Note: Product formulations are not interchangeable: Beconase AQ: One spray delivers 42 mcg; Qnasl: One spray delivers 40 mcg or 80 mcg
Nasal airway obstruction/adenoidal hypertrophy: Limited data available; dosing regimens variable: Intranasal: Beconase AQ (42 mcg/spray): Children 5 to 12 years: Initial: 2 sprays (84 mcg) per nostril twice daily (total dose: 336 mcg daily) for 4 weeks, followed by 1 spray (42 mcg) per nostril twice daily (total dose: 168 mcg daily). Dosing based on a double-blind, placebo-controlled crossover study (n=17, age range: 5 to 11 years); results showed significant reduction in adenoid hypertrophy and related obstructive nasal symptoms following 4 weeks of beclomethasone therapy vs placebo (Demain 1995). Positive efficacy findings were also observed in a single-blind, placebo-controlled crossover study of 53 children (mean age: 3.8 ± 1.3 years) using a total daily dose of 400 mcg/day (200 mcg twice daily [using 50 mcg/spray formulation, not available in US]) delivered as 100 mcg (2 sprays) per nostril twice daily (Ref). Lower daily dosage (200 mcg/day) have not been found effective (Ref).
Nasal polyps (postsurgical prophylaxis), vasomotor rhinitis: Intranasal: Beconase AQ (42 mcg/spray):
Children 6 to 12 years: Initial: 1 spray (42 mcg) per nostril twice daily (total dose: 168 mcg daily); if response inadequate, may increase to 2 sprays (84 mcg) per nostril twice daily (total dose: 336 mcg daily); once symptoms are adequately controlled, decrease dose to 1 spray (42 mcg) per nostril twice daily (total dose: 168 mcg daily).
Children and Adolescents ≥12 years: 1 or 2 sprays (42 mcg or 84 mcg) per nostril twice daily (total dose: 168 to 336 mcg daily); maximum daily dose: 336 mcg/day
A llergic r hinitis : Intranasal:
Beconase AQ (42 mcg/spray):
Children 6 to <12 years: Initial: 1 spray (42 mcg) per nostril twice daily (total dose: 168 mcg daily); if response inadequate, may increase to 2 sprays (84 mcg) per nostril twice daily (total dose: 336 mcg daily); once symptoms are adequately controlled, decrease dose to 1 spray (42 mcg) per nostril twice daily (total dose: 168 mcg daily).
Children ≥12 years and Adolescents: 1 or 2 sprays (42 mcg or 84 mcg) per nostril twice daily (total dose: 168 to 336 mcg daily); maximum daily dose: 336 mcg/day.
Qnasl:
Children 4 to <12 years: Qnasl 40 mcg: 1 spray (40 mcg) per nostril once daily (total dose: 80 mcg/day); maximum daily dose: 80 mcg/day.
Children ≥12 years and Adolescents: Qnasl 80 mcg: 2 sprays (160 mcg) per nostril once daily (total daily dose: 320 mcg/day); maximum daily dose: 320 mcg/day
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Beclomethasone (nasal): Drug information")
Note: For patients with mucous crusting, rinsing with saline nasal spray before administration can remove mucous crusting and improve nasal coating (Ref). If nasal obstruction is so severe that sprays cannot penetrate when treating rhinitis, consider concomitant use of an intranasal decongestant for up to 5 days (Ref).
Allergic rhinitis:
Beconase AQ: Intranasal: 1 or 2 inhalations (42 or 84 mcg) in each nostril twice daily; total dose: 168 to 336 mcg/day.
Qnasl: Intranasal: 2 inhalations (160 mcg) in each nostril once daily (maximum: 320 mcg/day).
Nasal polyps (postsurgical prophylaxis): Beconase QA: Intranasal: 1 or 2 inhalations (42 or 84 mcg) in each nostril twice daily; total dose: 168 to 336 mcg/day.
Nonallergic rhinitis: Beconase AQ: Intranasal: 1 or 2 inhalations (42 or 84 mcg) in each nostril twice daily; total dose: 168 to 336 mcg/day.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not always defined.
