Betamethasone (Systemic)

Pharmacologic Category

Corticosteroid, Systemic

Dosing: Adult

Note: Dosages expressed as combined amount of betamethasone sodium phosphate and betamethasone acetate; 1 mg is equivalent to betamethasone sodium phosphate 0.5 mg and betamethasone acetate 0.5 mg.

Usual dosage range: IM: Initial: 0.25 to 9 mg/day (based on severity of disease and patient response).

Indication-specific dosing:

Antenatal fetal maturation (off-label use): IM: 12 mg every 24 hours for a total of 2 doses (ACOG 171 2016). A single course of betamethasone is recommended for women between 24 and 34 weeks of gestation, including those with ruptured membranes or multiple gestations, who are at risk of delivering within 7 days. A single course may be appropriate in some women beginning at 23 weeks gestation or late preterm (between 34 0/7 weeks and 36 6/7 weeks gestation). A single repeat course may be considered in some women with pregnancies less than 34 weeks gestation at risk for delivery within 7 days and who had a course of antenatal corticosteroids >14 days prior (ACOG 171 2016; ACOG 217 2020; ACOG 713 2017,).

Bursitis (other than of foot): Intra-articular: 3 to 6 mg (0.5 to 1 mL) for one dose; additional injections may be required for acute exacerbations or chronic conditions; generally, injections should be separated by a minimum of 4 to 6 weeks and limited to ≤4 injections per year. If symptoms are not improved after 1 or 2 injections, additional injections are unlikely to provide benefit (Cardone 2002); following resolution of acute episodes, reduced doses may be warranted for chronic conditions.

Dermatologic conditions: Intradermal: 1.2 mg/cm2 (0.2 mL/cm2) into lesion for one dose (maximum: 6 mg [1 mL] weekly).

Foot disorders: Intra-articular: 1.5 mg to 6 mg (0.25 to 1 mL) per dose. Dose is based upon condition; additional injections (when required) should generally be separated by a minimum of 4 to 6 weeks and limited to ≤4 injections per year. If symptoms are not improved after 1 or 2 injections, additional injections are unlikely to provide benefit (Cardone 2002):

Bursitis: 1.5 mg to 3 mg (0.25 to 0.5 mL).

Tenosynovitis: 3 mg (0.5 mL).

Acute gouty arthritis: 3 mg to 6 mg (0.5 to 1 mL).

Multiple sclerosis: Note: Treatment guidelines recommend the use of high-dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis (AAN [Scott 2011]; NICE 2014).

IM: 30 mg daily for 1 week, followed by 12 mg every other day for 4 weeks.

Rheumatoid and osteoarthritis: Intra-articular: 3 mg to 12 mg (0.5 to 2 mL) for one dose. Dose is based upon the joint size:

Very large (eg, hip): 6 to 12 mg (1 to 2 mL).

Large (eg, knee, ankle, shoulder): 6 mg (1 mL).

Medium (eg, elbow, wrist): 3 mg to 6 mg (0.5 to 1 mL).

Small (eg, inter- or metacarpophalangeal, sternoclavicular): 1.5 mg to 3 mg (0.25 to 0.5 mL).

Tenosynovitis (other than of foot), peritendinitis: Intra-articular: 1.5 to 6 mg (0.25 to 1 mL) depending on joint size for one dose (Cardone 2002; Churgay 2009; Waryasz 2017; manufacturer labeling); additional injections (when required) should generally be separated by a minimum of 4 to 6 weeks and limited to ≤4 injections per year. If symptoms are not improved after 1 or 2 injections, additional injections are unlikely to provide benefit (Cardone 2002; Waryasz 2017).

Dosing: Geriatric

Refer to adult dosing. Use the lowest effective dose.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

Note: Dosages expressed as combined amount of betamethasone sodium phosphate and betamethasone acetate; 1 mg is equivalent to betamethasone sodium phosphate 0.5 mg and betamethasone acetate 0.5 mg. Dosage should be based on severity of disease and patient response; use lowest effective dose for shortest period of time to avoid HPA axis suppression

General dosing, treatment of inflammatory and allergic conditions: Infants, Children, and Adolescents: IM: Initial: 0.02 to 0.3 mg/kg/day (0.6 to 9 mg/m2/day) in 3 or 4 divided doses

Infantile hemangioma, severe: Limited data available: Infants and Children: Intralesional: Dosage dependent upon size of lesion: Commonly reported: 6 mg administered as a 6 mg/mL (in combination with triamcinolone injection) divided into multiple injections along the lesion perimeter; reported range: 1.5 to 18 mg/dose; doses usually administered every 8 to 14 weeks; reported range: 6 to 25 weeks (Buckmiller, 2008; Chowdri, 1994; Kushner, 1985; Praseyono, 2011). Dosing based on small trials and case-series, mostly reported in infants and children ≤4 years of age. The largest experience (n=70, age range: 2 months to 12 years) prospectively used a betamethasone/triamcinolone combination injection (1.5 to 18 mg betamethasone acetate) and showed that 89.23% of lesions with an initial volume <20 cc3 regressed by more than 50%, but only 22.2% of lesions with an initial volume >20 cc3 displayed a good or excellent response (Chowdri, 1994). Another trial (n=25, age range: 7 weeks to 2 years) used lower doses of 3 to 12 mg (in combination with triamcinolone); 16 patients experienced a marked response (Kushner, 1985).

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Calculations

• Body Surface Area (Mosteller Method)
• Corticosteroid Conversion (Glucocorticoid Effect)

Use: Labeled Indications

Intramuscular:

Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions

Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome)

Endocrine disorders: Congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Note: Hydrocortisone or cortisone is the drug of choice in primary or secondary adrenocortical insufficiency. Synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance

Gastrointestinal diseases: During acute episodes in regional enteritis and ulcerative colitis

Hematologic disorders: Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia

Neoplastic diseases: Palliative management of leukemias and lymphomas

Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Note: Treatment guidelines recommend the use of high-dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis (AAN [Scott 2011]; NICE 2014).

Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids

Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus

Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis

Rheumatic disorders: Adjunctive therapy for short-term administration in acute gout flares; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy); treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus.

Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy

Intra-articular or soft tissue administration:

Adjunctive therapy for short-term administration in acute gout flares, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis

Intralesional:

Treatment of alopecia areata; discoid lupus erythematosus; keloids; localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; necrobiosis lipoidica diabeticorum

Use: Off-Label: Adult

Accelerate fetal lung maturationLevel of Evidence [B, G]

According to systematic reviews of randomized controlled trials using betamethasone or dexamethasone, evidence supports the use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk for preterm delivery, with no clear advantages found regarding use of one corticosteroid over another Ref.

