beclomethasone dipropionate
Brand: QVAR RediHaler, Beconase AQ (nasal)
Prototype: fluticasone propionate
Drug Class: inhaled corticosteroid (ICS)
Drug Family: corticosteroid
Subclass: synthetic glucocorticoid — low-potency ICS
Organ Systems: respiratory
Mechanism of Action
Prodrug hydrolyzed to active beclomethasone-17-monopropionate (17-BMP) by airway esterases; 17-BMP binds glucocorticoid receptors in bronchial mucosa with high local potency, suppressing eosinophilic airway inflammation, reducing mucus secretion, and decreasing airway hyperresponsiveness.
glucocorticoid receptor (GR)airway inflammatory cells
Indications
- persistent asthma (all severity levels, maintenance therapy)
- allergic rhinitis (nasal formulation)
Contraindications
- acute bronchospasm or status asthmaticus
- hypersensitivity to beclomethasone
Adverse Effects
Common
- oropharyngeal candidiasis
- dysphonia
- throat irritation
- cough
Serious
- adrenal suppression (prolonged high-dose use)
- growth suppression in children
- osteoporosis
- increased intraocular pressure
Pharmacokinetics (ADME)
| Absorption | inhaled; extrafine QVAR particles deposit in small airways; systemic bioavailability approximately 11-15% |
| Distribution | prodrug rapidly converted to 17-BMP in airway tissues |
| Metabolism | airway esterase conversion to active 17-BMP; hepatic CYP3A4 further metabolizes to beclomethasone and 21-carboxylic acid |
| Excretion | fecal (~60%) and renal (~10%) |
| Half-life | approximately 2.7 hours (17-BMP) |
| Onset | anti-inflammatory effect within days |
| Peak | 0.3-0.7 hours (systemic) |
| Duration | 12 hours (twice-daily dosing) |
| Protein Binding | 87% |
| Vd | approximately 20 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| strong CYP3A4 inhibitors | increase systemic beclomethasone/17-BMP exposure; risk of adrenal suppression | moderate |
| ritonavir (and other HIV protease inhibitors) | potent CYP3A4 inhibition can cause cushingoid features and adrenal suppression with ICS | major |
Nursing Considerations
- Instruct patients to rinse mouth with water after each puff and spit to reduce oropharyngeal candidiasis and systemic absorption from swallowed drug; QVAR RediHaler is breath-actuated and simplifies technique.
- QVAR extrafine particle formulation reaches smaller airways at lower doses than conventional CFC-based beclomethasone; dose conversion is required when switching formulations — do not assume 1:1 equivalence.
- Monitor growth in pediatric patients receiving ICS therapy; use the lowest effective dose to minimize systemic corticosteroid burden.
- Counsel patients that ICS therapy is preventive, not rescue; regular use reduces frequency and severity of asthma attacks but will not relieve acute bronchospasm — ensure a SABA rescue inhaler is prescribed.
Clinical Pearls
- Beclomethasone was the first ICS developed for asthma (introduced in 1972), establishing the principle that topical airway corticosteroids could provide inflammation control with minimal systemic exposure at appropriate doses.
- The extrafine HFA formulation of beclomethasone (QVAR) delivers particles to peripheral airways below 5 microns and provides effective asthma control at approximately half the microgram dose of older CFC formulations — patients switching between formulations must have doses adjusted.
Safety Profile
Pregnancy safe
Lactation generally-safe
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.