Corticosteroid (inhaled, nasal, topical, rectal) Pregnancy: Considered safe — first-line inhaled steroid in asthma during pregnancy (uncontrolled asthma is more harmful than treatment).

Beclometasone dipropionate

Brand names: Clenil Modulite, Qvar, Fostair (with formoterol), Beconase (nasal), Clipper (rectal)

Adult dose

Dose: Asthma — Clenil: 200 mcg BD (mild) up to 1000 mcg BD (severe). Qvar (extra-fine): 50–400 mcg BD; ~half the Clenil dose for equivalent effect. Allergic rhinitis (Beconase): 100 mcg each nostril BD–QDS. UC distal disease (Clipper 5 mg foam/enema): once daily PR for 4 weeks.

Route: Inhalation / Nasal / Topical / Rectal

Frequency: Variable by indication

Max: 2000 mcg/day (Clenil) or 800 mcg/day (Qvar)

Rinse mouth after inhaler use to reduce oral candidiasis. Qvar is NOT dose-equivalent to Clenil — extra-fine particles double potency.

Paediatric dose

Route: Inhalation

Frequency: BD

≥5 yrs Clenil 100–200 mcg BD; ≥12 yrs adult dose. Qvar licensed ≥12 yrs only. Spacer recommended in children. BNFc.

Clinical pearls

First-line preventer in asthma at low–moderate doses (BTS/SIGN, NICE NG80).
Qvar's extra-fine particles deposit further in the small airways — useful in patients with peripheral airway disease; halve the daily dose vs Clenil.
Fostair (beclometasone + formoterol) can be used as both maintenance AND reliever (MART regimen) — single inhaler simplifies severe asthma.
Clipper (rectal foam/enema) useful for left-sided UC unresponsive to mesalazine — local effect, minimal systemic absorption.
Always provide a spacer for MDIs, particularly in children and elderly — improves drug delivery and reduces oropharyngeal deposition.

Contraindications

Untreated active pulmonary or systemic infection (relative — depending on indication)
Hypersensitivity

Side effects

Oral candidiasis (rinse mouth + spacer)
Dysphonia, sore throat
Paradoxical bronchospasm (rare)
Adrenal suppression at high doses (especially >1000 mcg/day)
Reduced linear growth in children (small, generally not affecting final adult height)
Cataracts, glaucoma (long-term high-dose)
Skin thinning, easy bruising
Behavioural changes in children (irritability, sleep disturbance)

Interactions

CYP3A4 inhibitors (ritonavir, ketoconazole, clarithromycin): markedly ↑ systemic exposure — risk of Cushingoid effects
Beta-blockers: ↑ risk of severe asthma exacerbation

Monitoring

Asthma control test, PEFR
Growth in children (annual height)
Adrenal axis if doses >1000 mcg/day or symptoms

Reference: BNFc; BNF 90; BNFc; BTS/SIGN Asthma 158 (2019); NICE NG80; SmPC Clenil/Qvar/Fostair/Clipper. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways