵⁷ ⁵⁸ ¹⁰¹ ¹³¹ ¹³² ¹³³

If bronchospasm occurs, treat immediately with a short-acting bronchodilator, and discontinue treatment with beclomethasone dipropionate and institute alternative therapy.¹⁴⁹

Infection

Use with caution, if at all, in patients with clinical tuberculosis or latent M. tuberculosis infection of the respiratory tract; untreated systemic fungal, bacterial, or parasitic infections; or ocular herpes simplex or untreated, systemic viral infections.¹ ² ¹⁰⁰ ¹⁴⁴ ¹⁴⁹

Sensitivity Reactions

Immediate or delayed hypersensitivity reactions, including bronchospasm, anaphylactic/anaphylactoid reactions,² urticaria, angioedema, and rash reported rarely.¹ ² ¹¹² ¹¹³ ¹⁴⁹

General Precautions

Systemic Corticosteroid Effects

Possible signs and symptoms of Cushing’s syndrome (e.g., hypertension, glucose intolerance, cushingoid features) in patients who are particularly sensitive to corticosteroid effects or when usual dosages of the drug are exceeded.¹⁰⁰ ¹⁴⁹

Carefully monitor neonates exposed to prenatal corticosteroids for manifestations of hypoadrenalism.² ⁶¹ ¹¹² ¹⁴⁴ ¹⁴⁹

Ocular Effects

Glaucoma, increased intraocular pressure, and cataracts reported rarely.¹⁴⁹

Other Effects

Unknown long-term, systemic, and local effects of the drug in humans, particularly developmental or immunologic processes in the mouth, pharynx, trachea, and lung.¹⁴⁹

Specific Populations

Pregnancy

Category C.¹⁴⁹ (See Systemic Corticosteroid Effects under Cautions.)

Lactation

Distributed into milk.¹⁴⁴ ¹⁴⁹ Discontinue nursing or the drug.¹⁴⁴ ¹⁴⁹

Pediatric Use

Safety and efficacy not established in children <5 years of age.¹⁴⁹ No overall differences in the pattern, severity, or frequency of adverse events in children 5–12 years of age compared with those in adults.¹⁴⁹ Monitor periodically children receiving prolonged therapy for possible adverse effects on growth and development.⁶² ¹⁴⁹

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹⁴⁹

Use caution due to the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy in geriatric patients.¹⁴⁹ (See Geriatric Patients under Dosage and Administration.)

Common Adverse Effects

Headache, pharyngitis, upper respiratory tract infection, rhinitis.¹⁴⁹

Drug Interactions

Metabolized by CYP3A4.¹⁴⁹

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP3A4: potential pharmacokinetic interaction (increased plasma beclomethasone dipropionate concentrations).^a

Inducers of CYP3A4: potential pharmacokinetic interaction (decreased plasma beclomethasone dipropionate concentrations).^a

Specific Drugs

Drug

Interaction

Comments

Antidiabetic agents

May increase blood glucose concentrations in patients with diabetes mellitus^d

Adjust insulin and/or oral hypoglycemic dosages as needed^d

NSAIAs

Possible increased risk of GI ulceration^a

Decreased serum salicylate concentrations.^a When corticosteroids are discontinued, serum salicylate concentration may increase possibly resulting in salicylate intoxication^a

Use salicylates and corticosteroids concurrently with caution^a

Observe patients receiving both drugs closely for adverse effects of either drug^a

May be necessary to increase salicylate dosage when corticosteroids are administered concurrently or decrease salicylate dosage when corticosteroids are discontinued^a

Vaccines and Toxoids

May cause a diminished response to toxoids and live or inactivated vaccines^a

May potentiate replication of some organisms contained in live, attenuated vaccines^a

Can aggravate neurologic reactions to some vaccines (supraphysiologic dosages) ^a

Generally defer routine administration of vaccines or toxoids until corticosteroid therapy is discontinued^a

May need serologic testing to ensure adequate antibody response for immunization^a

Additional doses of the vaccine or toxoid may be necessary^a

May undertake immunization procedures in patients receiving nonimmunosuppressive doses of glucocorticoids or in patients receiving glucocorticoids as replacement therapy (e.g., Addison’s disease)^a