Based on the American Congress of Obstetricians and Gynecologists (ACOG) practice bulletin for the management of premature rupture of membranes or preterm labor, the antenatal use of corticosteroids (eg, betamethasone) to accelerate fetal lung maturation is effective and recommended Ref. Access Full Off-Label Monograph

Level of Evidence Definitions

Level of Evidence Scale

Class and Related Monographs

Glucocorticoids

Clinical Practice Guidelines

Gout:

BSR/BHPR, Guideline for the Management of Gout, 2007

Juvenile idiopathic arthritis:

American College of Rheumatology, “2013 Update of the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis” 2013

Osteoarthritis:

ACR/AF, “Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee,” February 2020

Administration: IM

Shake well prior to use. May be administered intramuscularly.

Administration: Injectable Detail

pH 6.8 to 7.2 (suspension)

Administration: Other

Shake well prior to use.

Intra-articular: Needle size requirements vary based on the size of the joint to be treated (eg, <25 gauge [hip, knee, shoulder], 25 gauge [wrist, ankle, elbow]) and/or method of administration (Rastogi 2016).

Bursitis: Inject into affected bursa.

Rheumatoid or osteoarthritis: Inject into synovial cavity.

Tendinitis/tenosynovitis: Inject into affected tendon sheaths (not directly into tendons).

Administration: Intradermal

Shake well prior to use. Inject a uniform depot, using a 1 mL (eg, tuberculin) syringe with 1/2-inch needle (typically 26 or 27 gauge) (Love 2006). Do not inject subcutaneously.

Administration: Pediatric

Note: May be coadministered with a local anesthetic.

Parenteral: Do not administer IV.

IM: Shake well prior to use; administer deep IM injection.

Intrabursal: Tendinitis, tenosynovitis: Inject into affected tendon sheaths (not directly into tendons).

Intralesional: Using a 25-gauge tuberculin syringe with 1/2-inch needle inject a uniform depot; for infantile hemangioma, 26- and 27-gauge needles have been used for administration. Should be injected directly into the lesion area. Do not inject subcutaneously.

Storage/Stability

Store at 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Protect from light.

Preparation for Administration: Adult

If suspension is coadministered with a local anesthetic, it may be mixed in syringe with 1% or 2% lidocaine HCl (without parabens) or similar parabens-free local anesthetic. Withdraw the dose of betamethasone suspension from the vial into the syringe, then draw up the local anesthetic into the syringe and shake the syringe briefly. Do not inject the local anesthetic directly into the suspension vial.

Preparation for Administration: Pediatric

Parenteral: If suspension is coadministered with a local anesthetic, it may be mixed in syringe with 1% or 2% lidocaine HCl (without parabens). Withdraw the dose of betamethasone suspension from the vial into the syringe, then draw up the local anesthetic into the syringe, and shake the syringe briefly. Do not inject the local anesthetic directly into the suspension vial.

Compatibility

See Trissel’s IV Compatibility Database

Open Trissel's IV Compatibility

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems.

• This is not a list of all health problems that this drug may be used for. Talk with the doctor.

Frequently reported side effects of this drug

• Nausea

• Vomiting

• Increased appetite

• Restlessness

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• High blood sugar like confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit

• Cushing syndrome like weight gain in upper back or abdomen; moon face; severe headache; or slow healing

• Skin changes like pimples, stretch marks, slow healing, or hair growth

• Infection

• Low potassium like muscle pain or weakness, muscle cramps, or an abnormal heartbeat

• Pancreatitis like severe abdominal pain, severe back pain, severe nausea, or vomiting

• Adrenal gland problems like severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss

• DVT like swelling, warmth, numbness, change in color, or pain in the extremities

• Severe loss of strength and energy

• Tremors

• Irritability

• Fast heartbeat

• Confusion

• Sweating a lot

• Headache

• Severe dizziness

• Passing out

• Shortness of breath

• Excessive weight gain

• Swelling of arms or legs

• Slow heartbeat

• Chest pain

• Menstrual changes

• Joint pain

• Bone pain

• Muscle pain

• Muscle weakness

• Behavioral changes

• Seizures

• Depression

• Mood changes

• Burning or numbness feeling

• Vision changes

• Bruising

• Bleeding

• Abdominal swelling

• Abdominal pain

• Black, tarry, or bloody stools

• Vomiting blood

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Contraindications

Hypersensitivity to any component of the formulation; IM administration contraindicated in immune thrombocytopenia (formerly known as idiopathic thrombocytopenic purpura).

Canadian labeling: Additional contraindications (not in US labeling): Herpes simplex of the eye; systemic fungal infections; vaccinia; cerebral malaria; use in areas with local infection.

Documentation of allergenic cross-reactivity for glucocorticoids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Adult patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections. In stressful situations, HPA axis-suppressed patients should receive adequate supplementation with natural glucocorticoids (hydrocortisone or cortisone) rather than betamethasone (due to lack of mineralocorticoid activity).

• Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.

• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate infections, or limit response to killed or inactivated vaccines. Special pathogens (Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, Strongyloides, or Toxoplasma) may be activated or an infection exacerbation may occur (may be fatal). Amebiasis or Strongyloides infections should be particularly ruled out. Exposure to chickenpox or measles should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria, fungal infections, or viral hepatitis. Close observation is required in patients with latent tuberculosis and/or TB reactivity; restrict use in active TB (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to initiation of corticosteroids.

• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered.

• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.

• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.

Disease-related issues:

• Cardiovascular disease: Use with caution in patients with HF and/or hypertension; use has been associated with electrolyte disturbances, fluid retention, and hypertension. Dietary modifications may be necessary. Use with caution in patients with a recent history of myocardial infarction (MI); left ventricular free wall rupture has been reported after the use of corticosteroids.

• Diabetes: Use with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.

• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, fresh intestinal anastomoses, peptic ulcer, ulcerative colitis) due to perforation risk. Avoid ethanol may enhance gastric mucosal irritation.

• Head injury: Increased mortality was observed in patients receiving high-dose IV methylprednisolone; high-dose corticosteroids should not be used for the management of head injury.

• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis; long-term use has been associated with fluid retention.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred especially during initial treatment with corticosteroids.

• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Not recommended for the treatment of optic neuritis; may increase frequency of new episodes. Consider routine eye exams in chronic users.

• Osteoporosis: Use with caution in patients with osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures.

• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.

• Seizure disorders: Use with caution in patients with a history of seizure disorder; seizures have been reported with adrenal crisis.

• Systemic sclerosis: Use with caution in patients with systemic sclerosis; an increase in scleroderma renal crisis incidence has been observed with corticosteroid use. Monitor BP and renal function in patients with systemic sclerosis treated with corticosteroids (EULAR [Kowal-Bielecka 2017]).

• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroidism and decreases in hypothyroidism.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Elderly: Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.

• Pediatric: May affect growth velocity; growth should be routinely monitored in pediatric patients.

Other warnings/precautions:

• Appropriate use: For intramuscular, intra-articular or intralesional use only, do not administer intravenously or epidurally (see Epidural injection).

• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.

• Epidural injection: Corticosteroids are not approved for epidural injection. Serious neurologic events (eg, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke), some resulting in death, have been reported with epidural injection of corticosteroids, with and without use of fluoroscopy.

• Intra-articular injection: May produce systemic as well as local effects. Appropriate examination of any joint fluid present is necessary to exclude a septic process. Avoid injection into an infected site. Do not inject into unstable joints. Intra-articular injection may result in damage to joint tissues.

Geriatric Considerations

Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly, in the smallest possible dose, and for the shortest possible time.

Warnings: Additional Pediatric Considerations

Adrenal suppression with failure to thrive has been reported in infants after receiving intralesional corticosteroid injections for treatment of hemangioma (Goyal, 2004). May cause osteoporosis (at any age) or inhibition of bone growth in pediatric patients. Use with caution in patients with osteoporosis. In a population-based study of children, risk of fracture was shown to be increased with >4 courses of corticosteroids; underlying clinical condition may also impact bone health and osteoporotic effect of corticosteroids (Leonard, 2007).

Pregnancy Considerations

Betamethasone crosses the placenta (Brownfoot 2013) and is partially metabolized by placental enzymes to an inactive metabolite (Murphy 2007).

Some studies have shown an association between first trimester systemic corticosteroid use and oral clefts or decreased birth weight; however, information is conflicting and may be influenced by maternal dose/indication for use (Lunghi 2010; Park-Wyllie 2000; Pradat 2003). Hypoadrenalism may occur in newborns following maternal use of corticosteroids during pregnancy; monitor.

Betamethasone is classified as a fluorinated corticosteroid. When systemic corticosteroids are needed in pregnancy for rheumatic disorders, nonfluorinated corticosteroids (eg, prednisone) are preferred. Chronic high doses should be avoided (ACR [Sammaritano 2020]).

Antenatal corticosteroid administration promotes fetal lung maturity and is associated with the reduction of intraventricular hemorrhage, necrotizing enterocolitis, neonatal mortality, and respiratory distress syndrome. A single course of betamethasone is recommended for women between 24 0/7 and 33 6/7 weeks' gestation who are at risk of delivering within 7 days. This recommendation includes those with ruptured membranes or multiple gestations. A single course of betamethasone may be considered for women beginning at 23 0/7 weeks' gestation who are at risk of delivering within 7 days, in consultation with the family regarding resuscitation. In addition, a single course of betamethasone may be given to women between 34 0/7 weeks and 36 6/7 weeks who are at risk of preterm delivery within 7 days and who have not previously received corticosteroids if induction or delivery will proceed ≥24 hours and ≤7 days; delivery should not be delayed for administration of antenatal corticosteroids. Use of concomitant tocolytics is not currently recommended and administration of late preterm corticosteroids has not been evaluated in women with intrauterine infection, multiple gestations, pregestational diabetes, or women who delivered previously by cesarean section at term. Multiple repeat courses are not recommended. However, in women with pregnancies less than 34 weeks' gestation at risk for delivery within 7 days and who had a course of antenatal corticosteroids >14 days prior, a single repeat course may be considered; use of a repeat course in women with preterm prelabor rupture of membranes is controversial (ACOG 171 2016; ACOG 217 2020; ACOG 713 2017).

Corticosteroid administration to nonpregnant patients with coronavirus disease 2019 (COVID-19) may increase morbidity and mortality. However, it is unclear whether steroids worsen the patient condition or whether patients received steroids due to having a more critical status. Additionally, doses/duration of therapy for critically ill patients are different than what is used in pregnant patients treated for antenatal fetal lung maturation (McIntosh 2020). Based on available information, ACOG has suggested modifications for antenatal corticosteroid administration in patients with suspected or confirmed COVID-19. Antenatal steroids should continue to be administered to patients between 24 0/7 and 33 6/7 weeks' gestation at risk of delivering within 7 days. Antenatal corticosteroids should not be offered for fetal lung maturation in patients between 34 0/7 and 36 6/7 weeks' gestation. Regardless of gestational age, patient care should be individualized based on potential benefits to the neonate and possible harm to the mother (ACOG FAQ 2020). Extra caution is recommended for critically ill pregnant patients in an ICU setting (SMFM 2020). Additional guidelines are emerging and consultation with an infectious disease specialist, maternal fetal medicine specialist, and neonatologist is suggested (McIntosh 2020; Poon [FIGO 2020]).

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19 (https://www.acog.org/topics/covid-19; https://www.smfm.org/covid19). Interim guidance is also available from the CDC for pregnant women who are diagnosed with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html).

Breast-Feeding Considerations

Corticosteroids are present in breast milk.

The onset of milk secretion after birth may be delayed and the volume of milk produced may be decreased by antenatal betamethasone therapy; this affect was seen when delivery occurred 3 to 9 days after the betamethasone dose in women between 28 and 34 weeks gestation. Antenatal betamethasone therapy did not affect milk production when birth occurred <3 days or >10 days of treatment (Henderson 2008).

The manufacturer notes that when used systemically, maternal use of corticosteroids have the potential to cause adverse events in a breastfed infant (eg, growth suppression, interfere with endogenous corticosteroid production) and therefore, recommends that caution be exercised when administering betamethasone to breastfeeding women. Corticosteroids are generally considered compatible with breastfeeding when used in usual doses; however, monitoring of the breastfeeding infant for adverse reactions is recommended (WHO 2002). Betamethasone is classified as a fluorinated corticosteroid. When systemic corticosteroids are needed in a lactating woman for rheumatic disorders, low doses of nonfluorinated corticosteroids (eg, prednisone) are preferred (ACR [Sammaritano 2020]).

