Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Indications for Drugs ::

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Drug Dose ::

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Contraindication ::

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Drug Precautions ::

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Drug Side Effects ::

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 Indications Systemic treatment of primary or secondary adrenal cortex insufficiency, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, allergic and inflammatory ophthalmic processes, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states (resulting from nephrotic syndrome), GI diseases, multiple sclerosis, tuberculous meningitis and trichinosis with neurologic or myocardial involvement.

Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines when patient is receiving immunosuppressive doses.

Topical: Do not use as monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.

 Route/Dosage

BETAMETHASONE

PO 0.6 to 7.2 mg/day.

BETAMETHASONE SODIUM PHOSPHATE

IV/IM or into joint or soft tissue up to 9 mg/day.

BETAMETHASONE SODIUM PHOSPHATE AND BETAMETHASONE ACETATE

Intrabursal, intra-articular, intradermal, or intralesional 0.5 to 9 mg/day, depending on site of administration or condition being treated.

BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE

Topical Apply sparingly to affected areas 2 to 4 times/day.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral May alter anticoagulant dose requirements. Barbiturates May decrease pharmacologic effect of betamethasone. Hydantoins May increase clearance and decrease therapeutic efficacy of betamethasone. Nondepolarizing muscle relaxants (eg, tubocurarine). May potentiate or counteract neuromuscular blocking action. Rifampin May increase clearance and decrease therapeutic efficacy of betamethasone. Salicylates May reduce serum levels and efficacy of salicylates. Troleandomycin May increase effects of betamethasone.

 Lab Test Interferences Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T₃, and T₄; decreased uptake of I¹³¹; false-negative nitroblue-tetrazolium test.

 Adverse Reactions

CARDIOVASCULAR: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri); vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERMATOLOGIC: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; suppression of skin test reactions; SC fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation; hypopigmentation. Topical application may cause burning; itching; irritation; erythema; dryness; folliculitis; hypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; numbness of fingers; stinging and cracking/tightening of skin; maceration of skin; secondary infections; skin atrophy; striae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased IOP, glaucoma; exophthalmos. GI: Pancreatitis; abdominal distension; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; hypothalamic-pituitary-adrenal (HPA) axis suppression; endocrine abnormalities (eg, menstrual irregularities; cushingoid state; growth suppression in children secondary to adrenocortical and pituitary unresponsiveness; increased sweating; decreased carbohydrate tolerance; hyperglycemia; glycosuria; increased insulin or sulfonylurea requirements in diabetics; manifestations of latent diabetes mellitus; negative nitrogen balance caused by protein catabolism; hirsutism). OTHER: Musculoskeletal (eg, weakness; myopathy; tendon rupture; osteoporosis; aseptic necrosis of femoral and humeral heads; spontaneous fractures including vertebral compression fractures and pathologic fracture of long bones); hypersensitivity, including anaphylactic reactions; aggravation or masking of infections; malaise. Topical use may produce same adverse reactions seen with systemic use.

 Precautions

Pregnancy: Safety not established (systemic). Category C (topical). Lactation: Excreted in breast milk. CHILDREN: Growth and development of infants and children on prolonged therapy must be monitored, even with topical treatment. Elderly: May require lower doses. Consider benefits relative to risks. Adrenal Suppression: Prolonged therapy may lead to HPA suppression. Cardiovascular: Use with caution in patients with recent MI. Fluid and Electrolyte Balance: Can cause elevated BP, salt and water retention, and increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: May be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: May mask signs of infection. May decrease host-defense mechanisms. Ocular Effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic Ulcer: May contribute to peptic ulceration, especially in large doses. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Sulfites: Some products contain sulfites, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency. Use is discontinued gradually, while supplementation is increased during times of stress.

 Administration/Storage

• Administer before 9 am for minimal suppression of adrenal cortex activity.
• Give with meals or snacks.
• For large doses, administer antacids between meals.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Review baseline lab results before therapy, including liver and renal function studies.
• Monitor BP, body weight, 2-hr postprandial blood glucose (at regular intervals), and electrolytes. Note potassium and calcium levels and any radiographic findings.
• Assess for signs of infection before initiation of therapy because product may mask signs of infection and exacerbate systemic fungal infections.
• Report to health care provider any weight increase, edema, elevated BP or low potassium, GI bleeding, nausea, or vomiting.

 Patient/Family Education

• Tell patient to take with meals or snacks to avoid nausea.
• Explain that medication should be taken before 9 am for best results.
• When multiple doses are to be taken, show patient how to space them evenly throughout day.
• If patient has diabetes, discuss importance of closely monitoring blood glucose for possible increase in insulin dosage.
• If patient is receiving long-term therapy, tell patient to carry identification containing notification of steroid therapy.
• Tell patient not to stop taking medication suddenly.
• Instruct patient to report the following symptoms to health care provider: unusual weight gain or weight loss; swelling of lower extremities; muscle weakness; black tarry stools; vomiting blood; puffing face; prolonged sore throat, fever, or cold; anorexia; nausea; vomiting; diarrhea; weakness; dizziness.

Topical Use

• Demonstrate proper technique for cleaning affected area before applying medication and for applying sparingly as a thin film.
• Tell patient to avoid contact with eyes and to avoid tight-fitting clothing on treated area.
• Explain that alcohol-containing preparations should not be applied to area because of drying/irritation.
• Caution patient to discontinue medication and notify health care provider if affected area worsens or develops irritation, redness, burning, swelling, or stinging.

–>

Drug Mode of Action ::  

 Action Synthetic, long-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.