Qvar - Drug Monograph

Introduction

Qvar (beclomethasone dipropionate HFA) is an inhaled corticosteroid medication used for the maintenance treatment of asthma as prophylactic therapy. It is designed to deliver medication directly to the lungs with a hydrofluoroalkane (HFA) propellant, providing effective anti-inflammatory action with potentially reduced systemic effects compared to older CFC-propelled formulations.

Mechanism of Action

Beclomethasone dipropionate is a synthetic corticosteroid that exerts potent anti-inflammatory effects. After inhalation, it is activated by hydrolysis to the active metabolite beclomethasone 17-monopropionate. This compound binds to glucocorticoid receptors in lung tissue, inhibiting multiple inflammatory cells including mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils. The drug reduces production of cytokines and other mediators involved in the asthmatic inflammatory response, decreases mucosal edema, inhibits mucus secretion, and reduces airway hyperresponsiveness.

Indications

• Maintenance treatment of asthma as prophylactic therapy in patients 5 years and older
• Not indicated for the relief of acute bronchospasm

Dosage and Administration

• Starting dose: 40-160 mcg twice daily
• Maximum recommended dose: 320 mcg twice daily

• Starting dose: 40 mcg twice daily
• Maximum recommended dose: 80 mcg twice daily

• Administer by oral inhalation only
• Prime the inhaler before first use and if not used for more than 10 days
• Shake well before each use
• Rinse mouth after inhalation to reduce risk of oropharyngeal candidiasis
• Use spacer device if recommended for improved drug delivery

• Hepatic impairment: Use with caution
• Renal impairment: No dosage adjustment required
• Geriatric patients: Use lowest effective dose

Pharmacokinetics

Contraindications

• Hypersensitivity to beclomethasone dipropionate or any component of the formulation
• Primary treatment of status asthmaticus or other acute episodes of asthma
• Active or quiescent tuberculosis infection of the respiratory tract
• Untreated fungal, bacterial, or viral infections

Warnings and Precautions

• Paradoxical bronchospasm: May occur after dosing; discontinue if severe
• Systemic corticosteroid effects: May occur particularly at higher doses
• Immunosuppression: Increased risk of infections
• Adrenal suppression: May occur with higher doses, monitor during stress or trauma
• Osteoporosis: Consider bone density monitoring in patients at risk
• Ophthalmic effects: May cause cataracts, glaucoma, intraocular pressure increases
• Reduced growth velocity: Monitor growth in pediatric patients
• Hypercorticism and adrenal suppression: May occur when transferring from systemic corticosteroids

Drug Interactions

• Strong CYP3A4 inhibitors (ketoconazole, ritonavir): May increase systemic exposure to beclomethasone
• Other corticosteroids: Additive systemic effects possible
• Live vaccines: Avoid administration during treatment

Adverse Effects

• Headache
• Pharyngitis
• Upper respiratory tract infection
• Oral candidiasis
• Hoarseness/dysphonia
• Cough

• Adrenal suppression
• Severe bronchospasm
• Hypersensitivity reactions
• Glaucoma/cataracts
• Osteoporosis
• Growth suppression in children
• Eosinophilic conditions

Monitoring Parameters

• Asthma symptoms and peak flow measurements
• Pulmonary function tests
• Height and growth velocity in pediatric patients
• Signs/symptoms of oral candidiasis
• Ophthalmic examinations with long-term use
• Bone mineral density in high-risk patients
• Adrenal function during stress or in patients receiving high doses
• Signs of systemic corticosteroid effects

Patient Education

• Use regularly as prescribed, not for acute symptoms
• Always have a short-acting bronchodilator available for acute symptoms
• Rinse mouth with water after each use to prevent oral thrush
• Do not stop therapy abruptly without medical supervision
• Use spacer device if prescribed for better drug delivery
• Clean inhaler regularly as directed
• Report any worsening asthma symptoms, oral sores, or vision changes
• Keep regular appointments for monitoring
• Inform all healthcare providers about Qvar use

References

1. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 07-4051. Bethesda, MD: National Institutes of Health; 2007. 2. Qvar [package insert]. Irvine, CA: Teva Respiratory, LLC; 2021. 3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022. 4. Kelly HW. Comparison of inhaled corticosteroids. Ann Pharmacother. 1998;32(2):220-232. 5. Martin RJ, Szefler SJ, Chinchilli VM, et al. Systemic effect comparisons of six inhaled corticosteroid preparations. Am J Respir Crit Care Med. 2002;165(10):1377-1383. 6. Barnes PJ. Inhaled corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540.