Names and pronunciation
Beconase AQ, Beclovent , Rivanase AQ, Vanceril
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Drug reference
Beconase AQ, Beclovent , Rivanase AQ, Vanceril
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Func. class.: Antiasthmatic
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Chem. class.: Corticosteroid
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Do not confuse: beclomethasone/betamethasone
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ACTION: Prevents inflammation by sup- pression of the migration of polymorpho- nuclear leukocytes, fibroblasts, and the reversal of increased capillary permeability and lysosomal stabilization; does not sup- press hypothalamus and pituitary function
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USES: Chronic asthma, allergic/vaso- motor rhinitis, nasal polyps
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CONTRAINDICATIONS: Hyper- sensitivity, status asthmaticus (primary treatment) Precautions: Pregnancy, breastfeeding, children <12 yr, nasal disease/surgery, nonasthmatic bronchial disease; bacterial, fungal, viral infections of mouth, throat, lungs; HPA suppression, osteoporosis, Cushing’s syndrome, diabetes mellitus, measles, cataracts, corticosteroid hyper- sensitivity, glaucoma, herpes infection
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SIDE EFFECTS CNS: Headache, psychiatric/behavioral changes (child) EENT: Hoarseness, candidal infection of oral cavity, sore throat, loss of taste/smell, dysgeusia, pharyngitis, rhinitis, sinusitis, cataracts, fungal infections, epistaxis ENDO: HPA suppression GI: Dry mouth, dyspepsia MISC: Angioedema, adrenal insuffi- ciency, facial edema, Churg-Strauss syn- drome (rare) RESP: Bronchospasm, wheezing, cough Nasal CNS: Headache, dizziness EENT: Nasal burning/irritation, sneezing GI: Dry mouth, esophageal candidiasis RESP: Cough
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DOSAGE AND ROUTES Chronic asthma • Adult and child >12 yr: INH 40-80 mcg bid (alone) or 40-160 mcg bid (previous inhaled corticosteroids); max 320 mcg bid; Nasal: 1-2 sprays in each nostril bid B • Child 4-11 yr: INH 40 mcg bid; max 80 mcg bid; Nasal 1-2 sprays in each nostril bid Seasonal, perennial rhinitis; nasal polyp recurrence • Adult/child ≥12 yr: Nasal 1-2 sprays in each nostril bid • Child 6-12 yr: Nasal 1 spray in each nostril bid, may increase to 2 sprays bid as needed, decrease to 1 spray each nostril bid after symptoms are controlled
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Available forms: Oral inhalation 40, 80/actuation; nasal suspension 42 mcg/ spray
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Administer: • Oral inhalation: No shaking, spacer, or priming needed • Nasal: Shake, invert, tilt head back- ward, insert nozzle into nostril, compress activator, inhale through nose, exhale through mouth
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Assess: • Bronchospasm: use short-acting bron chodilator • Fungal infections: assess mucous membranes often for infection • Adrenal function periodically for HPA axis suppression during pro- longed therapy; monitor growth/devel- opment, taper corticosteroids • Vision changes: monitor for vision changes, cataracts may occur • Decreased bone density; monitor with bone density test • Bronchospasm: discontinue immedi- ately and treat with short-acting broncho- dilator • Provide gum, rinsing of mouth for dry mouth • Beers: avoid in older adults; high risk of delirium
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Evaluate: • Therapeutic response: decreased dys- pnea, wheezing, dry crackles; nasal pol- yps are reduced
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take as prescribed, not to double or skip doses, not to use for acute asthma • To gargle/rinse mouth after each use to prevent oral fungal infections • To notify prescriber if therapeutic re- sponse decreases; dosage adjustment may be needed • Proper administration technique and cleaning technique, no need to prime • About all aspects of product usage, including cushingoid symptoms • About adrenal insufficiency symp- toms: nausea, anorexia, fatigue, dizzi- ness, dyspnea, weakness, joint pain, de- pression • To check growth in child on long-term therapy • To taper PO products before starting inhalation products • That peak response may take up to 1 mo • To carry medical alert ID with cortico- steroid user listed • Not be used to treat acute bronchospasm • Allergic reaction: To inform health care professional of rash; itching; swell- ing of face, lips; trouble breathing • Pregnancy/breastfeeding: To notify prescriber if pregnancy is planned or suspected; may breastfeed
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PHARMACOKINETICS INH: Onset 1-4 wk, peak ½ hr; duration unknown; excreted in feces, urine (metabolites); half-life 2.8 hr; crosses placenta; metabolized in lungs, liver (by CYP3A)
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• Adult and child >12 yr: INH 40-80 mcg bid (alone) or 40-160 mcg bid (previous inhaled corticosteroids); max 320 mcg bid; Nasal: 1-2 sprays in each nostril bid B
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• Child 4-11 yr: INH 40 mcg bid; max 80 mcg bid; Nasal 1-2 sprays in each nostril bid Seasonal, perennial rhinitis; nasal polyp recurrence
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• Adult/child ≥12 yr: Nasal 1-2 sprays in each nostril bid
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• Child 6-12 yr: Nasal 1 spray in each nostril bid, may increase to 2 sprays bid as needed, decrease to 1 spray each nostril bid after symptoms are controlled
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