Briggs' Drugs in Pregnancy & Lactation

• Betamethasone

Adverse Reactions

Frequency not defined:

Cardiovascular: Bradycardia, cardiac arrhythmia, cardiomegaly, circulatory shock, edema, embolism (fat), hypertension, hypertrophic cardiomyopathy, myocardial rupture (following recent MI), syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

Central nervous system: Abnormal sensory symptoms, arachnoiditis, depression, emotional lability, euphoria, headache, increased intracranial pressure, insomnia, malaise, meningitis, myasthenia, neuritis, neuropathy, paraplegia, paresthesia, personality changes, pseudotumor cerebri, psychic disorder, seizure, spinal cord compression, vertigo

Dermatologic: Acne vulgaris, allergic dermatitis, atrophic striae, diaphoresis, ecchymoses, erythema, exfoliation of skin, fragile skin, hyperpigmentation, hypertrichosis, hypopigmentation, skin atrophy, skin rash, subcutaneous atrophy, suppression of skin test reaction, thinning hair, urticaria, xeroderma

Endocrine & metabolic: Amenorrhea, calcinosis, cushingoid state, decreased glucose tolerance, decreased serum potassium, fluid retention, glycosuria, growth suppression (pediatric), hirsutism, HPA-axis suppression, hypokalemic alkalosis, impaired glucose tolerance/prediabetes, insulin resistance (increased requirements for insulin or oral hyperglycemic agents), moon face, negative nitrogen balance, protein catabolism, sodium retention, weight gain

Gastrointestinal: Abdominal distention, change in bowel habits, hiccups, increased appetite, intestinal perforation, nausea, pancreatitis, peptic ulcer, ulcerative esophagitis

Genitourinary: Bladder dysfunction, spermatozoa disorder (decreased motility and number)

Hematologic & oncologic: Petechia

Hepatic: Hepatomegaly, increased liver enzymes

Hypersensitivity: Anaphylactoid reaction, anaphylaxis, angioedema

Infection: Infection (decreased resistance), sterile abscess

Local: Injection site reaction (intra-articular use). postinjection flare (intra-articular use)

Neuromuscular & skeletal: Amyotrophy, aseptic necrosis of femoral head, aseptic necrosis of humeral head, bone fracture, Charcot arthropathy, lipotrophy, myopathy, osteoporosis, rupture of tendon, steroid myopathy

Ophthalmic: Blindness, blurred vision, cataract, exophthalmos, glaucoma, increased intraocular pressure, papilledema

Respiratory: Pulmonary edema

Miscellaneous: Wound healing impairment

Allergy and Idiosyncratic Reactions

• Corticosteroid Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Acetylcholinesterase Inhibitors: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Risk C: Monitor therapy

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Risk X: Avoid combination

Amphotericin B: Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Androgens: Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Aprepitant: May increase the serum concentration of Corticosteroids (Systemic). Management: No dose adjustment is needed for single 40 mg aprepitant doses. For other regimens, reduce oral dexamethasone or methylprednisolone doses by 50%, and IV methylprednisolone doses by 25%. Antiemetic regimens containing dexamethasone reflect this adjustment. Risk D: Consider therapy modification

Axicabtagene Ciloleucel: Corticosteroids (Systemic) may diminish the therapeutic effect of Axicabtagene Ciloleucel. Management: Avoid use of corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity. Risk D: Consider therapy modification

Baricitinib: Immunosuppressants may enhance the immunosuppressive effect of Baricitinib. Management: Use of baricitinib in combination with potent immunosuppressants such as azathioprine or cyclosporine is not recommended. Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted. Risk D: Consider therapy modification

BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

Calcitriol (Systemic): Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol (Systemic). Risk C: Monitor therapy

Cladribine: May enhance the immunosuppressive effect of Immunosuppressants. Risk X: Avoid combination

Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Risk C: Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy

Cosyntropin: Corticosteroids (Systemic) may diminish the diagnostic effect of Cosyntropin. Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Deferasirox: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Risk C: Monitor therapy

Desirudin: Corticosteroids (Systemic) may enhance the anticoagulant effect of Desirudin. More specifically, corticosteroids may increase hemorrhagic risk during desirudin treatment. Management: Discontinue treatment with systemic corticosteroids prior to desirudin initiation. If concomitant use cannot be avoided, monitor patients receiving these combinations closely for clinical and laboratory evidence of excessive anticoagulation. Risk D: Consider therapy modification

Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

DilTIAZem: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Echinacea: May diminish the therapeutic effect of Immunosuppressants. Management: Consider avoiding Echinacea in patients receiving therapeutic immunosuppressants. If coadministered, monitor for reduced efficacy of the immunosuppressant during concomitant use. Risk D: Consider therapy modification

Estrogen Derivatives: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Fexinidazole [INT]: Corticosteroids (Systemic) may enhance the arrhythmogenic effect of Fexinidazole [INT]. Risk X: Avoid combination

Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Risk D: Consider therapy modification

Fosaprepitant: May increase the serum concentration of Corticosteroids (Systemic). The active metabolite aprepitant is likely responsible for this effect. Management: Decrease oral dexamethasone or methylprednisolone dose by 50% during coadministration with fosaprepitant/aprepitant. Reduce intravenous methylprednisolone dose by 25% during coadministration with fosaprepitant/aprepitant. Risk D: Consider therapy modification

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

Indacaterol: May enhance the hypokalemic effect of Corticosteroids (Systemic). Risk C: Monitor therapy

Indium 111 Capromab Pendetide: Corticosteroids (Systemic) may diminish the diagnostic effect of Indium 111 Capromab Pendetide. Risk X: Avoid combination

Isoniazid: Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid. Risk C: Monitor therapy

Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification

Loop Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Macimorelin: Corticosteroids (Systemic) may diminish the diagnostic effect of Macimorelin. Risk X: Avoid combination

Mifamurtide: Corticosteroids (Systemic) may diminish the therapeutic effect of Mifamurtide. Risk X: Avoid combination

MiFEPRIStone: May diminish the therapeutic effect of Corticosteroids (Systemic). MiFEPRIStone may increase the serum concentration of Corticosteroids (Systemic). Management: Avoid mifepristone in patients who require long-term corticosteroid treatment of serious illnesses or conditions (e.g., for immunosuppression following transplantation). Corticosteroid effects may be reduced by mifepristone treatment. Risk X: Avoid combination

Mitotane: May decrease the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination

Neuromuscular-Blocking Agents (Nondepolarizing): May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Management: If concomitant therapy is required, use the lowest dose for the shortest duration to limit the risk of myopathy or neuropathy. Monitor for new onset or worsening muscle weakness, reduction or loss of deep tendon reflexes, and peripheral sensory decriments Risk D: Consider therapy modification

Nicorandil: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nicorandil. Gastrointestinal perforation has been reported in association with this combination. Risk C: Monitor therapy

Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Management: Avoid use of immunosuppressants (including systemic corticosteroids) prior to initiation of nivolumab. Use of immunosuppressants after administration of nivolumab (eg, for immune-related toxicity) is unlikely to affect nivolumab efficacy. Risk D: Consider therapy modification

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Nonselective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Risk C: Monitor therapy

Ozanimod: Immunosuppressants may enhance the immunosuppressive effect of Ozanimod. Risk C: Monitor therapy

Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination

Quinolones: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. Risk C: Monitor therapy

Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Risk C: Monitor therapy

Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Management: Consider avoiding concomitant use of roflumilast and immunosuppressants as recommended by the Canadian product monograph. Inhaled or short-term corticosteroids are unlikely to be problematic. Risk D: Consider therapy modification

Salicylates: May enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor therapy

Sargramostim: Corticosteroids (Systemic) may enhance the therapeutic effect of Sargramostim. Specifically, corticosteroids may enhance the myeloproliferative effects of sargramostim. Risk C: Monitor therapy

Siponimod: Immunosuppressants may enhance the immunosuppressive effect of Siponimod. Risk C: Monitor therapy

Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Management: Evaluate patients to see if it is medically appropriate to reduce or discontinue therapy with immunosuppressants prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification

Somatropin: Corticosteroids (Systemic) may diminish the therapeutic effect of Somatropin. Risk C: Monitor therapy

Tacrolimus (Systemic): Corticosteroids (Systemic) may decrease the serum concentration of Tacrolimus (Systemic). Conversely, when discontinuing corticosteroid therapy, tacrolimus concentrations may increase. Risk C: Monitor therapy

Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Risk X: Avoid combination

Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tisagenlecleucel: Corticosteroids (Systemic) may diminish the therapeutic effect of Tisagenlecleucel. Management: Avoid use of corticosteroids as premedication or at any time during treatment with tisagenlecleucel, except in the case of life-threatening emergency (such as resistant cytokine release syndrome). Risk D: Consider therapy modification

Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Risk D: Consider therapy modification

Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy

Upadacitinib: Immunosuppressants may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination

Urea Cycle Disorder Agents: Corticosteroids (Systemic) may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Corticosteroids (Systemic) may increase protein catabolism and plasma ammonia concentrations, thereby increasing the doses of Urea Cycle Disorder Agents needed to maintain these concentrations in the target range. Risk C: Monitor therapy

Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Risk D: Consider therapy modification

Vaccines (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Vaccines (Live). Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Doses equivalent to less than 2 mg/kg or 20 mg per day of prednisone administered for less than 2 weeks are not considered sufficiently immunosuppressive to create vaccine safety concerns. Higher doses and longer durations should be avoided. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Corticosteroids (Systemic) may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Test Interactions

May suppress the wheal and flare reactions to skin test antigens

Monitoring Parameters

Growth in children; injection site reactions, risk of infection

Advanced Practitioners Physical Assessment/Monitoring

No intravenous/subcutaneous use. Regional corticosteroid therapy is contraindicated in locally infected areas. Dosage consideration when used concomitantly with peroral/parenteral corticosteroids or patients undergoing high stress. Always use lowest possible dose for management of any condition. Long-term use goal to switch from parenteral to oral administration. Review vaccination record prior to use. Avoid exposure to chickenpox while on immunosuppressant doses. Assess for infection as risk increased during immunosuppression. Ophthalmic exam done periodically for patients on greater than six weeks due to potential posterior cataracts, glaucoma or ocular infections. Monitor for hypertension, hyperglycemia, and hypokalemia. Gradual dosage reduction may reduce drug-induced secondary adrenocortical insufficiency. Monitor for psychiatric adverse effects; euphoria, insomnia, mood swings, severe depression and increased prior psychotic tendencies. Monitor growth of infants and children.

Nursing Physical Assessment/Monitoring

Administer intramuscular injections deep into large muscle to avoid local tissue atrophy. Monitor for blood pressure, potassium, and glucose. Accurate weight, height and head circumference of infants/children to assess growth. Monitor for adrenal insufficiency (chronic fatigue, muscle weakness, decreased appetite, weight loss, abdominal pain, irritability, hypoglycemia).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Kit, Injection:

Pod-Care 100C: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL [contains benzalkonium chloride, disodium edta]

ReadySharp Betamethasone: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL [contains benzalkonium chloride, disodium edta]

Suspension, Injection:

Celestone Soluspan: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL (5 mL) [contains benzalkonium chloride, edetate disodium]

Generic: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL (5 mL)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Suspension, Injection:

Betaject: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL ([DSC]) [contains benzalkonium chloride]

Celestone Soluspan: Betamethasone sodium phosphate 3 mg and betamethasone acetate 3 mg per 1 mL (1 mL, 5 mL) [contains benzalkonium chloride, edetate disodium]

Anatomic Therapeutic Chemical (ATC) Classification

• A07EA04
• H02AB01

Generic Available (US)

Yes

Pricing: US

Kit (ReadySharp Betamethasone Injection)

30 mg/5 mL (per each): $573.40

Suspension (Betamethasone Sod Phos & Acet Injection)

6 (3-3) mg/mL (per mL): $9.60 - $12.36

Suspension (Celestone Soluspan Injection)

6 (3-3) mg/mL (per mL): $8.98

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Controls the rate of protein synthesis; depresses the migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation

Pharmacodynamics/Kinetics

Protein binding: 64% (Peterson 1983)

Metabolism: Hepatic (Peterson 1983)

Half-life elimination: 6.5 hours (Peterson 1983)

Time to peak, serum: IV: 10 to 36 minutes (Peterson 1983)

Excretion: Urine (<5% as unchanged drug) (Peterson 1983)

Dental Use

Treatment of a variety of oral diseases of allergic, inflammatory, or autoimmune origin

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

Variable effects on anticoagulant therapy are observed with glucocorticoids such as betamethasone.

Related Information

• Beers Criteria 2019: Potentially Inappropriate Medication Use in Older Adults ≥65 Years of Age
• Corticosteroids Systemic Equivalencies
• Stress Replacement of Corticosteroids

Index Terms

Betamet Acet/Betamet Na pH; Betamethasone Acetate; Betamethasone Sod Phos/Acetate; Betamethasone Sodium Phosphate; Flubenisolone

FDA Approval Date

April 17, 1961

References

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Last Updated 6/8/20

Betamethasone (Topical)

Pharmacologic Category

Corticosteroid, Topical

Dosing: Adult

Note: Base dosage on severity of disease and patient response. Use lowest dose possible for shortest period of time to avoid HPA axis suppression. Therapy should be discontinued when control is achieved.

Corticosteroid-responsive dermatoses: Topical:

Cream, augmented formulation: Betamethasone dipropionate 0.05%: Apply once or twice daily (maximum: 50 g weekly).

Cream, unaugmented formulation:

Betamethasone dipropionate 0.05%: Apply once daily; may increase to twice daily if needed

Betamethasone valerate 0.1%: Apply 1 to 3 times daily. Note: Once- or twice-daily applications are usually effective.

