Anora (Beclomethasone) Inhaler Dosing Frequency
Inhaled beclomethasone should be administered twice daily for most patients with persistent asthma, with total daily doses ranging from 400-800 μg divided into two administrations. 1
Standard Dosing Regimen
Beclomethasone is effective when given twice daily (morning and evening) for patients with stable asthma, which is the recommended frequency for optimal symptom control. 1, 2
The typical starting dose is 400-800 μg per day divided into two doses (200-400 μg twice daily), which provides adequate control for most patients with mild to moderate persistent asthma. 1, 3
Four times daily dosing at the same total daily dose may be considered if symptoms are not controlled on twice daily administration, though this approach maintains the same total daily dose rather than increasing it. 1
Dose Escalation Strategy
If standard doses fail to control symptoms, increase the total daily dose up to 2000 μg beclomethasone equivalent before adding additional medications or changing frequency. 1, 2
Higher doses (up to 2000 μg daily) have been shown to provide additional clinical benefit in patients unresponsive to usual therapeutic dosages of 400-800 μg daily. 2
Once Daily Dosing Considerations
Once daily dosing is NOT recommended for beclomethasone as the primary maintenance regimen, unlike some combination products (budesonide/formoterol) which have demonstrated efficacy with once-daily evening administration. 4
Beclomethasone 400 μg daily is equally effective when administered in 2 or 4 divided doses in patients with stable asthma only, but lower frequency administration is likely less effective when asthma is unstable. 2
Clinical Pearls
Spacer devices should be used with metered-dose inhalers to increase lung deposition from 20-30% to significantly higher levels, improving effectiveness. 1
Patients should demonstrate 1-3 months of stability before attempting stepwise dose reduction, decreasing by 25-50% at each step. 1
Proper inhaler technique must be verified at each visit, as many patients use inhalers incorrectly, reducing therapeutic benefit regardless of dosing frequency. 1
Important Caveats
Beclomethasone has a delayed onset of action and should never be used for acute exacerbations; oral corticosteroids (30-40 mg prednisolone daily) are required for acute worsening. 1, 3
The most common side effect is oropharyngeal candidiasis, which is dose-related and more common in women; using a spacer device and rinsing the mouth after use reduces this risk. 3, 5
Patients transferring from systemic corticosteroids require 9-12 months of careful monitoring until hypothalamic-pituitary-adrenal axis recovery is sufficient to handle stress situations. 3