Betamethasone

Betamethasone is indicated for-

• Suppression of inflammatory and allergic disorders including rheumatoid arthritis, rheumatoid carditis, severe hypersensitivity reactions, bronchial asthma, inflammatory skin disorders;
• congenital adrenal hyperplasia;
• ear, eye, nose and oral ulceration.

Corticosteroids bind to the glucocorticoid receptor, inhibiting pro-inflammatory signals, and promoting anti-inflammatory signals. Betamethasone phosphate has a short duration of action as it is rapidly hydrolyzed to betamethasone. Corticosteroids have a wide therapeutic window as patients may require doses that are multiples of what the body naturally produces. Patients taking corticosteroids should be counselled regarding the risk of hypothalamic-pituitary-adrenal axis suppression and increased susceptibility to infections.

The lowest dosage that will produce an acceptable result should be used.

Adult Dosage: Usual range 0.5-5 mg daily. The dose used will depend upon the disease, its severity, and the clinical response obtained. The following regimens are for guidance only. Divided dosage is usually employed.

Short-term treatment: 2 to 3 mg daily for the first few days, subsequently reducing the daily dosage by 0.25 or 0.50 mg every two to five days, depending upon the response.

Rheumatoid arthritis: 0.5 to 2 mg daily. For maintenance therapy the lowest effective dosage is used.

Child Dosage: A proportion of the adult dosage may be used (e.g. 75% at twelve years, 50% at seven years and 25% at one year) but clinical factors must be given due consideration. Or as directed by the physician.

Use in elderly: The common adverse effects of systemic corticosteroids may be associated with more serious consequences in old age. Close clinical supervision is required to avoid life-threatening reactions.

Steroids may reduce the effects of anticholinesterases and non-steroidal anti-inflammatory agents. Rifampicin, rifabutin, carbamazepine, phenobarbitone, phenytoin, primidone, aminoglutethimide and ephedrine enhance the metabolism of corticosteroids; thus the corticosteroid therapeutic effect may be reduced.

Systemic infections, unless specific anti-infective therapy is employed. Hypersensitivity to any component of the tablets.

Side effects include diabetes, osteoporosis (which is a danger in elderly), muscle wasting (proximal myopathy), amenorrhoea and weight gain. High doses of corticosteroids can cause cushing’s syndrome-with moon face, striae, and acne; it is usually reversible on withdrawal of treatment. In children, administration of corticosteroids may result in suppression of growth.

Pregnancy category C. It should be given only if the potential benefit outweighs the potential risk to the fetus. No data is available for lactating mother.

Particular care is required when considering the use of systemic corticosteroids in patients with recent myocardial infarction, hypothyroidism, osteoporosis, hypertension or congestive heart failure, diabetes mellitus, history of active tuberculosis, glaucoma (or a family history of glaucoma), previous corticosteroid-induced myopathy, liver failure, renal insufficiency, epilepsy and peptic ulcer.

Corticosteroid

Keep all medicines out of reach of the children. Store in a cool and dry place, protected from light. Further information is available on request