Betamethasone

Betamethasone

Brand Name: betamethasone benzoate, Topical dermatologic ointment, cream, lotion, gel: Bepen (CAN), Uticort, betamethasone dipropionate

Pregnancy Category C

Drug classes: Corticosteroid (long acting), Glucocorticoid, Hormonal agent


Therapeutic actions

Binds to intracellular corticosteroid receptors, thereby initiating many natural complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects.


Indications

• Systemic administration: Hypercalcemia associated with cancer
• Short-term management of inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders: thrombocytopenia purpura, erythroblastopenia
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas
• Trichinosis with neurologic or myocardial involvement
• Unlabeled use: Prevention of respiratory distress syndrome in premature neonates
• Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques, and so forth
• Dermatologic preparations: Relief of inflammatory and pruritic manifestations of steroid-responsive dermatoses


Contraindications

• Systemic (oral and parenteral) administration: Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections, lactation.


Adverse effects

Vertigo, headache, paresthesias, insomnia, convulsions, psychosis, cataracts, increased intraocular pressure, glaucoma (long-term therapy), Hypotension, shock, hypertension, and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias, Na+ and fluid retention, hypokalemia, hypocalcemia, Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels, hypothalamic-pituitary-adrenal (HPA) suppression with systemic therapy longer than 5 days, Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain (long-term therapy, Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures (long-term therapy), Immunosuppression, aggravation, or masking of infections; impaired wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae; subcutaneous fat atrophy; hypersensitivity or anaphylactoid reactions


Drug Interactions

• Risk of severe deterioration of muscle strength in myasthenia gravis patients receiving ambenonium, edrophonium, neostigmine, pyridostigmine
• Decreased steroid blood levels with barbiturates, phenytoin, rifampin
• Decreased effectiveness of salicylates with betamethasone
Interactions with lab-test
• False-negative nitroblue-tetrazolium test for bacterial infection
• Suppression of skin test reactions


Nursing considerations

In 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.
In Topical dermatologic preparations:
• Examine area for infections, skin integrity before application.
• Administer cautiously to pregnant patients; topical corticosteroids have caused teratogenic effects and can be absorbed from systemic site.
• Use caution when occlusive dressings, 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.