Foam: Apply to the scalp twice daily, once in the morning and once at night. Note: Reassess if no improvement after 2 weeks of treatment.

Gel, augmented formulation: Apply once or twice daily; rub in gently (maximum: 50 g weekly). Note: Reassess if no improvement after 2 weeks of treatment.

Lotion, augmented formulation: Betamethasone dipropionate 0.05%: Apply a few drops once or twice daily (maximum: 50 mL weekly). Note: Reassess if no improvement after 2 weeks of treatment.

Lotion, unaugmented formulation:

Betamethasone dipropionate 0.05%: Apply a few drops twice daily

Betamethasone valerate 0.1%: Apply a few drops twice daily; may consider increasing dose for resistant cases. Following improvement, may apply once daily.

Ointment, augmented formulation: Betamethasone dipropionate 0.05%: Apply once or twice daily (maximum: 50 g weekly). Note: Reassess if no improvement after 2 weeks of treatment.

Ointment, unaugmented formulation:

Betamethasone dipropionate 0.05%: Apply once daily; may increase to twice daily if needed

Betamethasone valerate 0.1%: Apply 1 to 3 times daily. Note: Once- or twice-daily applications are usually effective.

Plaque psoriasis: Topical:

Patch [Canadian product]: Betamethasone valerate: Apply 1 patch (2.25 mg) to each affected area once daily [up to 5 patches (11.25 mg) may be applied daily]; maximum duration of therapy: 30 days.

Spray, unaugmented formulation: Betamethasone dipropionate 0.05%: Apply twice daily for up to 4 weeks

Dosing: Geriatric

Refer to adult dosing. Use the lowest effective dose.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

Note: Dosage should be based on severity of disease and patient response; use smallest amount for shortest period of time to avoid HPA axis suppression. Therapy should be discontinued when control is achieved.

Dermatoses (corticosteroid-responsive):

Betamethasone valerate:

Cream 0.1%, ointment 0.1%: Children and Adolescents: Topical: Apply a thin film to the affected area once to 3 times daily; usually once- or twice-daily application is effective.

Lotion 0.1%: Children and Adolescents: Topical: Apply a few drops to the affected area twice daily in the morning and at night; in some cases, more frequent application may be necessary; following improvement reduce to once-daily application.

Betamethasone dipropionate (augmented formulation):

Cream 0.05%, ointment 0.05%: Adolescents: Topical: Apply a thin film to affected area once or twice daily; maximum dose: 50 g/week; evaluate continuation of therapy if no improvement within 2 weeks of treatment.

Gel 0.05%: Children ≥12 years and Adolescents: Topical: Apply a thin layer to the affected area once or twice daily; rub in gently; maximum dose: 50 g/week; not recommended for use longer than 2 weeks.

Lotion 0.05%: Adolescents: Topical: Apply a few drops to the affected area once or twice daily; rub in gently; maximum dose: 50 mL/week; not recommended for use for longer than 2 weeks.

Psoriasis (plaque), treatment: Adolescents ≥18 years of age: Betamethasone dipropionate spray 0.05%: Topical: Apply spray to affected area twice daily and rub in gently for up to 4 weeks.

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Calculations

• Body Surface Area (Mosteller Method)
• Corticosteroid Conversion (Glucocorticoid Effect)

Use: Labeled Indications

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

Dermatoses of the scalp (foam): Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses of the scalp.

Plaque psoriasis (spray; patch [Canadian product]): Treatment of mild to moderate plaque psoriasis in patients 18 years and older.

Class and Related Monographs

Corticosteroids, Topical

Administration: Topical

Cream, ointment: Apply topical sparingly to affected areas. Not for use on broken skin or in areas of infection. Do not apply to wet skin unless directed; do not cover with occlusive dressing. Do not apply very high potency agents to face, groin, axillae, or diaper area. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.

Lotion: Apply topical sparingly to affected areas. Massage in gently until lotion disappears. Not for use on broken skin or in areas of infection. Do not apply to wet skin unless directed; do not cover with occlusive dressing. Do not apply very high potency agents to face, groin, axillae, or diaper area. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.

Foam: Invert can and dispense a small amount onto a saucer or other cool surface. Do not dispense directly into hands. Pick up small amounts of foam and gently massage into affected areas until foam disappears. Repeat until entire affected scalp area is treated. Do not cover with occlusive dressing unless directed otherwise by health care provider. Not for ophthalmic use. Avoid getting into eyes.

Patch [Canadian product]: Clean and dry area to be treated prior to each application. May cut patch to size to cover lesion. Peel off protective film and apply adhesive medicated side to affected area; patch should be worn for 20 to 24 hours. After removing patch wait at least 30 minutes before applying a new one. Keep dry; if patch becomes wet, remove and wait until next scheduled dose before applying a new one. Do not cover with occlusive dressing. Patch should not be reused if it comes off; if edges of patch start to lift, apply medical adhesive tape to detached part only.

Spray: Spray directly onto affected areas (spray only enough to sufficiently cover the area); rub in gently and wash hands after applying. Shake well before use. Do not use if atrophy is present at the treatment site. Do not cover with occlusive dressing unless directed otherwise by health care provider. For topical use only; not for oral, ophthalmic or vaginal use; avoid use on the face, scalp, axilla, groin, or other intertriginous areas.

Administration: Pediatric

Topical: For external use only. Apply sparingly to affected areas. Not for use on broken skin or in areas of infection. Do not apply to wet skin unless directed; do not cover with occlusive dressing unless directed. Do not apply very high potency agents to face, groin, axillae, or diaper area; avoid contact with eyes. Not for oral, ophthalmic, or intravaginal use. Wash hands after use.

Betamethasone dipropionate spray: Spray directly onto affected areas (spray only enough to sufficiently cover the area); rub in gently. Shake well before use. Do not use if atrophy is present at the treatment site. Avoid use on the face, scalp, axilla, groin, or other intertriginous areas.

Lotion: Shake well prior to use.

Storage/Stability

Cream, lotion, ointment, spray: Store at 15°C to 30°C (59°F to 86°F). Discard any unused spray after 4 weeks.

Foam: Store at 20°C to 25°C (68°F to 77°F). Avoid fire, flame, or smoking during use. Do not puncture or incinerate container. Do not expose to heat or store at temperatures above 49°C (120°F).

Patch [Canadian product]: Store at 15°C to 25°C (59°F to 77°F). Use immediately after opening sachet.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat psoriasis.

• It is used to treat skin irritation.

• It is used to treat skin rashes.

• It is used to treat scalp irritation.

• It is used to treat scalp psoriasis.

• It is used to treat plaque psoriasis.

• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Dry skin

• Stinging

• Burning

• Itching

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Cushing syndrome like weight gain in upper back or abdomen; moon face; severe headache; or slow healing

• Adrenal gland problems like severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss

• High blood sugar like confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit

• Skin changes like acne, stretch marks, slow healing, or hair growth

• Vision changes

• Skin thinning

• Skin irritation

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

Contraindications

Hypersensitivity to betamethasone, other corticosteroids, or any component of the formulation

Cream, Lotion: Untreated bacterial, tubercular, and fungal skin infections; viral diseases (eg, herpes simplex, chicken pox, vaccinia)

Canadian labeling: Additional contraindications (not in US labeling): Treatment of rosacea, acne vulgaris, perioral dermatitis, or pruritus without inflammation (foam); skin manifestations relating to tuberculosis or syphilis, eruptions following vaccinations; application to eyes (foam); <18 years of age (patch). Note: Product labels may vary (refer also to product labels).

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• Contact dermatitis: Allergic contact dermatitis can occur and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.

• Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to varicella zoster (chickenpox) should be avoided; corticosteroids should not be used to treat ocular herpes simplex.

• Ocular effects: Topical corticosteroids, including betamethasone, may increase the risk of posterior subcapsular cataracts and glaucoma. Monitor for ocular symptoms. Avoid contact with eyes.

• Skin reactions: Discontinue if skin irritation or contact dermatitis occurs; do not use in patients with decreased skin circulation.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome (rare), hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, application to large surface areas, or prolonged use.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Pediatric: Use of augmented formulations in patients <13 years of age is not recommended. For all formulations, children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients. Use lowest dose possible for shortest period of time to avoid HPA axis suppression.

Dosage form specific issues:

• Appropriate use: For topical use only; avoid contact with eyes. Not for oral, ophthalmic, or intravaginal use. Do not use occlusive dressings on weeping or exudative lesions and general caution with occlusive dressings should be observed; adverse effects may be increased. In the presence of a fungal or bacterial dermatologic infection, institute appropriate antifungal or antibacterial therapy. If the infection does not resolve promptly, discontinue use until the infection has been adequately controlled.

• Augmented (eg, very high potency) products: Use of augmented formulations in patients <13 years of age is not recommended. Not for treatment of rosacea, perioral dermatitis, or if skin atrophy is present at treatment site; not for facial, groin, axillary, oral, ophthalmic, or intravaginal use; not for use in a diapered area. Avoid concurrent use of other corticosteroids.

• Flammable contents: Foam contains flammable propellants. Avoid fire, flame and smoking during and immediately following administration.

• Patch [Canadian product]: Has not been studied in psoriasis of the face, scalp or intertriginous areas; contains methyl and propyl parahydroxybenzoate, which may cause hypersensitivity (sometimes delayed).

Other warnings/precautions:

• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose by reducing the frequency of application or substitution of a less potent steroid.

Geriatric Considerations

Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly, in the smallest possible dose, and for the shortest possible time.

Warnings: Additional Pediatric Considerations

The extent of percutaneous absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Infants and small children may be more susceptible to HPA axis suppression, intracranial hypertension, Cushing syndrome, or other systemic toxicities due to larger skin surface area to body mass ratio. HPA axis suppression was observed in 32% of infants and children (age range: 3 months to 12 years) being treated with betamethasone dipropionate cream (0.05%) for atopic dermatitis in an open-label trial (n=60); the incidence was greater younger patients vs older children (mean reported incidence for age ranges: ≤1 year: 50%; 2 to 8 years: 32% to 38%; 9 to 12 years: 17%).

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).

Pregnancy Considerations

Systemic bioavailability of topical corticosteroids is variable (eg, integrity of skin, use of occlusion) and may be further influenced by trimester of pregnancy (Chi 2017). In general, the use of topical corticosteroids is not associated with a significant risk of adverse pregnancy outcomes. However, there may be an increased risk of low birth weight infants following maternal use of potent or very potent topical products, especially in high doses.

Use of mild to moderate potency topical corticosteroids is preferred in pregnant females, and the use of large amounts or use for prolonged periods of time should be avoided (Chi 2016; Chi 2017; Murase 2014). Also avoid areas of high percutaneous absorption (Chi 2017). The risk of stretch marks may be increased with use of topical corticosteroids (Murase 2014).

Breast-Feeding Considerations

It is not known if systemic absorption following topical administration results in detectable quantities of betamethasone in breast milk.

Systemic corticosteroids are present in breast milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. However, topical corticosteroids are generally considered acceptable for use (Butler 2014; WHO 2002).

Do not apply topical corticosteroids to breast until breastfeeding ceases (Leachman 2006); hypertension was noted in a breastfed infant when a high potency topical corticosteroid was applied to the nipple (Butler 2014; Leachman 2006).

Briggs' Drugs in Pregnancy & Lactation

• Betamethasone

Adverse Reactions

>10%: Local: Application site reactions (54%; includes burning, stinging, and itching; most reactions were mild)

1% to 10%:

Central nervous system: Paresthesia (2%)

Dermatologic: Acne vulgaris (2%), alopecia (2%), pruritus (≤2%)

Ophthalmic: Conjunctivitis (2%)

Frequency not defined: Endocrine & metabolic: HPA axis suppression

<1%, postmarketing, and/or case reports: Bullous dermatitis, cataract, contact dermatitis, dermatitis, dysgeusia, erythema, erythematous rash, folliculitis, glaucoma, hyperglycemia, hypersensitivity reaction, increased intraocular pressure, localized vesiculation, retinopathy (central serous), skin discoloration, skin rash, telangiectasia

Allergy and Idiosyncratic Reactions

• Corticosteroid Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Risk X: Avoid combination

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Risk C: Monitor therapy

Test Interactions

May suppress the wheal and flare reactions to skin test antigens

Monitoring Parameters

HPA axis suppression and adrenal insufficiency, especially in children or with augmented formulation use; ocular symptoms. Foam, gel, lotion (augmented), and ointment (augmented): reassess if no improvement after 2 weeks of treatment.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External, as dipropionate [strength expressed as base]:

Generic: 0.05% (15 g, 45 g)

Cream, External, as dipropionate augmented [strength expressed as base]:

Diprolene AF: 0.05% (15 g, 50 g)

Generic: 0.05% (15 g, 50 g)

Cream, External, as valerate [strength expressed as base]:

Generic: 0.1% (15 g, 45 g)

Emulsion, External, as dipropionate [strength expressed as base]:

Sernivo: 0.05% (120 mL) [contains cetostearyl alcohol, methylparaben, propylparaben]

Foam, External, as valerate:

Luxiq: 0.12% (50 g [DSC], 100 g [DSC]) [contains alcohol, usp, cetyl alcohol, propylene glycol]

