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Beclomethasone (nasal): Drug information

Beclomethasone (nasal): Drug information
(For additional information see "Beclomethasone (nasal): Patient drug information" and see "Beclomethasone (nasal): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Beconase AQ [DSC];
  • Qnasl;
  • Qnasl Childrens
Brand Names: Canada
  • APO-Beclomethasone AQ;
  • MYLAN-Beclo AQ
Pharmacologic Category
  • Corticosteroid, Nasal
Dosing: Adult

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

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

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

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.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Beclomethasone (nasal): Pediatric drug information")

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

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, vasomotor rhinitis

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

Allergic rhinitis

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

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

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

Contraindications

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.

Warnings/Precautions

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.

Dosage Forms Considerations

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.

Dosage Forms: US

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]

Generic Equivalent Available: US

No

Pricing: US

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.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Nasal:

Generic: 50 mcg/actuation (1 ea, 22 mL)

Administration: Adult

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.

Administration: Pediatric

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.

Use: Labeled Indications

Nasal polyps, postsurgical prophylaxis (Beconase AQ only): Prevention of recurrence of nasal polyps following surgical removal in adults and children 6 years and older.

Rhinitis, allergic:

Beconase AQ: Relief of symptoms of seasonal or perennial allergic rhinitis in adults and children 6 years and older.

Qnasl: Treatment of the nasal symptoms associated with seasonal or perennial allergic rhinitis in adults and children 4 years and older.

Rhinitis, nonallergic: Beconase AQ: Relief of symptoms of nonallergic rhinitis in adults and children 6 years and older.

Use: Off-Label: Adult

Acute bacterial rhinosinusitis, adjunct to antibiotics (empiric treatment); Chronic Rhinosinusitis

Metabolism/Transport Effects

None known.

Drug Interactions

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

Pregnancy Considerations

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).

Breastfeeding Considerations

It is not known if sufficient quantities of beclomethasone are absorbed following intranasal inhalation to produce detectable amounts in breast milk.

Systemic corticosteroids are present in human milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Monitoring Parameters

Growth (adolescents and children); signs/symptoms of HPA axis suppression/adrenal insufficiency or hypercortisolism; ocular changes, including glaucoma and cataracts; signs/symptoms of Candida infection (long-term therapy); nasal effects (eg, epistaxis, nasal discomfort, nasal septal perforation, nasal ulcerations).

Mechanism of Action

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

Pharmacokinetics (Adult Data Unless Noted)

