beclomethasone dipropionate
(be kloe meth' a sone)
Apo-Beclomethasone (CAN), Beclodisk (CAN), Becloforte Inhaler (CAN), Beclovent Rotacaps (CAN), Beconase AQ, Propaderm (CAN), QVAR
Pregnancy Category C
Drug classes
Corticosteroid
Glucocorticoid
Hormone
Therapeutic actions
Anti-inflammatory effects; local administration into lower respiratory tract or nasal passages maximizes beneficial effects on these tissues while decreasing the likelihood of adverse corticosteroid effects from systemic absorption.
Indications
· Respiratory inhalant use: Control of bronchial asthma that requires corticosteroids along with other therapy
· Intranasal use: Relief of symptoms of seasonal or perennial rhinitis that respond poorly to other treatments; prevention of recurrence of nasal polyps following surgical removal
Contraindications and cautions
· Respiratory inhalant therapy: Contraindicated with acute asthmatic attack, status asthmaticus. Use caution with systemic fungal infections (may cause excerbations), allergy to any ingredient, lactation
· Intranasal therapy: Use caution with untreated local infections (may cause exacerbations); nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma (interferes with healing); lactation
Available forms
Aerosol—40 mcg/actuation, 80 mcg/actuation; nasal spray—0.042%
Dosages
Respiratory inhalant use
ADULTS AND CHILDREN > 11 YR
40–160 mcg bid. Do not exceed 320 mcg/bid.
PEDIATRIC PATIENTS 5–11 YR
40 mcg bid. Do not exceed 80 mcg bid.
PEDIATRIC PATIENTS < 5 YR
Do not use.
Intranasal therapy
Each actuation delivers 42 mcg. Discontinue therapy after 3 wk if no significant symptomatic improvement.
ADULTS AND CHILDREN > 11 YR
One to two inhalations (42–84 mcg) in each nostril bid (total dose 168–336 mcg/day).
PEDIATRIC PATIENTS 6–11 YR
One inhalation in each nostril bid. Total dose, 168 mcg. With more severe symptoms, may increase to two inhalation in each nostril bid (336 mcg).Pharmacokinetics
Route | Onset | Peak |
Inhalation | Rapid | 1–2 wk |
Metabolism: Lungs, GI, and liver; T1/2: 3–15 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Feces
Adverse effects
Respiratory inhalant use
· Endocrine: Cushing's syndrome with overdose, suppression of hypothalamic-pituitary-adrenal (HPA) function due to systemic absorption
· Local: Oral, laryngeal, pharyngeal irritation, fungal infections
Intranasal use
· Local: Nasal irritation, fungal infections
· Respiratory: Epistaxis, rebound congestion, perforation of the nasal septum, anosmia
· Other: Headache, nausea, urticaria
Nursing considerations
Assessment
· History: Acute asthmatic attack, status asthmaticus; systemic fungal infections; allergy to any ingredient; lactation; untreated local infections, nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma
· Physical: Weight, T; P, BP, auscultation; R, adventitious sounds; chest radiograph before respiratory inhalant therapy; examination of nares before intranasal therapy
Interventions
· WARNING: Taper systemic steroids carefully during transfer to inhalational steroids; deaths resulting from adrenal insufficiency have occurred during and after transfer from systemic to aerosol steroids.
· Use decongestant nose drops to facilitate penetration of intranasal steroids if edema, excessive secretions are present.
Teaching points
· This respiratory inhalant has been prescribed to prevent asthmatic attacks, not for use during an attack.
· Allow at least 1 minute between puffs (respiratory inhalant); if you also are using an inhalational bronchodilator (isoproterenol, albuterol, metaproterenol, epinephrine), use it several minutes before using the steroid aerosol.
· Rinse your mouth after using the respiratory inhalant aerosol.
· Use a decongestant before the intranasal steroid, and clear your nose of all secretions if nasal passages are blocked; intranasal steroids may take several days to produce full benefit.
· Use this product exactly as prescribed; do not take more than prescribed, and do not stop taking the drug without consulting your health care provider. The drug must not be stopped abruptly but must be slowly tapered.
· You may experience these side effects: Local irritation (use the device correctly), headache (consult your health care provider for treatment).
· Report sore throat or sore mouth.
Adverse effects in Italic are most common; those in Bold are life-threatening.
1 comments:
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Beclovent
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