Luxiq: 0.12% (50 g, 100 g) [cfc free; contains alcohol, usp, cetyl alcohol, propylene glycol]

Generic: 0.12% (50 g, 100 g)

Gel, External, as dipropionate augmented [strength expressed as base]:

AlphaTrex: 0.05% (15 g [DSC], 50 g [DSC])

Generic: 0.05% (15 g, 50 g)

Lotion, External, as dipropionate [strength expressed as base]:

Generic: 0.05% (60 mL)

Lotion, External, as dipropionate augmented [strength expressed as base]:

Diprolene: 0.05% (30 mL [DSC], 60 mL [DSC]) [contains isopropyl alcohol, propylene glycol]

Generic: 0.05% (30 mL, 60 mL)

Lotion, External, as valerate [strength expressed as base]:

Generic: 0.1% (60 mL)

Ointment, External, as dipropionate [strength expressed as base]:

Generic: 0.05% (15 g, 45 g)

Ointment, External, as dipropionate augmented [strength expressed as base]:

Diprolene: 0.05% (15 g, 50 g)

Generic: 0.05% (15 g, 45 g, 50 g)

Ointment, External, as valerate [strength expressed as base]:

Generic: 0.1% (15 g, 45 g)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Betaderm: 0.05% (15 g, 454 g)

Celestoderm V/2: 0.05% (450 g)

Generic: 0.05% (450 g)

Cream, External, as dipropionate [strength expressed as base]:

Diprosone: 0.05% (15 g, 50 g)

TARO-Sone: 0.05% (15 g, 50 g, 450 g)

Generic: 0.05% (15 g, 50 g, 450 g)

Cream, External, as dipropionate augmented [strength expressed as base]:

Diprolene: 0.05% ([DSC])

Generic: 0.05% (15 g, 50 g)

Cream, External, as valerate [strength expressed as base]:

Betaderm: 0.1% (15 g, 454 g)

Celestoderm V: 0.1% (450 g)

Prevex B: 0.1% ([DSC])

Generic: 0.1% (15 g, 450 g)

Foam, External, as valerate:

Luxiq: 0.12% (12 g, 50 g, 100 g) [contains alcohol, usp, cetyl alcohol, propylene glycol]

Lotion, External:

Generic: 0.05% (60 mL)

Lotion, External, as dipropionate [strength expressed as base]:

Diprosone: 0.05% (75 mL)

TARO-Sone: 0.05% (30 mL, 75 mL)

Generic: 0.05% (30 mL, 75 mL)

Lotion, External, as dipropionate augmented [strength expressed as base]:

Diprolene: 0.05% ([DSC])

Generic: 0.05% (30 mL, 60 mL)

Lotion, External, as valerate [strength expressed as base]:

Betaderm: 0.1% (30 mL, 75 mL)

Valisone Scalp: 0.1% (30 mL, 75 mL)

Generic: 0.1% (30 mL, 60 mL, 75 mL)

Ointment, External:

Betaderm: 0.05% (15 g, 454 g)

Celestoderm V/2: 0.05% (450 g)

Ointment, External, as dipropionate [strength expressed as base]:

Diprosone: 0.05% (15 g, 50 g)

Generic: 0.05% (15 g, 50 g, 450 g)

Ointment, External, as dipropionate augmented [strength expressed as base]:

Diprolene: 0.05% (15 g, 50 g)

Generic: 0.05% (15 g, 50 g)

Ointment, External, as valerate [strength expressed as base]:

Betaderm: 0.1% (15 g, 454 g)

Celestoderm V: 0.1% (450 g)

Patch 24 Hour, External:

Beteflam: 2.25 mg (4 ea, 8 ea, 16 ea) [contains edetate disodium, methylparaben, propylparaben]

Anatomic Therapeutic Chemical (ATC) Classification

• C05AA05
• D07AC01
• R01AD06
• R03BA04
• S01BA06
• S01CB04
• S02BA07
• S03BA03

Generic Available (US)

May be product dependent

Pricing: US

Cream (Betamethasone Dipropionate Aug External)

0.05% (per gram): $0.31 - $5.58

Cream (Betamethasone Dipropionate External)

0.05% (per gram): $2.77 - $3.52

Cream (Betamethasone Valerate External)

0.1% (per gram): $0.17 - $1.27

Cream (Diprolene AF External)

0.05% (per gram): $6.83

Emulsion (Sernivo External)

0.05% (per mL): $9.03

Foam (Betamethasone Valerate External)

0.12% (per gram): $6.28 - $6.54

Foam (Luxiq External)

0.12% (per gram): $10.75

Gel (Betamethasone Dipropionate Aug External)

0.05% (per gram): $4.10

Lotion (Betamethasone Dipropionate Aug External)

0.05% (per mL): $2.50 - $3.18

Lotion (Betamethasone Dipropionate External)

0.05% (per mL): $0.72 - $0.80

Lotion (Betamethasone Valerate External)

0.1% (per mL): $1.20

Ointment (Betamethasone Dipropionate Aug External)

0.05% (per gram): $4.23 - $5.55

Ointment (Betamethasone Dipropionate External)

0.05% (per gram): $3.36 - $4.10

Ointment (Betamethasone Valerate External)

0.1% (per gram): $1.36 - $1.39

Ointment (Diprolene External)

0.05% (per gram): $7.24

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Betamethasone has intermediate to very high range potency (dosage-form dependent).

Pharmacodynamics/Kinetics

Absorption: Topical corticosteroids are absorbed percutaneously. The extent of absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children.

Metabolism: Hepatic

Excretion: Urine and bile

Dental Use

Treatment of a variety of oral diseases of allergic, inflammatory, or autoimmune origin

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

Variable effects on anticoagulant therapy are observed with glucocorticoids such as betamethasone.

Dental Usual Dosing

Allergic or inflammatory diseases: Topical: Gel: Apply small quantity with cotton swab to affected area 3-4 times/day

Related Information

• Comparison of Representative Topical Corticosteroid Preparations (Classified According to the US System)
• Corticosteroids Systemic Equivalencies
• Stress Replacement of Corticosteroids

Pharmacotherapy Pearls

Very high potency: Augmented betamethasone dipropionate ointment, lotion, gel

High potency: Augmented betamethasone dipropionate cream, betamethasone dipropionate cream and ointment

Intermediate potency: Betamethasone dipropionate lotion, spray, betamethasone valerate cream

Index Terms

Betamethasone Dipropionate; Betamethasone Dipropionate, Augmented; Betamethasone Valerate; Betamethasone/Propylene Glyc

FDA Approval Date

June 26, 1984

References

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Last Updated 6/8/20