betamethasone

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betamethasone

 [ba″tah-meth´ah-sōn]
a synthetic glucocorticoid, the most active of the steroid antiinflammatory agents; 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.

betamethasone

Betnelan (CA), Celestone

betamethasone acetate and sodium phosphate

Celestone Soluspan

Pharmacologic class: Glucocorticoid (inhalation)

Therapeutic class: Antiasthmatic, antiinflammatory (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: 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 single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate 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.

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, diminished hypoglycemic effects

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, potassium: decreased levels

Cholesterol, glucose: 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.

betamethasone

(bā′tə-mĕth′ə-sōn′, bē′-)
n.
A synthetic glucocorticoid, C22H29FO5, that occurs as a white crystalline powder and is used as a topical anti-inflammatory agent for the treatment of dermatological conditions.

betamethasone

A corticosteroid drug used directly on the skin to treat ECZEMA and PSORIASIS, by inhalation to treat ASTHMA, by mouth for more severe allergic conditions and by injection to reduce brain swelling in head injuries, tumour and infections. The drug is on the WHO official list. Brand names are Betnelan, Betnesol, Betnovate, Bettamousse and Vista-Methasone.