Dosing & Uses
Dosage Forms & Strengths
cream/lotion/ointment
- 0.05%
- 0.1%
gel
- 0.05%
foam
- 0.12% (Luxiq)
spray
- 0.05% (Sernivo)
Plaque Psoriasis
Indicated for mild-to-moderate plaque psoriasis in adults
Sernivo spray: Apply to affected area(s) q12hr
Steroid-Responsive Dermatoses
Apply ointment/cream/lotion/gel (betamethasone dipropionate) qDay or q12hr
Apply ointment (betamethasone valerate) qDay or q8hr
Luxiq: Apply foam to scalp q12hr
Dosage Forms & Strengths
cream/lotion/ointment
- 0.05%
- 0.1%
gel
- 0.05%
foam
- 0.12%
Inflammatory Conditions
<12 years: Not recommended
≥12 years: Apply to affected area q12hr (low or medium potency)
Dosing considerations
- Use minimal amount for shortest period of time to avoid HPA axis suppression
Steroid-Responsive Dermatoses
Apply ointment/cream/lotion/gel (betamethasone dipropionate) qDay or q12hr
Apply ointment (betamethasone valerate) qDay or q8hr
Adverse Effects
Frequency Not Defined
Skin atrophy
Striae
Allergic dermatitis
Burning
Dry skin
Erythema folliculitis
Hypertrichosis
Irritation
Miliaria
Vesiculation
Acneform lesions
Pigmentation changes
HPA suppression (with higher potency used >2 wk)
Postmarketing Reports
Ophthalmic: Cataracts, glaucoma, increased intraocular pressure, and central serous chorioretinopathy
Pruritus, bullous dermatitis, and erythematous rash
Warnings
Contraindications
Underlying infection present
Hypersensitivity
Ophthalmic use
Cautions
Chronic topical corticosteroid therapy may interfere with growth and development in children
Prolonged treatment with corticosteroids is associated with Kaposi sarcoma (consider discontinuation of therapy if diagnosed)
Discontinue if contact dermatitis occurs; not for use in patients with decreased skin circulation
Manifestations of Cushing syndrome, hyperglycemia, or glycosuria occur, especially if occlusive dressings are used
May increase risk of posterior subcapsular cataracts and glaucoma; cataracts and glaucoma reported postmarketing with use of topical corticosteroid products, including ointment
Use may increase risk of posterior subcapsular cataracts and glaucoma; avoid contact with eyes; advise patients to report any visual symptoms and consider referral to ophthalmologist for evaluation
Pregnancy & Lactation
Pregnancy
There are no available data on ointment use in pregnant women to identify a drug- associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; observational studies suggest an increased risk of low birthweight infants with the use of greater than 300 grams of potent or very potent topical corticosteroid during a pregnancy; advise pregnant women that the ointment may increase risk of having a low birthweight infant and to use it on the smallest area of skin and for the shortest duration possible
Animal data
- In animal reproduction studies, increased malformations, including umbilical hernias, cephalocele, and cleft palate, were observed after intramuscular administration to pregnant rabbits; the available data do not allow calculation of relevant comparisons between systemic exposure in animal studies to systemic exposure that would be expected in humans after topical use of the ointment
Lactation
There are no data regarding the presence of drug in human milk, effects on breastfed infant, or on milk production after topical ointment application to women who are breastfeeding
It is possible that topical administration of betamethasone dipropionate could result in sufficient systemic absorption to produce detectable quantities in human milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant drug or from underlying maternal condition
To minimize potential exposure to breastfed infant via breast milk, use ointment on smallest area of skin and for shortest duration possible while breastfeeding; advise breastfeeding women not to apply ointment directly to nipple and areola to avoid direct infant exposure
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.Pharmacology
Mechanism of Action
Corticosteroids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes, inhibiting macrophage accumulation in inflamed areas, reducing leukocyte adhesion to capillary endothelium, reducing capillary wall permeability and edema formation, decreasing complement components, antagonizing histamine activity and release of kinin from substrates, and reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation
Absorption
Yes
Administration
Topical Administration
Use medium to very high potency for less than 2 weeks to reduce local and systemic side effects
Use low potency for chronic therapy
Avoid medium to very high potency on face, folds, and groin, because use in these areas can increase steroid absorption
Use lower potency for children (ie, increased BSA/kg, therefore increased systemic absorption)
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Formulary
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