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)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Beclomet aqua;
  • (AU) Australia: Aldecin aqueous | Beconase | Beconase allergy & hayfever 12 hour | Beconase aqueous;
  • (BD) Bangladesh: Beconase AQ | Becospray | Decomit;
  • (BE) Belgium: Beclometatop | Beconase;
  • (BF) Burkina Faso: Humex rhume des foins a la beclometasone;
  • (BG) Bulgaria: Beconase;
  • (BR) Brazil: Beclosol aquoso | Clenil nasal aquoso;
  • (CH) Switzerland: Beconase | Beconasol;
  • (CL) Chile: Beconase;
  • (CO) Colombia: Beclometasona | Beclometasona dipropionato | Beclomex | Beclort aqua | Beconase AQ | Rinoclenil;
  • (CZ) Czech Republic: Beclomet | Nasobec;
  • (DE) Germany: Beclomet | Beclometason | Beclometason ct | Beconase | Otri allergie | Otriven Allergie Aktiv mit Beclometason | Ratioallerg;
  • (DK) Denmark: Becotide;
  • (DO) Dominican Republic: Aldecina | Beconase;
  • (EC) Ecuador: Beconase aqua;
  • (EE) Estonia: Beclonasal | Beconase | Nasobec;
  • (EG) Egypt: Beclo;
  • (FI) Finland: Beclonasal | Beconase;
  • (FR) France: Beclo Rhino | Beconase | Humex rhume des foins a la beclometasone | Rinoclenil;
  • (GB) United Kingdom: Beclo aqua | Beclometasone | Beclomethasone | Beclomethasone cox | Beclomist | Beconase | Beconase Hayfever | Boots hayfever & allergy relief | Hayfever Relief | Nasobec aqueous | Nasobec hayfever | Rino clenil aqueou | Vivabec | Zonivent;
  • (GR) Greece: Iriniozol | Rinosol;
  • (HK) Hong Kong: Aldecin | Beclate | Beconase | Nasobec;
  • (HU) Hungary: Beclonasal aqua;
  • (ID) Indonesia: Beclomet | Beconase;
  • (IE) Ireland: Beclo Rhino | Beclomethasone Dipropionate | Beconase | Beconase allergy | Beconase Hayfever | Nasobec;
  • (IL) Israel: Beconase;
  • (IN) India: Beclate | Beclate aquanase | Econase;
  • (IT) Italy: Rino Clenil | Rinoclenil;
  • (JP) Japan: Albezon | Aldecin | Alroyer | Beclometasone | Becloze aq | Espetat aq | Espetat aq maruko | Espetat aq merck hoei | Espetat aq teikoku | Espetat aq yoshindo | Espetat aq zensei | Mily | Mily merck hoei | Nanadora | Nazal alpha AR C | Penbulin | Taunus | Taunus amel | Taunus aqua | Taunus nikken;
  • (KE) Kenya: Beclate aquanase | Becort aquanase | Decomit;
  • (KR) Korea, Republic of: Beconase | Nasobec aqueous | Rinoclenil;
  • (LB) Lebanon: Beconase | Rinoclenil;
  • (LT) Lithuania: Beclomet aqua | Beclonasal | Beconase;
  • (LU) Luxembourg: Beconase;
  • (LV) Latvia: Beclate aquanase | Beclonasal | Beconase;
  • (MA) Morocco: Beconase;
  • (MX) Mexico: Beclometasona | Beconase | Beconase aqua | Rinoclenil;
  • (MY) Malaysia: Apo-beclomethasone | Beclate | Beclomet | Beconase | Belax | Rino Clenil;
  • (NL) Netherlands: Beclometason | Beclometason Nevel | Beconase | Beconase aqueous nevel | Beconase nevel | Viarin;
  • (NO) Norway: Becotide;
  • (NZ) New Zealand: Alanase aqueous | Aldecin aqueous | Atomase | Becloclear | Beconase;
  • (PE) Peru: Beconase aqua | Rinoclenil;
  • (PH) Philippines: Beconase;
  • (PK) Pakistan: Beclo Rino | Gnadion;
  • (PL) Poland: Beconase | Nasobec;
  • (PR) Puerto Rico: Beconase AQ | Qnasl | Vancenase AQ;
  • (PT) Portugal: Beconase;
  • (PY) Paraguay: Rinosol;
  • (QA) Qatar: Beclocort | Beconase Aqueous Spray | Nasobec Aqueous Spray | Rinobek;
  • (RU) Russian Federation: Aldecin | Beclometasone orion | Beclomethasone orion pharma | Beconase | Nasobec;
  • (SA) Saudi Arabia: Apo-beclomethasone | Rinoclenil;
  • (SE) Sweden: Becotide;
  • (SG) Singapore: Beconase | Decomit;
  • (SI) Slovenia: Beconase;
  • (SK) Slovakia: Nasobec;
  • (TH) Thailand: Beclate | Beclomet | Beclomet nasal aqua | Beclomet nasal aqua spray | Beclomethasone jewim | Beconase aqueous nasal spray | Bemase | Dipronase | Rino Clenil | Rinoclenil;
  • (TR) Turkey: Beclomax | Beclosp | Beconase | Beklomil | Nazobec | Rinobek | Rinoclenil | Rinomil | Zonabec;
  • (TW) Taiwan: Aldecin | Beclomet | Beconase | Becoton | Belax | Betonase aqueous | Nosecone;
  • (UA) Ukraine: Beclometasone | Beconase;
  • (UG) Uganda: Beclate;
  • (VE) Venezuela, Bolivarian Republic of: Beconase AQ | Nasair acuoso | Rinoclenil | Rinoclenil acuoso;
  • (VN) Viet Nam: Meclonate;
  • (ZA) South Africa: Anceron | Beclate | Beconase | Ciplanaze multicare | Clenil | Nobec | Rolab-beclomethasone | Ventnaze | Viarox | Viarox aq;
  • (ZM) Zambia: Clenil;
  • (ZW) Zimbabwe: Beclate | Beclate aquanase
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