What to Know About Qvar Redihaler (Beclomethasone)

Qvar Redihaler (beclomethasone dipropionate) is an inhaled corticosteroid (ICS) prescribed for long-term control of asthma symptoms in adults and children age 4 and over. Used twice daily, Qvar delivers medication directly to the lungs. While safe and effective for treating persistent asthma symptoms, it is not for acute episodes (asthma attacks).

Qvar Redihaler replaced the original Qvar asthma inhaler in 2017. There are currently no generic versions.

Uses

Qvar belongs to a class of drugs called corticosteroids (also known simply as steroids) that temper the immune response and help relieve inflammation. It is used when a short-acting rescue inhaler like albuterol (a bronchodilator medication) fails to control asthma symptoms and needs to be used more than twice weekly.

QVAR is available as a low dose ICS and a medium dose ICS. It is indicated for the treatment of mild to moderate persistent asthma. This ICS typically is used in combination with a long-acting beta-agonist (LABA) like Serevent (salmeterol) to ensure long-term control of asthma symptoms.

In addition to Qvar, there are five other inhaled corticosteroids approved for asthma:

• Arnuity (flunisolide)
• Alvesco (ciclesonide)
• Asmanex (mometasone furoate)
• Flovent (fluticasone propionate)
• Pulmicort (budesonide)

There also are several combination inhalers that each contain a steroid and a LABA:

• Advair (fluticasone/salmeterol)
• Symbicort (budesonide/formoterol)
• Dulera (mometasone/formoterol)
• Breo Ellipta (fluticasone/vilanterol)

Trelegy contains three medications: a steroid (fluticasone), a LABA (vilanterol) and a long-acting muscarinic antagonist, or LAMA (umeclidinium). It's the only combination inhaler of its kind.

Off-Label Uses

Qvar is sometimes prescribed off-label to help treat chronic obstructive pulmonary disease (COPD), in which case it is used along with a bronchodilator for someone whose COPD is especially severe or who has frequent exacerbations. Qvar is not used alone to treat COPD.

Before Taking

Qvar is added to an ongoing asthma treatment plan when a rescue inhaler is not effective for controlling symptoms. It is not a first-line option for managing mild asthma.

A healthcare provider will prescribe Qvar based largely on clinical judgement rather than relying on diagnostic measures such as pulmonary function tests (PFTs).

Precautions and Considerations

The only absolute contraindication for the use of Qvar is a known allergy to beclomethasone or some other ingredient in the medication.

However, there other conditions for which Qvar may pose risks:

• Eye disorders: Long-term use of corticosteroids may increase the risk of glaucoma and cataracts, which a healthcare provider will take into consideration before prescribing Qvar to someone with a pre-existing vision problem.
• Osteopenia: Over time, continuous use of corticosteroids may increase the risk of osteopenia (bone loss), so care is taken when prescribing Qvar for people with osteoporosis. Young children should be monitored as Qvar may cause impaired growth, albeit modestly.
• Childhood infections: Because corticosteroids suppress the immune system, Qvar should be used with caution in children who have not yet been immunized against chickenpox or measles.
• Tuberculosis: Qvar may need to be avoided in people with active tuberculosis and used with caution in those with other active fungal, bacterial, parasitic, or viral infections.
• Oral steroid use: Qvar may need to be avoided for several months after the discontinuation of systemic steroids like prednisone. This is because systemic steroids suppress the triad of organs called the HPA axis that regulate many body functions. If Qvar is introduced too quickly, it may slow the recovery of the HPA axis and increase the risk of a potentially life-threatening adrenal crisis.
• Immunosuppression: Because Qvar suppresses the immune system, it should be used with caution in people with advanced or untreated HIV infection, people undergoing cancer chemotherapy, or organ transplant recipients who rely on life-long immunosuppressant drugs to prevent organ rejection. However, it is contraindicated if a person's immune system is severely compromised.

Qvar should be used with caution during pregnancy. In animal studies, Qvar was found to be potentially harmful to fetuses and there have been no well-controlled studies in humans. Although the risk of harm is considered low, it cannot be ruled out.

If you are pregnant, plan to get pregnant, or are breastfeeding, speak with your healthcare provider about the potential risks of Qvar and whether they outweigh the benefits of the drug for you.

Dosage

Qvar Redihaler is available in a 40-microgram (mcg) and an 80-mcg metered-dose inhaler (MDI). Each 10.6-gram (g) canister contains 120 doses.

As a rule, the lowest dose able to achieve control of asthma symptoms should always be used, as prescribed by your healthcare provider. If the starting dose provides less than adequate control, the dose can be incrementally increased under their direction.

The recommended Qvar dosage varies by age:

• Adults and adolescents 12 and over: Start with between a 40-mcg to 80-mcg dose twice daily, taken roughly 12 hours apart. If symptoms don't improve after two weeks, the dose may be increased up to a maximum of 320 mcg twice daily.
• Children 4 to 11: Start with 40 mcg twice daily, taken roughly 12 hours apart. If symptoms don't improve after two weeks, increase to 80 mcg twice daily. Never use more than 80 mcg twice daily.

