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Wednesday, July 23, 2025

Beclometasone nasal spray


Beclometasone nasal spray is a topical intranasal corticosteroid (INCS) used for the treatment and prevention of nasal inflammation associated with allergic and non-allergic rhinitis. It exerts potent local anti-inflammatory effects in the nasal mucosa with minimal systemic absorption, making it suitable for long-term use in chronic nasal conditions.

Brand Names

Beclometasone nasal spray is marketed under several brand and generic names globally, including:

  • Beconase AQ®

  • Beclonase®

  • Rhinoclenil®

  • Vancenase® (discontinued in many markets)

  • Nasobec®

  • Qnasl® (dry aerosol form, US)

  • Abeclo, Beclorhinol, Beclo AQ

Available formulations include:

  • Aqueous nasal spray (most common): 50 micrograms/spray

  • Pressurized metered-dose inhaler (pMDI): Dry nasal aerosol (e.g., Qnasl)

Each spray delivers 50 mcg of beclometasone dipropionate, with a standard bottle containing 100 to 200 metered doses.

Mechanism of Action

Beclometasone dipropionate is a synthetic corticosteroid that binds to glucocorticoid receptors in the nasal mucosa, modulating gene expression and suppressing inflammation.

It:

  • Reduces capillary permeability

  • Inhibits the release of inflammatory mediators (e.g., histamine, prostaglandins, leukotrienes)

  • Downregulates cytokine production (IL-4, IL-5, TNF-α)

  • Decreases eosinophil and mast cell infiltration

These effects collectively reduce nasal congestion, sneezing, itching, and rhinorrhea.

Therapeutic Uses

Beclometasone nasal spray is indicated for:

Primary Indications:

  • Seasonal allergic rhinitis (hay fever)

  • Perennial allergic rhinitis

  • Non-allergic (vasomotor) rhinitis

  • Nasal polyps (as adjunctive therapy)

  • Prevention of seasonal rhinitis (start 1–2 weeks before pollen season)

Off-label/Secondary Uses:

  • Post-nasal drip syndrome

  • Eustachian tube dysfunction

  • Adjunct in chronic rhinosinusitis

  • Allergic conjunctivitis with nasal involvement

Dosage and Administration

Adults and Adolescents (12 years and older):

  • 100 to 200 micrograms per day, administered as:

    • One spray (50 mcg) in each nostril twice daily

    • Or two sprays in each nostril once daily

  • Maximum daily dose: 400 micrograms (usually not needed)

Children 6–11 years:

  • One spray per nostril once or twice daily

  • Maximum daily dose: 200 micrograms

Children under 6:

  • Safety and efficacy not well established; use only under specialist supervision.

Administration Technique:

  • Shake bottle well before use

  • Clear the nasal passage before spraying

  • Insert the nozzle into one nostril while closing the other

  • Aim spray slightly away from the septum to avoid irritation or bleeding

  • Clean the nozzle regularly to prevent blockage

Onset and Duration of Action

  • Onset: Begins within 12–24 hours after first dose

  • Peak effect: Achieved after 3 to 7 days of consistent use

  • Prophylactic use: Recommended 1–2 weeks before allergen exposure for maximum benefit

Contraindications

  • Hypersensitivity to beclometasone or excipients

  • Untreated nasal infections (e.g., bacterial, fungal, viral)

  • Recent nasal surgery or trauma: Risk of delayed healing

  • Nasal septum ulceration or perforation

Precautions

  • Use lowest effective dose for long-term treatment

  • Monitor for nasal septum damage, especially in long-term users

  • Systemic effects (e.g., adrenal suppression, growth delay) are rare but possible with prolonged use or high doses

  • May cause local immunosuppression, increasing risk of nasal Candida infection

  • Caution in patients with tuberculosis, herpetic eye disease, or severe hepatic impairment

Side Effects

Local:

  • Nasal irritation or dryness

  • Burning or stinging

  • Sneezing

  • Epistaxis (nosebleeds) – most common adverse event

  • Pharyngitis

  • Candidiasis of the nose or throat – uncommon but possible

Systemic (rare):

  • Suppression of hypothalamic-pituitary-adrenal (HPA) axis

  • Growth suppression in children

  • Ocular effects: Increased intraocular pressure, glaucoma, cataracts (rare)

  • Headache

  • Anosmia (loss of smell) – very rare

Side effects are dose- and duration-dependent, more likely at doses exceeding 400 mcg/day over extended periods.

Drug Interactions

  • CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole): May increase systemic steroid exposure, although less relevant with intranasal route

  • Other nasal medications (e.g., decongestants, antihistamines): Space applications to avoid interference

  • Avoid concurrent use of multiple steroids unless medically indicated

Systemic absorption is low, so clinically significant interactions are uncommon.

Use in Special Populations

Pregnancy:

  • Considered safe when clearly needed and used at the lowest effective dose

  • Studies suggest minimal fetal risk when used as a nasal spray

Lactation:

  • No significant excretion in breast milk expected

  • Compatible with breastfeeding when used in standard doses

Children:

  • Monitor growth if used long-term

  • Prefer once-daily regimens at the lowest effective dose

Comparative Notes with Other Intranasal Corticosteroids

Beclometasone is comparable in efficacy to:

  • Fluticasone propionate

  • Budesonide

  • Mometasone furoate

  • Triamcinolone acetonide

However:

  • Beclometasone has a slightly higher systemic bioavailability (~44%) than newer agents like fluticasone or mometasone (≤1%), which makes systemic effects more likely with long-term use or high doses

  • Dry aerosol formulations (e.g., Qnasl) may cause less nasal run-off but can irritate the nasal lining more

Patients unresponsive to one intranasal steroid may benefit from switching to another.

Patient Counseling Points

  • Use daily, even if symptoms are not present, for best effect

  • Not a decongestant; do not expect immediate relief

  • Blow nose gently before each use

  • Use only in the nose, avoid contact with eyes and mouth

  • Clean nozzle once weekly to prevent blockage

  • Do not exceed prescribed dose

  • Inform healthcare provider if symptoms persist beyond 7–10 days or worsen

  • Monitor growth in children if used long-term

Storage and Handling

  • Store at room temperature (15–30°C)

  • Do not freeze

  • Keep upright and away from direct sunlight

  • Discard after expiration date or 120 actuations, even if solution remains

Regulatory and Clinical Guidance

  • Recommended by:

    • ARIA guidelines (Allergic Rhinitis and its Impact on Asthma)

    • British Society for Allergy & Clinical Immunology (BSACI)

    • American Academy of Allergy, Asthma & Immunology (AAAAI)

  • First-line therapy for persistent allergic rhinitis

  • Comparable to oral antihistamines, but more effective for nasal congestion




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