Betamethasone (topical and injectable corticosteroid)

Betamethasone is a corticosteroid drug. Corticosteroids, or steroids, are synthetic drugs that are modeled after the naturally occurring hormone cortisol, which is produced in the adrenal glands located above the kidneys. Corticosteroids reduce inflammation, pain, itchiness, and other effects mediated by the immune system response.

Uses

What is betamethasone used for?

Betamethasone is mainly indicated to treat the following conditions:

• Allergic reactions and disorders
• Inflammatory disorders
• Congenital adrenal hyperplasia
• Steroid-responsive dermatoses
• Plaque psoriasis

How should I take betamethasone?

Betamethasone is available as a topical ointment, lotion, cream, and parenteral suspension for injection. The topical dosage forms should be applied as a thin layer on the affected areas of skin. Wash your hands thoroughly before and after application.

The suspension for injection should be administered via intramuscular (IM), intralesional, or intra-articular (IA) routes by a licensed health professional.

How do I store betamethasone?

This product is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer. 

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using betamethasone?

Corticosteroids, including betamethasone, are associated with an increased risk of infection, bone demineralization, weight gain, water retention, and various other effects. This risk is further increased in elderly patients, young patients, immunocompromised patients, and those undergoing chronic treatment with steroids.

Never stop taking corticosteroids suddenly. If side effects are being experienced or you have completed your therapy, your doses must be tapered gradually until it is safe to stop taking corticosteroids. Abruptly stopping the use of steroids can result in adrenal insufficiency, which is potentially life-threatening.

Some groups of people with conditions like osteoporosis, diabetes mellitus, hypertension, hypothyroidism, myopathy, glaucoma, and myasthenia gravis may experience an exacerbation of symptoms after using corticosteroids.

Before using this drug, tell your doctor if you are/have:

• Pregnant or breastfeeding.
• Taking any other medicines. This includes any prescription, OTC, and herbal remedies.
• An allergy to any of the ingredients of this product.
• Any other illnesses, disorders, or medical conditions.

Is it safe during pregnancy or breastfeeding?

Unfortunately, there isn’t enough information about the safety of using this drug during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking any medication.

This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

• A=No risk
• B=No risk in some studies
• C=There may be some risk
• D=Positive evidence of risk
• X=Contraindicated
• N=Unknown

Side effects

What side effects can occur when using betamethasone?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

• Growth suppression (in children)
• Menstrual irregularities
• Cushingoid facies (“moon face”)
• Hirsutism (excessive growth of body hair)
• Weight gain
• Water retention
• Increased appetite
• Glucose or carbohydrate intolerance
• Sweating
• Opportunistic infections (e.g. candidiasis)
• Reactivation of latent infections
• Osteoporosis
• Increased risk of bone fractures
• Tendon rupture
• Change in mental state and behavior
• Insomnia or sleep disturbances
• Increase intraocular pressure
• Glaucoma
• Papilledema
• Cataracts
• Impaired healing
• Peptic ulcers
• Acne
• Skin atrophy

Seek medical attention immediately if you experience any of these serious, potentially fatal drug reactions:

• Adrenal insufficiency
  • Extreme fatigue
  • Weight loss
  • Decreased appetite
  • Nausea, vomiting, diarrhea,
• Stevens-Johnson syndrome (SJS)

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with betamethasone?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. 

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. 

Drugs with known interactions:

• CYP3A4 inhibitors
• Oral contraceptives
• Rifampicin, rifabutin
• Carbamazepine, phenobarbitone, phenytoin, primidone
• Aminoglutethimide
• Ephedrine
• Hypoglycemic agents
• Antihypertensives
• Neuromuscular blockers
• Diuretics
• Theophylline
• Cardiac glycosides
• Somatotropin
• Fluoroquinolones
• Tretinoin
• NSAIDs
• Coumarin anticoagulants

If you experience an adverse drug interaction, do not stop taking this drug. Inform your doctor immediately to reevaluate your treatment plan. Approaches include dose adjustment, drug substitution, or tapering therapy.

Does food or alcohol interact with betamethasone?

This drug may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with betamethasone?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

• Exposure to chickenpox or measles
• Active tuberculosis
• Latent amebiasis, candidiasis, and other infections
• Optic neuritis
• Myasthenia gravis
• Diabetes mellitus

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Allergic and inflammatory disorders

• Parenteral: (as betamethasone Na phosphate): 4-20 mg via deep IM injection or IV injection over 0.5-1 min or IV infusion, repeated 3 to 4 times in 24 hours, as necessary.
• Intranasal: instill 2-3 drops into each nostril twice a day, as required.
• Ophthalmic: instill 1-2 drops into the affected eye(s) every 2 hours, reduce the frequency as symptoms improve.
• Oral: (as betamethasone Na phosphate): 0-5-5 mg daily in divided doses, depending on the severity of the disease and clinical response. Recommended regimen:
  • Short-term treatment: 2-3 mg daily for the first few days, then gradually decrease by 0.25 or 0.5 mg every 2-5 days, depending on response.
  • Rheumatoid arthritis: 0.5-2 mg per day.
  • Other conditions: 1.5-5 mg daily for 1 to 3 weeks, then gradually reduce to the minimum effective dose.

Corticosteroid-responsive dermatoses

• As 0.05% betamethasone dipropionate: apply to affected area 1-2 times per day for up to 2 weeks.
• 0.025 or 0.1% betamethasone valerate cream: apply thinly onto the affected areas 1-3 times per day for up to 4 weeks or until symptoms improve.
• 0.1% betamethasone valerate solution: rub it gently onto the affected area twice a day.
• 0.12% betamethasone valerate foam: massage gently onto the scalp twice a day.

What is the dose for a child?

Allergic and inflammatory disorders

• Parenteral: (as betamethasone Na phosphate):

• ≤1 year: give 1 mg
• >1-5 years: give 2 mg
• 6-12 years: give 4 mg.
• Doses are given via IV injection or infusion, repeated 3-4 times in 24 hours, as necessary.

• Oral: the dose is based on the normal adult dose and the age of the child
  • Age 1 year: give 25% of the adult dose
  • 1 to 7 years: give 50% of the adult dose
  • 7 to 12 years: give 75% of the adult dose

How is betamethasone available?

This drug is available in the following brands, dosage forms, and strengths:

• Allerkan cream 0.05% betamethasone dipropionate
• Betnoderm cream 1 mg/g betamethasone valerate
• Betnovate ointment 1 mg/g betamethasone valerate
• Betnovate scalp lotion 1 mg/mL betamethasone valerate
• Celestone suspension for injection, 3 mg/mL betamethasone Na phosphate + 3 mg/mL betamethasone acetate
• Diprolene cream 0.05% betamethasone dipropionate
• Diprolene ointment 0.05% betamethasone dipropionate
• Diprosone cream 0.05% betamethasone dipropionate
• Diprosone ointment 0.05% betamethasone dipropionate
• Innodesone cream 0.1% betamethasone valerate

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose or suddenly stop taking your medication.