BETAMETHASONE

BETAMETHASONE
(bay-ta-meth'a-sone)
Betnelan , Celestone
BETAMETHASONE ACETATE AND BETAMETHASONE SODIUM PHOSPHATE
Celestone Soluspan
BETAMETHASONE BENZOATE
Beben 
BETAMETHASONE DIPROPIONATE
Alphatrex, Diprolene
BETAMETHASONE SODIUM PHOSPHATE (PH 8.5)
Betameth, Betnesol , Celestone S
BETAMETHASONE VALERATE
Betaderm , Beta-Val, Betnovate , Celestoderm , Ectosone Lotion , Luxiq, Metaderm , Novobetamet , Valnac
Classifications: antiinflammatory; adrenal corticosteroid; glucocorticoid;
Therapeutic: antiinflammatory
; adrenal corticosteroid
Prototype: Hydrocortisone
Pregnancy Category: C

Availability

Betamethasone: 0.6 mg tablets; 0.6 mg/5 mL syrup

Betamethasone Acetate and Betamethasone Sodium: 3 mg acetate, 3 mg sodium phosphate/mL suspension

Betamethasone Benzoate and Betamethasone Dipropionate: 4 mg/mL injection

Betamethasone Valerate: 0.1% ointment; 0.01%, 0.05%, 0.1% cream; 0.1% lotion; 1.2 mg/g foam

Betamethasone Sodium Phosphate: 0.6 mg/5 mL syrup

Action

Synthetic, long-acting glucocorticoid with minor mineralocorticoid properties but strong immunosuppressive, antiinflammatory, and metabolic actions.

Therapeutic Effect

Relieves antiinflammatory manifestations and is an immunosuppressive agent.

Uses

Reduces serum calcium in hypercalcemia, suppresses undesirable inflammatory or immune responses, produces temporary remission in nonadrenal disease, and blocks ACTH production in diagnostic tests. Topical use provides relief of inflammatory manifestations of corticosteroid-responsive dermatoses.

Unlabeled Uses

Prevention of neonatal respiratory distress syndrome (hyaline membrane disease).

Contraindications

In patients with systemic fungal infections. Pregnancy (category C), lactation; acne vulgaris; acne rosacea; Cushing's syndrome; periorbital dermatitis; vaccines.

Cautious Use

Ocular herpes simplex; concomitant use of aspirin; osteoporosis; diverticulitis, nonspecific ulcerative colitis, abscess or other pyrogenic infection, peptic ulcer disease; asthmatics; diabetes mellitus; hypertension; renal insufficiency; myasthenia gravis.

Route & Dosage

Antiinflammatory Agent
Adult: PO 0.6–7.2 mg/d IM/IV Up to 9 mg/d as sodium phosphate

Topical (See Appendix A-4)
Child: PO 0.0175–0.25 mg/kg/d or 0.5–0.75 mg/m2/d divided q6–8h IM 0.0175–0.125 mg/kg/d or 0.5–0.75 mg/m2/d divided q6–8h

Respiratory Distress Syndrome
Adult: IM 2 mL of sodium phosphate to mother once daily 2–3 d before delivery

Administration

Oral
  • Give with food or milk to lessen stomach irritation.
Intraarticular/Intramuscular/Intralesional
  • Use Celestone Soluspan for intraarticular, IM, and intralesional injection. The preparation is not intended for IV use. Do not mix with diluents containing preservatives (e.g., parabens, phenol).
  • Use 1% or 2% lidocaine hydrochloride if prescribed. Withdraw betamethasone mixture first, then lidocaine; shake syringe briefly.
Intravenous

PREPARE: Direct: Give by direct IV undiluted or further diluted in D5W or NS.  

ADMINISTER: Direct: Give at a rate of 1 dose/min.  IV Infusion: Give at a rate determined by the total amount of IV fluid.  

INCOMPATIBILITIES Solution/additive: Unknown. Y-site: Unknown.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity or anaphylactoid reactions; aggravation or masking of infections; malaise, weight gain, obesity. Most adverse effects are dose and treatment duration dependent. CNS: Vertigo, headache, nystagmus, ataxia (rare), increased intracranial pressure with papilledema (usually after discontinuation of medication), mental disturbances, aggravation of preexisting psychiatric conditions, insomnia. CV: Hypertension; syncopal episodes, thrombophlebitis, thromboembolism or fat embolism, palpitation, tachycardia, necrotizing angiitis; CHF. Endocrine: Suppressed linear growth in children, decreased glucose tolerance; hyperglycemia, manifestations of latent diabetes mellitus; hypocorticism; amenorrhea and other menstrual difficulties. Special Senses: Posterior subcapsular cataracts (especially in children), glaucoma, exophthalmos, increased intraocular pressure with optic nerve damage, perforation of the globe, fungal infection of the cornea, decreased or blurred vision. Metabolic: Hypocalcemia; sodium and fluid retention; hypokalemia and hypokalemic alkalosis; negative nitrogen balance. GI: Nausea, increased appetite, ulcerative esophagitis, pancreatitis, abdominal distention, peptic ulcer with perforation and hemorrhage, melena; decreased serum concentration of vitamins A and C. Hematologic: Thrombocytopenia. Musculoskeletal: Osteoporosis, compression fractures, muscle wasting and weakness, tendon rupture, aseptic necrosis of femoral and humeral heads (all resulting from long-term use). Skin: Skin thinning and atrophy, acne, impaired wound healing; petechiae, ecchymosis, easy bruising; suppression of skin test reaction; hypopigmentation or hyperpigmentation, hirsutism, acneiform eruptions, subcutaneous fat atrophy; allergic dermatitis, urticaria, angioneurotic edema, increased sweating. Urogenital: Increased or decreased motility and number of sperm; urinary frequency and urgency, enuresis. With parenteral therapy, IV site: Pain, irritation, necrosis, atrophy, sterile abscess; Charcot-like arthropathy following intraarticular use; burning and tingling in perineal area (after IV injection).

Diagnostic Test Interference

May increase serum cholesterol, blood glucose, serum sodium, uric acid (in acute leukemia) and calcium (in bone metastasis). It may decrease serum calcium, potassium, PBI, thyroxin (T4), triiodothyronine (T3) and reduce thyroid I 131 uptake. It increases urine glucose level and calcium excretion; decreases urine 17-OHCS and 17-KS levels. May produce false-negative results with nitroblue tetrazolium test for systemic bacterial infection and may suppress reactions to skin tests.

Interactions

Drug: barbiturates, phenytoin, rifampin may reduce pharmacologic effect of betamethasone by increasing its metabolism.

Nursing Implications

Assessment & Drug Effects

  • Assess therapeutic effectiveness. Response following intraarticular, intralesional, or intrasynovial administration occurs within a few hours and persists for 1–4 wk. Following IM administration response occurs in 2–3 h and persists for 3–7 d.

Patient & Family Education

  • Monitor weight at least weekly.
  • Discontinue slowly after systemic use of ≥1 wk. Abrupt withdrawal, especially following high doses or prolonged use, can cause dizziness, nausea, vomiting, fever, muscle and joint pain, weakness.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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