Drug information of Betamethasone

Mechanism of effect

Potent glucocorticoid with minimal to no mineralocorticoid activity.

Controls or prevents inflammation by controling rate of protein synthesis, suppressing migration of PMNs & fibroblasts, reversing capillary permeability, & stabilizing lysosome at cellular level.

Pharmacodynamic

Betamethasone and its derivatives, betamethasone sodium phosphate and betamethasone acetate, are synthetic glucocorticoids. Used for its antiinflammatory or immunosuppressive properties, betamethasone is combined with a mineralocorticoid to manage adrenal insufficiency and is used in the form of betamethasone benzoate, betamethasone dipropionate, or betamethasone valerate for the treatment of inflammation due to corticosteroid-responsive dermatoses. Betamethasone and clotrimazole are used together to treat cutaneous tinea infections.

Pharmacokinetics

Absorption : Minimal if applied topically. 

Peak plasma time : IV: 10-36 min 

Volume of distribution : 75-90 L 

Protein binding : 64%

Metabolism : Hepatic 

Route of elimination :  Mainly in urine, minimally in bile 

Half life : 6.5 hours 

Renal clearance : 9.5 mL/min

Drug indications

Asthma , Allergy , Osteoporesis , Intestinal diseases , Acne , itching , allergic reactions , Allergic Rhinitis

Dosage

• Adult:

Endocrine Disorders

0.6-7.2 mg PO divided BID/QID or 0.6-9 mg/day IM qDay/divided BID

Inflammatory Conditions

0.6-7.2 mg PO divided BID/QID or 0.6-9 mg/day IM qDay/divided BID

Rheumatoid Arthritis/Osteoarthritis

Intrabursal, intra-articular, intradermal: 0.25-2 mL (6 mg/mL)

Intralesional (6 mg/mL)

Very large joints: 1-2 mL

Large joints: 1 mL

Medium joints: 0.5 - 1 mL

Small joints: 0.25-0.5 mL

Administration: Base dosage on severity of disease and patient response.

• Pediatric:

Adrenal Insufficiency

<12 years old: 0.0175-0.25 mg/kg/day divided q6-12hr IM/PO; use lowest dose as initial dose  

>12 years old: As in adults; use lowest dose as initial dose

Inflammatory Conditions

<12 years old: 0.0175-0.25 mg/kg/day IM/PO divided q6-12hr

>12 years old: As in adults

Drug contraindications

hypersensitivity to this drug

Side effects

Anxiety , Insomnia , Headache , edema , dizziness , Seizures , Blurred vision , vertigo , itching , dry skin , Cataracts , increased appetite , indigestion

Interactions

Amphotericin B , Bupropion , Deferasirox , Ciprofloxacin , Cyclosporine , Ketoconazole , Cholestyramine , Aminoglutethimide (Oral) , Phenindione , Desirudin , Tolfenamic Acid , Grepafloxacin , Tisagenlecleucel , Adenovirus types 4 and 7 live, oral , Axicabtagene ciloleucel , Lopinavir and Ritonavir , Glycerol Phenylbutyrate , Meningococcal conjugate vaccine

Alerts

• NOT effective in treatment of RDS in premature neonates
• Minimal sodium retention activity: however, may increase with high doses
• If used to treat adrenocortical insufficiency should also use mineralocorticoid
• Thromboembolic disorders
• Myopathy,
• Delayed wound healing
• Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
• Latent TB may be reactivated (monitor patients with positive tuberculin test)
• Some suggestion of slightly increased cleft palate risk if corticosteroids used in pregnancy, but not fully substantiated
• Prolonged corticosteroid use may result in elevated IOP, glaucoma, and/or cataracts
• Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted

Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)

Points of recommendation

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Pregnancy level

C

Related drugs

Beclomethasone , Triamcinolone , Dexamethasone , Fluticasone , Fludrocortisone , Methylprednisolone , Hydrocortisone , Prednisolone , Flucinolone , Mometasone , Clobetasole , flurandrenolide