Betamethasone is a steroid medication. A glucocorticoid has given orally, parenterally, by local injection, by inhalation, or applied topically in the management of various disorders in which corticosteroids are indicated. Its lack of mineralocorticoid properties makes betamethasone particularly suitable for treating cerebral edema and congenital adrenal hyperplasia. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic conditions such as asthma and angioedema, preterm labor to speed the development of the baby’s lungs, Crohn’s disease, cancers such as leukemia, and along with fludrocortisone for adrenocortical insufficiency, among others. It can be taken by mouth, injected into a muscle, or applied as a cream. When given by injection, anti-inflammatory effects begin in around two hours and last for seven days.
Mechanism of Action of Betamethasone
Betamethasone is a glucocorticoid receptor agonist. This leads to changes in genetic expression once this complex binds to the GRE. The anti-inflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. The immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system, a reduction in immunoglobulin and complement concentrations, the precipitation of lymphocytopenia, and interference with antigen-antibody binding. Betamethasone binds to plasma transcortin, and it becomes active when it is not bound to transcortin.
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The mechanisms by which the glucocorticoids promote gluconeogenesis are not fully defined. Amino acids mobilized from a number of tissues in response to glucocorticoids reach the liver and provide a substrate for the production of glucose and glycogen. In the liver, glucocorticoids induce the transcription of a number of enzymes involved in gluconeogenesis and amino acid metabolism, including phosphoenolpyruvate carboxykinase, glucose-6-phosphatase, and fructose-2,6-bisphosphatase. Analyses of the molecular basis for regulation of phosphoenolpyruvate carboxykinase gene expression have identified complex regulatory influences involving an interplay among glucocorticoids, insulin, glucagon, and catecholamine. The effects of these hormones and amines on phosphoenolpyruvate carboxykinase gene expression mirror the complex regulation of gluconeogenesis in the intact organism.
Indications of Betamethasone
- Atopic dermatitis
- Plaque psoriasis
- Dermatological disorders
- Lichen sclerosus
- Dermatitis
- Acute gouty arthritis
- Adrenal cortical hypofunctions
- Alopecia areata
- Ankylosing Spondylitis
- Berylliosis
- Bullous dermatitis herpetiformis
- Bursitis
- Congenital adrenal hyperplasia
- Congenital hypoplastic anemia
- Dermatomyositis
- Dermatosis
- Discoid lupus erythematosus
- Edema of the cerebrum
- Epicondylitis
- Glomerulonephritis minimal lesion
- Hypercalcemia of malignancy
- Keloid scars
- Leukemias
- Lichen planus
- Lichen simplex chronicus
- Lupus erythematosus
- Malignant lymphomas
- Multiple sclerosis exacerbation
- Mycosis fungoides
- Necrobiosis lipoidica diabeticorum
- Ophthalmia, sympathetic
- Pemphigus
- Plaque psoriasis of the body
- Plaque psoriasis of the scalp
- Polymyositis
- Psoriatic arthritis
- Psoriatic plaque
- Pure Red cell aplasia
- Regional enteritis
- Rheumatoid arthritis
- Rheumatoid arthritis, juvenile
- Secondary thrombocytopenia
- Severe asthma
- Severe atopic dermatitis
- Stevens johnson syndrome
- Systemic lupus erythematosus
- Temporal arteritis
- Trichinosis
- Tuberculosis, pulmonary
- Tuberculous meningitis
- Ulcerative colitis
- Uveitis
- Acquired immune hemolytic anemia
- Acute nonspecific tenosynovitis
- Acute rheumatic carditis
- Exfoliative erythroderma
- Granuloma annulare lesions
- Idiopathic eosinophilic types of pneumonia
- Non-suppurative thyroiditis
- Ocular inflammatory conditions
- Severe allergic rhinitis
- Severe drug hypersensitivity reactions
- Symptomatic sarcoidosis
- Synovitis of osteoarthritis
Contra-Indications of Betamethasone
- Untreated tuberculosis
- Inactive tuberculosis
- Herpes simplex infection of the eye
- An intestinal infection caused by the roundworm Strongyloides
- Hypothyroidism
- Diabetes
- Insufficiency of the hypothalamus and pituitary gland
- High cholesterol
- Low amount of potassium in the blood
- Reduction in the body’s resistance to infection
- Mental disorder with loss of normal personality & reality
- Muscle problems
- Increased pressure in the eye
- Wide-angle glaucoma
- High blood pressure
- Chronic heart failure
- Ulcer from stomach acid
- Burning stomach
- Diverticulitis
- Surgical joining of two parts of the intestine
- Hardening of the liver
- Rupture of a tendon
- Osteoporosis
- Decreased calcification or density of bone
- Visible water retention
- High blood sugar
- Citrullinemia
- Infection caused by the Varicella zoster virus
- Measles
- Ornithine carbamoyltransferase deficiency
- Arginase deficiency
- Muscle pain or tenderness with increase creatine kinase
- Broken bone due to disease or illness
- Avascular necrosis of bone
- Malaria affecting the brain
- Muscle wasting
Dosage of Betamethasone
Dermatitis
- Cream, gel, ointment: Apply a thin film to the affected area once or twice a day
- Foam, lotion: Apply twice a day (once in the morning and once at night)
Pediatric Dermatitis
12 years or older
- Cream, gel, ointment: Apply a thin film to the affected area once or twice a day.
- Foam, lotion: Apply twice a day (once in the morning and once at night)
Side Effects of Betamethasone
The most common
- Constipation
- Burning or stinging
- itching at the application site
- Blistering, burning, crusting, dryness, or flaking of the skin
- cracking or tightening of the skin
- Euphoria
- Adrenal suppression
- Hypertension
- Groupings of fine blood vessels becoming prominent under the skin,
- dizziness
- drowsiness
- dry mouth
- chest pain
- headache
- joint painPain
- dizziness
- nausea and vomiting
- Severe stomach ache
- epigastric pain,
- diarrhoea,
- anorexia,
- flatulence,
- headache,
- fainting, fast or pounding heartbeats.
More common
- Fast or irregular heartbeat
- fever
- Back pain
- dizziness
- headache
- increased cough
- Acid or sour stomach
- decreased appetite
- Agitation
- chest congestion
- chest pain
- cold sweats
- confusion
- decreased sexual ability or desire
- diarrhea or loose stools
- heartburn
- sleepiness or unusual drowsiness
- stomach or abdominal cramps, gas, or pain
- trouble sleeping
Less common
- Abnormal dreams
- change in sense of taste
- congestion
- discouragement, feeling sad, or empty
- Suicide attempts
- Acting on dangerous impulses
- Aggressive or violent behavior
- Thoughts about suicide or dying
- New or worse depression
- New or worse anxiety or panic attacks
- Agitation, restlessness, anger, or irritability
- Trouble sleeping
Drug Interactions of Betamethasone
Betamethasone may interact with following drugs, supplements & may decrease the efficacy of the drug
- chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- itraconazole
- medications applied to the skin that have irritating effects
- other topical medications that contain corticosteroids
- natalizumab
- pimecrolimus
- ritonavir
- tacrolimus
Pregnancy & Lactation of Betamethasone
FDA Pregnancy Category C
Pregnancy
Betamethasone should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.
Lactation
It is not known if betamethasone applied to the skin passes into breast milk. If you are a breastfeeding mother and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding. If this medication is used, it should not be applied to the breast in order to avoid the baby getting this medication in their mouth.
References
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