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betamethasone (Rx)Brand and Other Names:Celestone, Celestone Soluspan, more...Betaject, Betamethasone IM/PO

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable suspension

  • 6mg/mL

oral solution

  • 0.6mg/5mL
more...

Endocrine Disorders

0.6-7.2 mg PO divided BID/QID or 0.6-9 mg/day IM qDay/divided BID

Inflammatory Conditions

0.6-7.2 mg PO divided BID/QID or 0.6-9 mg/day IM qDay/divided BID

Rheumatoid Arthritis/Osteoarthritis

Intrabursal, intra-articular, intradermal: 0.25-2 mL (6 mg/mL)

Intralesional (6 mg/mL)

  • Very large joints: 1-2 mL
  • Large joints: 1 mL
  • Medium joints: 0.5 - 1 mL
  • Small joints: 0.25-0.5 mL

Administration

Base dosage on severity of disease and patient response

Other Indications & Uses

Adrenal insufficiency, conditions treated with immunosuppression, corticosteroid responsive dermatoses

Off-label: prophylaxis of neonatal respiratory distress syndrome

Various autoimmune diseases, collagen vascular disease, allergic states, hypersensitivity reactions, respiratory disease, hematologic disorders, neoplastic disease, ophthalmic disorders, edematous states, GI disease, & nervous system disorders. Also used in bacterial meningitis, acute mountain sickness, Graves' ophthalmopathy, severe alcoholic hepatitis, hirsutism, septic shock, spinal cord injury, as antiemetics.

Dosage Forms & Strengths

injectable suspension

  • 6mg/mL

oral solution

  • 0.6mg/5mL
more...

Adrenal Insufficiency

<12 years old: 0.0175-0.25 mg/kg/day divided q6-12hr IM/PO; use lowest dose as initial dose  

>12 years old: As in adults; use lowest dose as initial dose

Inflammatory Conditions

<12 years old: 0.0175-0.25 mg/kg/day IM/PO divided q6-12hr

>12 years old: As in adults

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Adverse Effects

>10% (selected)

Blurred vision

Increased appetite

Indigestion

Nervousness

1-10%

Itching

Frequency Not Defined (selected)

Arthralgia

Cataracts

Dizziness

DM

Edema

Erythema (topical)

Headache

Seizure

Skin dryness (topical)

Vertigo

Fluid/electrolyte disturbances

Adrenal suppression

Psychosis

Insomnia

Vertigo

Pseudotumor cerebri (on withdrawal)

Acne

Osteoporosis

Myopathy

Delayed wound healing

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Warnings

Contraindications

Systemic fungal infection

Hypersensitivity to betamethasone

TBI (high doses)

Untreated serious infections

Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

Cautions

Cirrhosis, ocular herpes simplex, HTN, diverticulitis, hypothyroidism, myasthenia gravi, PUD, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy

NOT effective in treatment of RDS in premature neonates

Minimal sodium retention activity: however, may increase with high doses

If used to treat adrenocortical insufficiency should also use mineralocorticoid

Thromboembolic disorders

Myopathy,

Delayed wound healing

Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated

Latent TB may be reactivated (monitor patients with positive tuberculin test)

Some suggestion of slightly increased cleft palate risk if corticosteroids used in pregnancy, but not fully substantiated

Prolonged corticosteroid use may result in elevated IOP, glaucoma, and/or cataracts

Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted

Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)

Epidural injection

  • Serious neurologic events, some resulting in death, have been reported with epidural injection
  • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
  • These serious neurologic events have been reported with and without use of fluoroscopy
  • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
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Pregnancy & Lactation

Pregnancy Category: C

Lactation: systemically administered corticosteroids enter breast milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other effects; use with caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

more...
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Pharmacology

Mechanism of Action

Potent glucocorticoid with minimal to no mineralocorticoid activity

Controls or prevents inflammation by controling rate of protein synthesis, suppressing migration of PMNs & fibroblasts, reversing capillary permeability, & stabilizing lysosome at cellular level

Pharmacokinetics

Peak plasma time: IV: 10-36 min

Protein bound: 64%

Vd: 75-90 L

Metabolism: Extensively metabolized in liver

Half-life: 6.5 hr

Renal clearance: 9.5 mL/min

Excretion: Mainly in urine, minimally in bile

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Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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