Intranasal Corticosteroid Pregnancy: Mometasone or budesonide preferred in pregnancy — more safety data; beclometasone may be used if already established treatment

Beclometasone Dipropionate Nasal Spray

Brand names: Beconase, Pollenase

Adult dose

Dose: 100 mcg per nostril (2 sprays × 50 mcg) twice daily

Route: Intranasal

Frequency: Twice daily

Max: 400 mcg/day (200 mcg per nostril twice daily)

Treatment and prevention of seasonal and perennial allergic rhinitis and vasomotor rhinitis. Available OTC (Beconase, Pollenase). Effective within 1–2 weeks of regular use.

Paediatric dose

Dose: Age-based mcg/kg

Route: Intranasal

Frequency: Twice daily

Max: 200 mcg/day

BNFc: licensed from 6 years — 100 mcg per nostril twice daily. Mometasone or fluticasone preferred in children — better safety profile and lower systemic bioavailability.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

BNFc: licensed from 6 years — 100 mcg per nostril twice daily. Mometasone or fluticasone preferred in children — better safety profile and lower systemic bioavailability.

Clinical pearls

Higher systemic bioavailability than mometasone or fluticasone — mometasone and fluticasone preferred where systemic effects are a concern (e.g. children, patients on other corticosteroids)
Spray technique matters: tilt head slightly forward, spray away from the nasal septum (toward outer wall of nose) to prevent septal damage
Must be used regularly for maximum effect — onset 1–2 weeks; full effect at 3–4 weeks; do not judge efficacy after single use
OTC availability (Beconase): NICE and BSACI recommend intranasal steroids as first-line for AR of ≥1-week duration
Combination product with azelastine (Dymista) for moderate-severe allergic rhinitis — step-up therapy per BSACI

Contraindications

Untreated nasal infection
Post-nasal surgery (until healing complete)

Side effects

Epistaxis (most common)
Nasal irritation/dryness
Nasal septum perforation (rare — with incorrect technique, spray toward septum)
Systemic corticosteroid effects (rare at recommended doses — higher bioavailability than mometasone/fluticasone)

Interactions

Ritonavir, itraconazole — CYP3A4 inhibition may increase systemic exposure of beclometasone

Monitoring

Symptom response
Nasal inspection (epistaxis, septal changes)
Growth in children on prolonged use

Reference: BNFc; BNF 90; BNFc; BSACI Rhinitis Guidelines 2017; NICE NG28 (Sinusitis); SIGN 134. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

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