Beclomethasone
QVAR
What it isInhaled or intranasal corticosteroid; asthma and allergic rhinitis.
Why this oneThe smallest particle size of the inhaled steroids, so it reaches the small airways.
What limits itOral candidiasis when inhaled — rinse afterwards. Controller only.
FDA-approved for
- asthma maintenance
- allergic rhinitis
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Asthma — maintenance/prophylactic therapy | Adults & adolescents ≥12 yr | 40-80 mcg BID (ICS-naive); 40, 80, 160, or 320 mcg BID if switching from another ICS (match prior ICS strength/severity) | Lowest effective dose; doses ~12 h apart | 320 mcg BID |
| Asthma — maintenance/prophylactic therapy | Peds 4-11 yr | 40 mcg BID | May increase to 80 mcg BID if inadequate response after 2 weeks | 80 mcg BID |
Titration If inadequate response after 2 weeks at initial dosage, increasing the dosage may provide additional control
Renal Undefined
Hepatic Undefined
Maximum benefit may take 3-4 weeks of therapy
Instructions
- Oral inhalation only, ~12 hours apart; rinse mouth with water without swallowing after use (reduces oropharyngeal candidiasis)
- Do NOT use with a spacer or volume holding chamber
- No priming required; do not shake; never wash or put inhaler in water
- Discard when dose counter displays 0 or at expiration, whichever first
- Titrate downward over time to lowest dose that maintains control (especially children — growth effects)
Contraindications
- Primary treatment of status asthmaticus or other acute asthma episodes requiring intensive measures
Cautions
- Not for relief of acute bronchospasm/rescue; re-evaluate immediately in rapidly deteriorating asthma
- Oropharyngeal candidiasis — rinse mouth; treat with antifungals if it develops
- Adrenal insufficiency when transferring from systemic corticosteroids (deaths have occurred) — wean systemic steroids slowly; resume oral corticosteroids during stress or severe attack
- Immunosuppression: risk of worsening TB, fungal/bacterial/viral/parasitic infections, ocular herpes simplex; chickenpox or measles may be serious or fatal in susceptible patients
- Paradoxical bronchospasm — treat immediately with SABA and discontinue
- Hypercorticism/adrenal suppression at very high doses or in susceptible individuals
- Monitor growth in pediatric patients (reduced growth velocity ~0.5 cm/yr observed)
- Decreased bone mineral density — monitor patients with major risk factors
- Glaucoma and cataracts — monitor with vision changes or relevant history
Adverse reactions
- Oral candidiasis (up to 3-8% at higher doses)
- Upper respiratory tract infection, nasopharyngitis, sinusitis, allergic rhinitis
- Oropharyngeal pain
- 1-3%: back pain, headache, pain, nausea, cough
Pregnancy No adequate human studies; published data (incl. large birth registries) show no increase in malformations with ICS; poorly controlled asthma increases preeclampsia, prematurity, low-birth-weight risk — maintain optimal control
Lactation No data on beclomethasone in human milk; other inhaled corticosteroids detected in milk; weigh benefits of breastfeeding against maternal need and infant risk
NO BOXED WARNINGS
Principal riskOral candidiasis when inhaled
Cost, est. cash$300–$2,500/month
Generic entry2041 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.
Mechanism of action: Beclomethasone ballicule
