Dosing and uses of Beconase AQ, QNASL (beclomethasone intranasal)
Adult dosage forms and strengths
metered-dose nasal spray suspension
- 42mcg/actuation (Beconase AQ)
metered-dose nasal spray solution
- 80mcg/actuation (QNASL)
Allergic Rhinitis
Indicated for the relief of the symptoms of seasonal or perennial allergic and nonallergic (vasomotor) rhinitis
Beconase AQ: 1-2 sprays/nostril twice daily (total daily dose: 168-336 mcg/day)
QNASL: 2 sprays/nostril qDay (total daily dose: 320 mcg/day)
Nasal Polyps (Postsurgical Prophylaxis)/ Vasomotor Rhinitis
Beconase AQ: 1-2 sprays/nostril twice daily (total daily dose: 168-336 mcg/day)
Administration
Beconase AQ
- Shake well before each use
- Before first use, prime pump by 6 actuations into air
- If not used for 7 days, reprime pump until fine spray appears
QNASL
- Before first use, prime pump by spraying into air away from eyes 4 times (dosage counter on canister should read 120 after priming)
- To prime, hold device upright between thumb and index finger (the canister should be on top, pointing down)
- If not used for 7 days, reprime pump with 2 sprays before use
Pediatric dosage forms and strengths
metered-dose nasal spray suspension
- 42mcg/actuation (Beconase AQ)
metered-dose nasal spray solution
- 40mcg/actuation (QNASL)
- 80mcg/actuation (QNASL)
Rhinitis
Indicated for the relief of the symptoms of seasonal or perennial allergic, and nonallergic (vasomotor) rhinitis
Beconase AQ
- <6 years: Safety and efficacy not established
- 6-11 years: 1 spray/nostril twice daily (168 mcg/day); may increase to 2 sprays/nostril (336 mcg/day) in patients not adequately responding or those with more severe symptoms; decrease dose to 1 spray/nostril twice daily once adequate control achieved
- 12 years: As in adults; 1-2 sprays/nostril twice daily (total dose: 168-336 mcg/day)
QNASL
- <4 years: Safety and efficacy not established
- 4-11 years: 1 spray (40 mcg/actuation) each nostril qDay (total dose: 80 mcg/day)
- ≥12 years: As in adults; 2 sprays (80 mcg/actuation) each nostril qDay (total dose: 320 mcg/day)
Administration
Beconase AQ
- Shake well before each use
- Before first use, prime pump by 6 actuations into air
- If not used for 7 days, reprime pump until fine spray appears
QNASL
- Before first use, prime pump by spraying into air away from eyes 4 times (dosage counter on canister should read 120 after priming)
- To prime, hold device upright between thumb and index finger (the canister should be on top, pointing down)
- If not used for 7 days, reprime pump with 2 sprays before use
Beconase AQ, QNASL (beclomethasone intranasal) adverse (side) effects
>10%
Nasopharyngeal irritation (24%)
1-10%
Headache (<5%)
Nausea (<5%)
Lightheadedness (<5%)
Sneezing attacks after administration (4%)
Nasal congestion (<3%)
Nose bleeds (<3%)
Rhinorrhea (<3%)
Increased lacrimation (<3%)
Epistaxis (<3%)
Frequency not defined
Nasal mucosa ulceration
Nasal septum perforation
Warnings
Contraindications
Hypersensitivity
Used as primary treatment of status asthmaticus or acute episodes of asthma where intensive measures are required
Cautions
Monitor for vision change, or with history of increased IOP, glaucoma, or cataracts
Recent nasal surgery, nasal trauma, nasal septum ulcers (until healing has occurred)
Potential worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections, or ocular herpes simplex
More serious or fatal course of chickenpox or measles in susceptible patients
Risk for hypercorticism and adrenal suppression with higher than normal doses
Potential reduction of growth velocity in children
Prolonged corticosteroid use may result in elevated IOP, glaucoma, and/or cataracts
Nasal septal perforation and localized Candida albicans infections of the nose and/or pharynx may occur
Nasal discomfort, epistaxis, and nasal ulceration reported
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether distributed in breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Beconase AQ, QNASL (beclomethasone intranasal)
Mechanism of action
Corticosteroid with potent anti-inflammatory properties; elicits effects on various cells, including mast cells and eosinophils; also elicits effects on inflammatory mediators (eg, histamine, eicosanoids, leukotrienes, cytokines)
Absorption
Bioavailability: 44% (43% from swallowing portion of intranasal dose; 1% from nasal absorption)
Peak Plasma Concentration: Undetectable (<50 pg/mL)
Distribution
Protein Bound: 87%
Vd: 20 L; 424 L for B-17-MP metabolite
Metabolism
Metabolites: B-17-MP active metabolite
Metabolized by: Esterase enzymes found in most tissues
Elimination
Half-life: 0.3 hr
Excretion: feces (60%), urine (12%); after oral administration