Beclomethasone (Systemic, Oral Inhalation) Pharmacokinetics

Absorption

Bioavailability

Absorbed into circulation following oral inhalation, ¹⁴⁹ with peak plasma concentrations usually attained at 0.5 hour.¹⁴⁹ After oral inhalation, 51–60% of the dose is deposited in the respiratory tract.¹⁵⁴

Onset

Relief of respiratory symptoms usually is evident within 24 hours; however, about 1–4 weeks of continuous therapy may be required for optimum effectiveness.¹⁴⁹

Distribution

Extent

Glucocorticoids cross the placenta and are distributed into milk.¹⁴⁴ ¹⁴⁹ ^a No evidence of tissue storage of parent drug or metabolites.¹⁴⁹

Elimination

Metabolism

Metabolized to active metabolites via CYP3A4.¹⁴⁹

Elimination Route

Beclomethasone dipropionate and its metabolites eliminated principally in feces and to a lesser extent in the urine (<10%).¹⁴⁹

Half-life

2.8 hours.¹⁴⁹

Stability

Storage

Oral Inhalation

25°C (may be exposed to 15–30°C).¹⁴⁹

Do not puncture aerosol containers, use or store near heat or an open flame, expose to temperatures >49°C, or place into a fire or incinerator for disposal.¹ ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹

Actions

Potent glucocorticoid and minimal mineralocorticoid activity.¹⁴⁹ ^a ^c At recommended dosages, provides less than normal physiologic amounts of glucocorticoid systemically.¹⁴⁹
Inhibits inflammatory cells and release of inflammatory mediators in the respiratory tract.¹⁴⁹ Improves lung function (e.g., FEV₁, morning peak expiratory flow).¹⁴⁹
Principal sites of action are the bronchi and bronchioles.¹⁴⁹
May reduce the following: number of mediator cells (basophils, leukocytes, and mast cells) at the epithelial level, number of eosinophils, sensitivity of sensory nerves to mechanical stimuli, secretory response to cholinergic receptor stimulation, and fibroblast activity.^c
May inhibit capillary dilation and permeability, stabilize lysosomal membranes, and prevent subsequent release of proteolytic enzymes.^c

Advice to Patients

Importance of providing the patient a copy of the manufacturer's patient information.¹⁴⁹
Importance of understanding proper storage, preparation, and administration techniques.¹⁴⁹ ^b
Advise that oral inhalation must be used at regular intervals to be therapeutically effective.¹⁰⁰ ¹⁰³ ¹⁴⁴ ¹⁴⁹
Importance of understanding that although improvement may occur within the first 24 hours, at least 1–4 weeks of continuous therapy may be required for optimal effectiveness.¹ ² ⁶¹ ⁷⁷ ¹⁰⁰ ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹
Importance of rinsing the mouth after inhalation and not exceeding the recommended dosage.¹ ² ⁷¹ ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ ^b
Importance of not using orally inhaled beclomethasone dipropionate as a bronchodilator or for emergency use (e.g., relief of acute bronchospasm).¹ ² ¹⁰³ ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹
Importance of contacting a clinician immediately when asthmatic attacks that are not controlled by bronchodilator therapy occur.¹ ² ¹¹² ¹¹³ ¹⁴⁹
dvise patients being transferred from systemic corticosteroid to beclomethasone dipropionate oral inhalation therapy to carry special identification (e.g., card, bracelet) indicating the need for supplementary systemic corticosteroids during periods of stress.¹ ² ¹¹² ¹¹³ ¹⁴⁴ ¹⁴⁹ (See Concomitant Therapy under Cautions.)
Importance of immunosuppressed patients avoiding exposure to certain infections (e.g., chickenpox, measles) and if exposed, of immediately consulting their clinician.¹¹³ ¹³⁴ ¹³⁵ ¹³⁶ ¹⁴² ¹⁴³ ¹⁴⁴ ¹⁴⁹
Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.¹⁴⁹
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.¹⁴⁹
Importance of advising patients of other important precautionary information.¹⁴⁹ (See Cautions.)

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Beclomethasone Dipropionate
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral Inhalation	Aerosol	40 mcg/metered spray	QVAR Oral Inhaler (with tetrafluoroethane propellants)	Teva
		80 mcg/metered spray	QVAR Oral Inhaler (with tetrafluoroethane propellants)	Teva

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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