What to Know About Qvar Redihaler (Beclomethasone)

This inhaled steroid is used for long-term asthma control

Qvar Redihaler

Teva Pharmaceuticals

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

Qvar Redihaler replaced the original Qvar asthma inhaler in 2017. There are currently no generic versions of Qvar Redihandler. It will likely be many years before patent exclusivity expires.

Qvar Redihaler boxes and inhalers on a white background
Teva Pharmaceuticals

Uses

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

Qvar is offered in a low-dose and high-dose formulation to treat mild, moderate, and severe asthma. When used on a continual basis, Qvar can help dampen airway hyperresponsiveness so that the lungs are less likely to react to an asthma trigger.

This inhaler is typically used in combination with a long-acting beta-agonist (LABA) like Serevent (salmeterol) to ensure long-term control of asthma symptoms.

In the past, inhaled steroids were used prior to the addition of a LABA to the treatment plan. Today, the Global Initiative for Asthma recommends the combined use of inhaled steroids and LABAs when treatment is indicated.

In addition to Qvar, there are six other inhaled corticosteroids approved for the treatment of asthma:

There are also two combination inhalers that contain a steroid and a LABA: Advair (fluticasone/salmeterol) and Symbicort (budesonide/formoterol).

Off-Label Uses

Qvar is sometimes used off-label to treat chronic obstructive pulmonary disease (COPD). Like asthma, COPD is classified as an obstructive respiratory disorder, although asthma is considered reversible while COPD is not.

There is growing evidence that inhaled steroids like Qvar may be beneficial in the first-line treatment of asthma in children (in part to reduce inflammation that can cause long-term injury to developing lungs). At present, however, there are no official guidelines endorsing such practices.

Before Taking

Qvar is not used in the first-line treatment of mild asthma; rescue inhalers are. It is only introduced to a treatment plan when control cannot be achieved with first-line options.

The decision to start is based on clinical judgment. Pulmonary function tests (PFTs) used to diagnose asthma play less of a role in the decision that the frequency and severity of acute symptoms.

Precautions and Considerations

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

However, there other conditions in which the use of Qvar may pose risks that should be considered:

  • Eye disorders: The long-term use of corticosteroids may increase the risk of glaucoma and cataracts. Clinical judgment should be used when prescribing Qvar to people with pre-existing vision problems.
  • Osteopenia: The long-term use of corticosteroids may increase the risk of osteopenia (bone loss). Care should be taken when prescribing Qvar in people with osteoporosis. Young children should be also 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 is a Pregnancy Category C drug, meaning the potential for fetal harm was seen in animal studies but no well-controlled studies are available in humans. With Category C drugs, the risk of harm is considered low but cannot be ruled out.

If you are pregnant, plan to get pregnant, or are breastfeeding, speak with your doctor before using Qvar to fully understand the benefits and risks.

Dosage

Qvar Redihaler is available in a 40-microgram (mcg) and 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 doctor. If the starting dose provides less-than-adequate control, the dose can be incrementally increased under their direction.

To be effective, Qvar needs to be taken twice daily every day, whether or not you're experiencing symptoms.

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 are switching from another inhaled steroid to Qvar may need a larger starting dose than those using Qvar for the first time. Your doctor 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 neither requires priming nor 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.

With the Qvar Redihaler, the dose is accurately measured each time you open and close the hinged mouthpiece cover. With each click of the cover, the dose counter will display the number of remaining doses.

To use a Qvar Redihaler:

  1. Holding 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 the lungs.
  3. Place the mouthpiece in your mouth, closing your lips 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

While Qvar is generally well tolerated, there are a few side effects associated with its use. Most are comparable to what you would experience with other inhaled steroids and will generally decrease with time.

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

Common

The most common side effects of Qvar Redihaler are:

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 doctor.

Severe

Less commonly, Qvar has been known to cause severe side effects, including breathing problems, allergy, and adrenal dysfunction. Among the events requiring 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.
When to Call 911
Paradoxical bronchospasm
  • Difficulty breathing
  • Shortness of breath
  • Wheezing when inhaling and exhaling
  • Persistent coughing
  • Chest pain
  • Lightheadedness
  • Inability to speak
  • Inability to relieve symptoms with a rescue inhaler
Anaphylaxis
  • Hives or rash
  • Rapid heartbeats
  • Dizziness or lightheadedness
  • Confusion
  • Fainting
  • Shortness of breath
  • Wheezing
  • Swelling of the face, mouth, or throat
Adrenal crisis
  • Abdominal or flank pain
  • Dizziness or lightheadedness
  • Fatigue
  • Headache
  • High fever
  • Loss of appetite
  • Nausea and vomiting
  • Confusion
  • Profuse sweating on the face or palms
  • Rapid heart rate
  • Rapid breathing

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 on chemotherapy, HIV therapy, or immunosuppressive drugs of any sort, let the prescribing physician know so that you can be monitored for side effects. This may include routine blood tests commonly used to monitor the immune function in suppressed individuals.

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

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