Dosing and uses of Qvar (beclomethasone, inhaled)
Adult dosage forms and strengths
MDI
- 40mcg/actuation
- 80mcg/actuation
Chronic Asthma
No prior history of inhaled corticosteroid use: 40-80 mcg inhaled PO BID; do not exceed 320 mcg BId
Prior history of inhaled corticosteroid use: 40-160 mcg inhaled PO BID; do not exceed 320 mcg BId
Administration
Prime inhaler (2 actuations into air) before first use and after prolonged idleness (>10 days)
Pediatric dosage forms and strengths
MDI
- 40mcg/inhaler
- 80mcg/inhaler
Chronic Asthma
<5 years: Safety and efficacy not established
5-12 years: 40 mcg inhaled PO BID for patients with/without prior history of inhaled corticosteroid use; do not exceed 80 mcg inhaled BId
>12 years
- No prior history of inhaled corticosteroid use: 40-80 mcg inhaled PO BID; do not exceed 320 mcg BID
- Prior history of inhaled corticosteroid use: 40-160 mcg inhaled PO BID; do not exceed 320 mcg BID
Dosing Considerations
May cause growth velocity reduction with extended use; monitor closely if on prolonged therapy
Administration
<5 years: Use with spacer device is not recommended
Geriatric dosage forms and strengths
Start at lower end of dosing range due to increased risk of adverse effects
Qvar (beclomethasone, inhaled) adverse (side) effects
>10%
Pharyngitis (5-27%)
Headache (8-25%)
URI (5-11%)
1-10%
Rhinitis (3-7%)
Pain (1-5%)
Increased asthma symptoms (2-4%)
Dysphonia (1-4%)
Sinusitis (3%)
Oral symptoms (2-3%)
Nausea (1-2%)
Postmarketing Reports
Psychiatric events and behavioral changes (eg, aggression, depression, sleep disorders, psychomotor hyperactivity, and suicidal ideation [primarily in children])
Warnings
Contraindications
Hypersensitivity
Primary treatment of status asthmaticus, acute bronchospasm
Cautions
Respiratory tract TB
Untreated fungal or bacterial infections
Viral/parasitic infections
Ocular herpes simplex
Nasal septum perforation
Wheezing
Cataracts
Glaucoma
Increased IOp
Risk for more serious or fatal course of chickenpox or measles in susceptible patients (eg, unvaccinated or immunologically unexposed individuals); care must be taken to avoid exposure
Deaths have occurred due to adrenal insufficiency following abrupt withdrawal of oral steroids; taper withdrawal gradually
May decrease growth velocity in children
Immunocompromised patients
Risk of infections of nose and pharynx, including Candida albicans; must rinse mouth after inhalation to reduce risk
Risk of bronchospasm with immediate increase in wheezing after administration; if this occurs, discontinue therapy and administer SABA immediately
Excessive use may suppress HPA function; monitor closely, especially postoperatively or during periods of stress
During periods of stress or severe status asthmaticus, may require supplementary systemic corticosteroids immediately; patient should carry warning card indicating possible need for supplementary systemic steroids in such emergencies
Switching from systemic steroids to therapy may unmask allergic conditions (eg, conjunctivitis, eczema, rhinitis)
Prolonged corticosteroid use may result in elevated IOP, glaucoma, and/or cataracts
Not a bronchodilator; should not be administered for rapid relief of acute bronchospasm
Pregnancy and lactation
Pregnancy category: C
Lactation: Potential for excretion into milk; use only if benefits greatly outweigh risks
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 Qvar (beclomethasone, inhaled)
Mechanism of action
Potent anti-inflammatory glucocorticoid; inhibits inflammatory cells and release of inflammatory mediators
Absorption
Bioavailability: 20% systemic
Onset: 1-3 weeks
Duration: 6 hr
Peak plasma concentration: 88 pg/mL
Distribution
Protein binding: 94-96% over concentration range of 1000-5000 pg/mL
Metabolism
Prodrug; rapidly activated by hydrolysis to active monoester (17-BMP)
Liver (CYP450-3A)
Elimination
Half-life: 30 minutes (17-BMP: 2.8 hr)
Excretion: Feces (major), urine (<10%)
