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betamethasone

Drug Name
Generic Name: betamethasone, betamethasone dipropionate, betamethasone sodium phosphate, betamethasone sodium phosphate and acetate , betamethasone valerate
Brand Name:
  • Topical dermatologic ointment, cream, lotion, aerosol: Diprolene, Diprolene AF, Diprosone, Maxivate, Taro-Sone (CAN), Teladar
  • Systemic, including IV and local injection: Betnesol (CAN), Celestone Phosphate
  • Systemic, IM, and local intra-articular, intralesional, intradermal injection: Celestone Soluspan
  • Topical dermatologic ointment, cream, lotion: Betaderm (CAN), Beta-Val, Luxiq, Prevex B (CAN), Psorion Cream, Valisone
Classification: Corticosteroid (long acting), Glucocorticoid, Hormone

Pregnancy Category C


Dosage & Route
  • PO Allergic and inflammatory disorders; congenital adrenal hyperplasia 0.5-5 mg/day. IM Allergic and inflammatory disorders As betamethasone Na phosphate and betamethasone acetate: Initial: 0.25-9 mg/day in 1-2 divided doses. Ophth Allergic and inflammatory conditions of the eye As 0.1% soln: As Na phosphate: Instill 1-2 hrly until symptoms are controlled. As 0.1% oint: As Na phosphate: Apply 2-4 times/day or at night w/ the eye drops. Topical Skin disorders As dipropionate (0.05%) or valerate (0.025 or 0.1%): Apply as directed.
Therapeutic actions
  • Betamethasone is a corticosteroid with mainly glucocorticoid activity. It prevents and controls inflammation by controlling the rate of protein synthesis, depressing the migration of polymorphonuclear leukocytes and fibroblasts, and reversing capillary permeability and lysosomal stabilisation.
Indications
Systemic administration
  • Hypercalcemia associated with cancer
  • Short-term management of inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders
  • Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
  • Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
  • Trichinosis with neurologic or myocardial involvement
Intra-articular or soft-tissue administration
  • Arthritis, psoriatic plaques, and so forth
Dermatologic preparations
  • Relief of inflammatory and pruritic manifestations of steroid-responsive dermatoses
Adverse effects
  • Sodium and fluid retention, potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing; hirsutism, bruising, striae, acne; raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, DM. Suppression of pituitary-adrenocortical axis. Growth retardation in children (prolonged therapy). Increased susceptibility for infections. Topical use: Dermal atrophy, local irritation, folliculitis, hypertrichosis. Inhalation: Hoarseness, candidiasis of mouth and throat. Topical application to the eye: Corneal ulcers, raised IOP and reduced visual acuity. Intradermal injection: Local hypopigmentation of deeply pigmented skin. Intra-articular injection: Joint damage, fibrosis, esp in load bearing joints.
  • Potentially Fatal: Abrupt withdrawal leading to acute adrenal insufficiency manifesting as malaise, weakness, mental changes, muscle and joint pains, dystonia, hypoglycaemia, hypotension, dehydration and death. Rapid IV inj may cause CV collapse.
Contraindications
  • Hypersensitivity; systemic fungal or acute infections.
Nursing considerations
Assessment
  • History (systemic administration): Infections, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; kidney or liver disease; hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF; hypertension; thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation
  • Physical: Baseline weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose
Interventions
Systemic use

  • Give daily dose before 9 AM to mimic normal peak corticosteroid blood levels.
  • Increase dosage when patient is subject to stress.
  • Taper doses when discontinuing high-dose or long-term therapy.
  • Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
Topical dermatologic preparations

  • Examine area for infections and skin integrity before application.
  • Administer cautiously to pregnant patients; topical corticosteroids have caused teratogenic effects and can be absorbed from systemic site.
  • WARNING: Use caution when occlusive dressings or tight diapers cover affected area; these can increase systemic absorption of the drug.
  • Avoid prolonged use near eyes, in genital and rectal areas, and in skin creases.
Teaching points
Systemic use

  • Do not stop taking the oral drug without consulting your health care provider.
  • Take single dose or alternate-day doses before 9 AM.
  • Avoid exposure to infections; ability to fight infections is reduced.
  • Wear a medical alert tag so emergency care providers will know that you are on this medication.
  • You may experience these side effects: Increase in appetite, weight gain (counting calories may help); heartburn, indigestion (eat frequent small meals; take antacids); poor wound healing (consult with your care provider); muscle weakness, fatigue (frequent rest periods will help).
  • Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of original disorder.
Intrabursal, intra-articular therapy

  • Do not overuse joint after therapy, even if pain is gone.
Topical dermatologic preparations

  • Apply sparingly; do not cover with tight dressings.
  • Avoid contact with the eyes.
  • Report irritation or infection at the site of application

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