DIPROSPAN Injection
Betamethasone Sodium Phosphate, Betamethasone Dipropionate
Mechanism of Action
Pharmacology
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 and Usage
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
Monotherapy in primary bacterial infections. Do not use on face, groin, or axilla or for ophthalmic treatments.
Dosage and Administration
Betamethasone
PO 0.6 to 7.2 mg/day.
Betamethasone Sodium Phosphate and Betamethasone Acetate
Intrabursal / Intra-articular / Intradermal / 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.
Storage/Stability
Store between 36° and 86°F. Protect from excessive moisture.
drug Interactions
Anticholinesterases
May antagonize anticholinesterase effects in myasthenia gravis.
Anticoagulants, oral
May alter anticoagulant dose requirements.
Barbiturates
May decrease pharmacologic effect of betamethasone.
Hydantoins, rifampin
May increase Cl and decrease therapeutic efficacy of betamethasone.
Nondepolarizing muscle relaxants (eg, tubocurarine)
May potentiate or counteract neuromuscular blocking action.
Salicylates
May reduce serum levels and efficacy of salicylates.
Troleandomycin
May increase effects of betamethasone.
Laboratory Test Interactions
Increased urine glucose and serum cholesterol; decreased serum levels of potassium, T 3 , and T 4 ; decreased uptake of I 131 ; 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; subcutaneous 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.
Genitourinary
Increased or decreased motility and number of spermatozoa.
Hematologic
Leukocytosis.
Metabolic
Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia; 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).
Miscellaneous
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
Category C (topical). Safety not established (systemic).
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.
Hypersensitivity
Anaphylactoid reactions have occurred rarely.
Adrenal suppression
Prolonged therapy may lead to HPA suppression.
CV
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.
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.
Overdosage
Symptoms
Fever, myalgia, arthralgia, malaise, anorexia, nausea, skin desquamation, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia (acute overdosage); cushingoid changes, moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer, infarction, electrolyte and fluid imbalance (chronic overdosage).
Patient Information
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
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.