betamethasone

betamethasone /be·ta·meth·a·sone/ (ba″tah-meth´ah-sōn) a synthetic glucocorticoid, the most active of the antiinflammatory steroids; used topically as the benzoate, dipropionate, or valerate salts as an antiinflammatory, topically or rectally as the sodium phosphate salt as an antiinflammatory, and systemically as the base or the combination of sodium phosphate and acetate salts as an antiinflammatory, as a replacement for adrenal insufficiency, and as an immunosuppressant.

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be·ta·meth·a·sone (bt-mth-sn, b-)

n.

A synthetic crystalline glucocorticoid powder used as a topical anti-inflammatory agent for the treatment of dermatological conditions.

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betamethasone,

a glucocorticoid.

indication It is prescribed for topical corticosteroid-responsive dermatoses and injected directly into lesions (bursitis, rheumatoid arthritis, etc.) to help control pain and inflammation.

contraindications Systemic fungal infections, dermatologic viral and fungal infections, impaired circulation, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse reactions associated with prolonged use of the drug are GI, endocrine, neurologic, and fluid and electrolyte disturbances.

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betamethasone (valerate, betamethasone benzoate, betamethasone dipropionate) (bā´tmeth´sōn),

n brand names: Uticort, Beben, and others;
drug class: topical corticosteroid;
action: interacts with steroid cytoplasmic receptors to induce antiinflammatory effects; possesses antipruritic, antiinflammatory actions;
uses: treatment of psoriasis, eczema, contact dermatitis, pruritus, and oral ulcerative inflammatory lesions.

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betamethasone

a long-acting synthetic glucocorticoid, used as an anti-inflammatory.

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betamethasone

Betnelan (CA), Celestone

Pharmacologic class: Glucocorticoid (inhalation)

Therapeutic class: Antiasthmatic, anti-inflammatory (steroidal)

Pregnancy risk category C

Action

Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines

Availability

Solution for injection: 4 mg/ml of betamethasone sodium phosphate; 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml

Suspension for injection (acetate, phosphate): 6 mg (total)/ml

Syrup: 0.6 mg/5 ml

Tablets: 0.6 mg

Tablets (effervescent): 0.5 mg

Tablets (extended-release): 1 mg

⊘Indications and dosages

➣ Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery

Adults: 0.6 to 7.2 mg/day P.O. as a single daily dose or in divided doses; or up to 9 mg I.M. or I.V. of betamethasone sodium phosphate; or 0.5 to 9 mg I.M. of betamethasone sodium phosphate and betamethasone acetate suspension.

➣ Bursitis or tenosynovitis

Adults: 1 ml of suspension intrabursally

➣ Rheumatoid arthritis or osteoarthritis

Adults: 0.5 to 2 ml of suspension intra-articularly

Off-label uses

• Respiratory distress syndrome

Contraindications

• Hypersensitivity to drug
• Breastfeeding

Precautions

Use cautiously in:
• systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability
• patients receiving systemic corticosteroids
• pregnant patients
• children younger than age 6.

Administration

• Give as a single daily dose before 9:00 A.M.
• Give oral dose with food or milk.
• Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy).
☞ Don't give betamethasone acetate I.V.
• Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours.
☞ To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing.
• Know that drug may be given with other immunosuppressants.

Route	Onset	Peak	Duration
P.O.	Unknown	1-2 hr	3-25 days
I.V., I.M. (phosphate)	Rapid	Unknown	Unknown
I.M. (acetate/phosphate)	1-3 hr	Unknown	1 wk

Adverse reactions

CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure

CV: hypertension, thrombophlebitis, thromboembolism

EENT: cataracts, burning and dryness of eyes, rebound nasal congestion, sneezing, epistaxis, nasal septum perforation, difficulty speaking, oropharyngeal or nasopharyngeal fungal infections

GI: nausea, vomiting, anorexia, dry mouth, esophageal candidiasis, peptic ulcers

Metabolic: decreased growth, hyperglycemia, cushingoid appearance, adrenal insufficiency or suppression

Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis

Respiratory: cough, wheezing, bronchospasm

Skin: facial edema, rash, contact dermatitis, acne, ecchymosis, hirsutism, petechiae, urticaria, angioedema

Other: loss of taste, bad taste, weight gain or loss, Churg-Strauss syndrome, increased susceptibility to infection, hypersensitivity reaction

Interactions

Drug-drug. Amphotericin B, loop and thiazide diuretics, ticarcillin: additive hypokalemia

Barbiturates, phenytoin, rifampin: stimulation of betamethasone metabolism, causing decreased drug effects

Digoxin: increased risk of digoxin toxicity

Fluoroquinolones (such as ciprofloxacin, norfloxacin): increased risk of tendon rupture

Hormonal contraceptives: blockage of betamethasone metabolism

Insulin, oral hypoglycemics: increased betamethasone dosage requirement

Live-virus vaccines: decreased antibody response to vaccine, increased risk of neurologic complications

Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects

Drug-diagnostic tests. Calcium, cholesterol, glucose, potassium: increased levels

Nitroblue tetrazolium test for bacterial infection: false-negative result

Drug-herbs. Echinacea: increased immune-stimulating effects

Ginseng: increased immune-modulating effects

Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers

Patient monitoring

• Monitor weight daily and report sudden increase, which suggests fluid retention.
• Monitor blood glucose level for hyperglycemia.
• Assess serum electrolyte levels for sodium and potassium imbalances.
• Watch for signs and symptoms of infection (which drug may mask).

Patient teaching

• Advise patient to report signs and symptoms of infection.
• Tell patient to report visual disturbances (long-term drug use may cause cataracts).
• Instruct patient to eat low-sodium, high potassium diet.
☞ Advise patient to carry medical identification describing drug therapy.
• Inform female patients that drug may cause menstrual irregularities.
☞ Caution patient not to stop taking drug abruptly.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.