Decomit

Beclomethasone Dipropionate is a high-potency corticosteroid with strong anti-inflammatory properties. It is used in various inhaled, intranasal, and topical forms for a wide range of conditions:

A. Respiratory (Inhalation)

• Asthma (mild to severe persistent) – for maintenance therapy and prevention of bronchospasm
• Chronic Obstructive Pulmonary Disease (COPD) – as part of combination therapy in selected patients (moderate to severe)
• Exercise-induced bronchospasm – prophylactic use in asthma patients

B. Nasal (Intranasal Formulations)

• Allergic Rhinitis (seasonal and perennial)
• Non-allergic rhinitis
• Nasal polyps – prevention of recurrence post-surgical removal
• Rhinosinusitis (chronic) – as adjunctive therapy

C. Dermatologic (Topical Cream or Ointment)

• Inflammatory skin conditions including:
• Eczema
• Psoriasis (limited, non-exfoliative)
• Contact dermatitis (allergic/irritant)
• Atopic dermatitis
• Seborrheic dermatitis
• Lichen planus
• Discoid lupus erythematosus
• Insect bites with inflammation

A. Inhalation (Asthma, COPD)

• Adults:
• Initial: 200–400 mcg twice daily via inhaler or nebulizer
• Maximum: Up to 1000 mcg/day in divided doses (based on severity)
• Pediatrics (6–12 years):
• 100–200 mcg twice daily
• Children (≤5 years):
• Nebulized solution preferred: 100 mcg twice daily (under supervision)
• Elderly: No routine dose adjustment; monitor response closely

B. Intranasal

• Adults & Children ≥12 years:
• 1–2 sprays (50 mcg/spray) in each nostril once or twice daily
• Max: 400 mcg/day
• Children 6–11 years:
• 1 spray in each nostril once daily

C. Topical (Skin Application)

• Apply a thin film to the affected area once or twice daily
• Avoid prolonged use (>2 weeks) or use under occlusive dressings unless directed

Special Populations

• Renal/Hepatic Impairment: No dosage adjustment typically required
• Avoid sudden discontinuation in long-term users; tapering may be needed

Beclomethasone Dipropionate is a synthetic glucocorticoid prodrug that is converted in vivo to its active form, beclomethasone-17-monopropionate (B-17-MP). It binds to intracellular glucocorticoid receptors, modulating gene transcription and suppressing the production of pro-inflammatory mediators such as prostaglandins, leukotrienes, interleukins, and tumor necrosis factor-α. This results in reduced vascular permeability, leukocyte migration, and inflammatory cytokine expression, producing potent anti-inflammatory and anti-allergic effects in the lungs, nasal mucosa, or skin depending on the route.

• Absorption:
• Inhaled: 10–25% reaches lungs; rest is swallowed and undergoes first-pass metabolism
• Topical: Minimal systemic absorption with intact skin
• Intranasal: Absorbed through nasal mucosa; minimal systemic exposure
• Distribution:
• Plasma protein binding ~87%
• Peak plasma levels reached in ~0.5–2 hours (inhaled)
• Metabolism:
• Rapidly converted by esterase enzymes to B-17-MP (active metabolite)
• Further metabolism occurs in the liver
• Excretion:
• Primarily via feces (as metabolites)
• Small amount in urine
• Half-life: ~2.8 hours (B-17-MP)
• Bioavailability:
• Inhaled: ~20–30%
• Intranasal: <44%
• Topical: Negligible systemic bioavailability

• Pregnancy:
• Category C (FDA) – No adequate human studies; animal studies show possible fetal risks.
• Inhaled and topical forms should be used only if clearly needed and for short durations.
• Avoid prolonged or high-dose use during pregnancy.
• Lactation:
• Excretion into breast milk is not well studied, but systemic exposure is low.
• Use with caution; avoid topical application to the breast area.
• Inhaled and nasal use unlikely to harm a breastfed infant.

• Primary Class: Corticosteroid (Glucocorticoid)
• Subclasses:
• Inhaled Corticosteroid (ICS) – for asthma, COPD
• Topical Corticosteroid – dermatologic
• Intranasal Corticosteroid – for rhinitis and polyps

• Hypersensitivity to beclomethasone or any formulation components
• Untreated fungal, bacterial, or viral infections at the site of application
• Active or latent tuberculosis involving the respiratory tract (for inhaled use)
• Ocular herpes simplex
• Children <6 years (intranasal use) – unless directed by physician

• Local Immunosuppression: May mask or exacerbate infections
• Systemic Effects: With high doses or prolonged use, adrenal suppression, Cushing’s syndrome, or growth retardation in children may occur
• Paradoxical bronchospasm: Rare with inhaled use; discontinue if occurs
• Nasal Septum Perforation: Reported with long-term nasal use
• Skin Thinning and Striae: Possible with long-term topical use
• Monitor: Children’s growth (with prolonged use), signs of systemic corticosteroid effects

Inhaled/Nasal Use

• Common: Hoarseness, cough, sore throat, nasal irritation, epistaxis
• Less Common: Oral candidiasis, dysphonia
• Serious: Adrenal suppression, growth retardation (in children), glaucoma, cataracts

Topical Use

• Common: Burning, itching, dryness, erythema
• Prolonged Use: Skin atrophy, telangiectasia, striae, acneiform eruptions
• Rare: Allergic contact dermatitis, secondary infections

• CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir): May increase systemic levels of beclomethasone, increasing risk of adrenal suppression
• Systemic corticosteroids: Risk of additive effects
• Live vaccines: May reduce immune response (if systemic exposure occurs)

Note: No significant drug-food or drug-alcohol interactions reported.

• GINA 2024 guidelines recommend low-dose inhaled corticosteroids like Beclomethasone as the cornerstone of long-term asthma control.
• FDA recently emphasized the importance of rinsing the mouth after inhaled use to prevent oral candidiasis.
• Increasing preference for low-dose inhaled steroids in pediatric asthma to reduce long-term risks.

• Inhalers: Store at 20°C to 25°C; protect from heat and freezing. Avoid puncturing or burning the canister.
• Nasal Sprays: Store between 15°C to 30°C; do not freeze.
• Topical Cream/Ointment: Store below 25°C; protect from light and moisture.
• Handling: Shake well before use (inhalers); keep container tightly closed; discard after expiry or 3 months after opening (for nasal sprays).