Modifications

People who have mild persistent asthma may not need to use an inhaled corticosteroid every day, according to updated guidelines for asthma issued in December 2020 by the National Institutes of Health (NIH).

The recommendations offer two approaches: daily ICS as a controller medication plus a short-acting beta agonist (SABA) as a rescue intervention, or intermittent use, which the NIH defines as "the temporary use of an ICS in response to worsening asthma in an individual with asthma who is not taking ICS controller therapy regularly."

This means both a SABA and an ICS would be used only as needed in the event of an asthma attack. This strategy is appropriate for people 12 and over and should only be applied with the guidance of a medical professional. Don't change how you use your controller inhaler without talking to your healthcare provider first.

People who are switching from another inhaled steroid to Qvar may need a larger starting dose than those using Qvar for the first time. Your healthcare provider will recommend the appropriate dose based on your treatment history and current symptoms.

How to Take and Store

Qvar Redihaler has several advantages over aerosolized inhalers that use a hydrofluoroalkane (HFA) propellant and traditional MDIs that use a chlorofluorocarbon (CFC) propellant.

As a breath-actuated metered dose inhaler, Qvar doesn't need to be primed nor does it require hand-breath coordination. You don't have to shake the canister, and there is no button to press to deliver the medication. A spacer is not needed and should not be used.

The ease of use of this proprietary design is, in fact, what prompted Qvar Redihaler to be introduced as a replacement for the original Qvar inhaler. Both products used the same active ingredients in the same amounts—just the method of delivery changed.

To use a Qvar Redihaler:

These steps may look complicated at first, but are easy to master and will become second-nature with practice:

1. Hold the canister upright and open the hinged mouthpiece cover. Do not shake the container as this may affect the dose.
2. Exhale fully to empty your lungs.
3. Place the mouthpiece in your mouth and wrap your lips around it tightly to form a seal.
4. Inhale fully.
5. Hold your breath for 5 seconds, then exhale.
6. Click the mouthpiece cover shut to measure out the next dose. Repeat steps 2 through 5.
7. If the mouthpiece needs cleaning, gently wipe with a tissue or cloth.
8. Click the mouthpiece fully shut when finished.
9. Rinse your mouth with water to clear any remnants of the drug.

Qvar is best stored at 77 degrees F but is generally stable at temperatures between 59 and 86 degrees F.

The device is pressurized, so do not puncture, incinerate, or expose to temperatures over 120 degrees F.

Do not wash or submerge the canister as this can cause seepage.

Never use Qvar past its expiration date. Keep of out reach of children and pets.

Side Effects

Qvar is generally well tolerated but as is the case with most medications it has been associated with side effects. Most are comparable to those of other inhaled steroids and are likely to decrease with time.

If the side effects are persistent or worsen, let your healthcare provider know.

Common

The most common side effects of Qvar Redihaler are:

• Headache
• Throat irritation
• Runny nose
• Sneezing
• Cold-like symptoms
• Sinus infection
• Upper respiratory infection
• Oral candidiasis (thrush)
• Vomiting

The risk of thrush is increased if you do not wash your mouth after using Qvar. If you develop thrush, you may need to temporarily halt the drug until the infection clears. For this or any other reason, do not stop taking Qvar or adjust the dosage without first speaking with your healthcare provider.

Severe

Although uncommon, Qvar has been known to cause severe side effects, including breathing problems, allergic reactions, and adrenal dysfunction. Among those that may require emergency medical attention:

• Paradoxical bronchospasm is an unexpected reaction to an inhaled corticosteroid in which bronchoconstriction (narrowing of the airways) increases rather than decreases. When this occurs, it is almost always a medical emergency.
• Anaphylaxis is a severe, whole-body allergy that can occur within minutes or hours of taking Qvar. If left untreated, anaphylaxis can lead to shock, coma, cardiac or respiratory failure, and death.
• Adrenal crisis occurs when the adrenal glands fail to produce enough cortisol to regulate body functions. While adrenal insufficiency (AI) is not uncommon among inhaled steroid users—and may affect as many as 9.3% of children—it can turn very serious if cortisol drops too low, leading to shock and possibly death.

Warnings and Interactions

Because Qvar is administered by inhalation, it is less likely to cause the same kinds of drug interactions associated with oral or injected steroids. The manufacturer did not identify any notable interactions from pre-market research.

Because Qvar has immunosuppressive effects, it may amplify the effects of immunosuppressant drugs used for chemotherapy, organ transplant recipients, and other medical conditions. These include:

• Aldesleukin
• Azasan (azathioprine)
• Cisplatin
• Cyclosporine
• Simulect (basiliximab)
• Taxol (paclitaxel)
• Zinbryta (daclizumab)

If you're on chemotherapy, HIV therapy, or immunosuppressive drugs of any sort, tell the healthcare provider who prescribes Qvar for you so they can monitor you for side effects. This may include routine blood tests commonly used to monitor immune function in immunosuppressed individuals.

To avoid drug interactions, let your healthcare provider know about any medications you are taking, whether they are prescription, over-the-counter, supplemental, herbal, or recreational.