>10%: Respiratory: Nasopharyngitis (≤24%; children: 2%), epistaxis (2% to 11%)
1% to 10%:
Central nervous system: Dizziness (≤5%), headache (≤5%)
Endocrine & metabolic: Adrenal suppression (at high doses or in susceptible individuals), hypercorticoidism (at high doses or in susceptible individuals)
Gastrointestinal: Nausea (≤5%), oral candidiasis (rare; more likely with aqueous solution)
Immunologic: Immunosuppression
Neuromuscular & skeletal: Decreased linear skeletal growth rate
Ophthalmic: Intraocular pressure increased (5%), lacrimation (≤3%)
Respiratory: Sneezing (4%), upper respiratory tract infection (children: 3%), nasal congestion (≤3%), rhinorrhea (≤3%), nasal mucosa irritation (erosion) (≤1%), nasal candidiasis (rare; more likely with aqueous solution), pharyngeal candidiasis (rare; more likely with aqueous solution)
Miscellaneous: Fever (children: 3%), wound healing impairment
<1%, postmarketing, and/or case reports: Ageusia, altered sense of smell, anaphylactoid reaction, anaphylaxis, angioedema, anosmia, blurred vision, bronchospasm, burning sensation, cataract, chorioretinitis, dry nose, glaucoma, hypersensitivity reaction, nasal mucosa ulcer, nasal septum perforation, skin rash, unpleasant taste, urticaria, wheezing
Hypersensitivity to beclomethasone or any component of the formulation
Canadian labeling: Additional contraindications (not in US labeling): Tuberculosis (TB) infection (latent TB) or disease (active TB), or untreated fungal, bacterial and viral infections.
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Adult patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.
• Delayed wound healing: Avoid nasal corticosteroid use in patients with recent nasal septal ulcers, nasal surgery or nasal trauma until healing has occurred.
• Hypersensitivity reactions: Hypersensitivity reactions (including anaphylaxis, angioedema, rash, urticaria, and wheezing) have been reported; discontinue for severe reactions.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infections, mask an acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines; avoid exposure to chickenpox and/or measles, especially if not immunized. Avoid use or use with caution in patients with tuberculosis (TB) infection (latent TB) or disease (active TB), untreated bacterial or fungal infections (local or systemic), viral or parasitic infections, or ocular herpes simplex.
• Local nasal effects: Nasal septal perforation and localized Candida albicans infections of the nose and/or pharynx may occur. Nasal discomfort, epistaxis, and nasal ulceration may also occur; periodically examine nasal mucosa in patients on long-term therapy. Monitor patients for adverse nasal effects; discontinuation of therapy may be necessary if an infection occurs.
• Ocular disease: Increased intraocular pressure, open-angle glaucoma, and/or cataracts have occurred with intranasal corticosteroid use; use with caution in patients with a history of increased intraocular pressure, cataracts and/or glaucoma. Consider routine eye exams in chronic users or in patients who report visual changes.
Special populations:
• Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercortisolism (Cushing syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).
Other warnings/precautions:
• Appropriate use: Rhinitis: Do not use in the presence of untreated localized infection involving the nasal mucosa. Do not continue use beyond 3 weeks in the absence of significant symptomatic improvement. Symptomatic relief may not occur for as long as 2 weeks.
• Appropriate use: Nasal polyps: Treatment may need to be continued for several weeks or more before a therapeutic result can be fully assessed. Treatment of nasal polyps with beclomethasone should be considered adjunctive therapy to surgical removal and/or the use of other medications that will permit effective penetration of beclomethasone into the nose. Recurrence can occur after stopping treatment.
Beconase AQ 25 g canisters contain 180 sprays.
Qnasl 6.8 g canisters contains 60 actuations and the 10.6 g canisters contain 120 actuations.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol Solution, Nasal, as dipropionate:
Qnasl: 80 mcg/actuation (10.6 g)
Qnasl Childrens: 40 mcg/actuation (6.8 g)
Suspension, Nasal, as dipropionate:
Beconase AQ: 42 mcg/spray (25 g [DSC]) [contains benzalkonium chloride]
No
Aerosol solution (Qnasl Childrens Nasal)
40 mcg/ACT (per gram): $53.72
Aerosol solution (Qnasl Nasal)
80 mcg/ACT (per gram): $34.46
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension, Nasal:
Generic: 50 mcg/actuation (1 ea, 22 mL)
When used short term as adjunctive therapy in acute bacterial rhinosinusitis (ABRS), intranasal steroids show modest symptomatic improvement and few adverse effects; improvement is primarily due to increased sinus drainage. Use should be considered optional in ABRS; however, intranasal corticosteroids should be routinely prescribed to ABRS patients who have a history of or concurrent allergic rhinitis (Chow 2012).
For intranasal use only. Shake well prior to each use. Blow nose to clear nostrils. Insert applicator into nostril, keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray. Avoid spraying directly onto the nasal septum or into eyes. Discard after the "discard by" date or after labeled number of doses has been used, even if bottle is not completely empty.
Beconase AQ: Prior to initial use, prime pump 6 times (or until fine spray appears); repeat priming if product not used for ≥7 days. Nasal applicator and dust cap may be washed in warm water and dried thoroughly.
Qnasl: Spray in nostril(s); avoid spraying in eyes or mouth. Do not blow nose for 15 minutes following administration. Do not wash or put any part of canister or actuator in water; wipe nasal tip with clean, dry tissue or cloth.
Beconase AQ: Shake well prior to each use. Prior to initial use, prime pump 6 times (or until fine spray appears); repeat priming if product not used for ≥7 days. Spray in nostril(s); avoid spraying in eyes or mouth. Nasal applicator and dust cap may be washed in warm water and dry thoroughly.
Qnasl: Spray in nostril(s); avoid spraying in eyes or mouth.
Beconase AQ: Store between 15°C to 30°C (59°F to 86°F).
Qnasl: Store between 20°C and 25°C (68°F and 77°F), excursions permitted to 15°C to 30°C (59°F to 86°F). Do not puncture. Do not store near heat or open flame. Do not expose to temperatures higher than 49°C (120°F).
Beconase AQ: Management of nasal symptoms associated with seasonal or perennial allergic and nonallergic (vasomotor) rhinitis and prevention of recurrence of nasal polyps following surgical removal (FDA approved in ages ≥6 years and adults)
Qnasl: Management of nasal symptoms associated with seasonal and perennial allergic rhinitis (FDA approved in ages ≥4 years and adults)
Intranasal corticosteroids have also been used for the following: As an adjunct to antibiotics in empiric treatment of acute bacterial rhinosinusitis primarily in patients (adolescents and adults) with a history of allergic rhinitis (AAP [Wald 2013]; Chow 2012); however, data in children showing adjunct therapy is beneficial are less conclusive (AAP [Wald 2013]); in pediatric patients with mild obstructive sleep apnea syndrome who cannot undergo adenotonsillectomy or who still have symptoms after surgery (Marcus 2012); and for children with nasal obstruction caused by adenoidal hypertrophy.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Esketamine: Corticosteroids (Nasal) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal corticosteroid on an esketamine dosing day should administer the nasal corticosteroid at least 1 hour before esketamine. Risk D: Consider therapy modification
Intranasal corticosteroids may be acceptable for the treatment of rhinitis during pregnancy when used at recommended doses (Lal 2016).
Pregnant females adequately controlled on beclomethasone may continue therapy; if initiating treatment during pregnancy, use of an agent with more data in pregnant females and less systemic absorption may be preferred (Alhussien 2018; Namazy 2016).
Mucous membranes for signs of fungal infection, growth (pediatric patients), signs/symptoms of HPA axis suppression/adrenal insufficiency; ocular changes
Controls the rate of protein synthesis; depresses the migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation
Onset of action: Within a few days up to 2 weeks
Distribution: Beclomethasone dipropionate (BDP): 20 L; Beclomethasone-17-monopropionate (17-BMP): 424 L
Protein binding: BDP 87%; 17-BMP: 94% to 96%
Metabolism: BMP is a prodrug (inactive); undergoes rapid conversion to 17-BMP (major active metabolite) during absorption; followed by additional metabolism via CYP3A4 to other, less active metabolites (beclomethasone-21-monopropionate [21-BMP] and beclomethasone [BOH])
Bioavailability: 17-BMP: 44% (43% from swallowed portion)
Half-life elimination: BDP: 0.5 hours; 17-BMP: 2.7 hours
Excretion: Feces (60%); urine (<10% to 12%; as free and conjugated metabolites)
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