betamethasone (systemic) (bay-ta-meth-a-sone)
Therapeutic: anti-inflammatories (steroidal)
Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity. Used systemically and locally in a wide variety of chronic diseases, including Inflammatory; Allergic; Hematologic; Neoplastic; Autoimmune disorders. Replacement therapy in adrenal insufficiency. Unlabeled Use: Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn.
In pharmacologic doses, suppresses inflammation and the normal immune response. Has numerous intense metabolic effects (see Adverse Reactions and Side Effects). Suppresses adrenal function at chronic doses of 0.6 mg/day. Has negligible mineralocorticoid activity. Therapeutic Effects: Suppression of inflammation and modification of the normal immune response. Replacement therapy in adrenal insufficiency.
Adverse Reactions/Side Effects
Adverse reactions/side effects are much more common with high-dose/long-term therapy
CNS: depression, euphoria, headache, increased intracranial pressure (children only), personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure. CV: hypertension. GI: PEPTIC ULCERATION, anorexia, nausea, vomiting. Derm: acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis. Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain, weight loss. MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: cushingoid appearance (moon face, buffalo hump), increased susceptibility to infection.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of thrombophlebitis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.
Monitor and report signs of peptic ulcer, including heartburn, nausea, vomiting blood, tarry stools, and loss of appetite.
Assess any muscle or joint pain. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology (aseptic necrosis, fracture).
Assess muscle strength periodically to document the degree of muscle wasting during long-term use.
Measure blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Monitor personality changes, including depression, euphoria, restlessness, hallucinations, and psychosis. Notify physician if these changes become problematic.
Assess signs of increased intracranial pressure in children, including changes in mood and behavior, decreased consciousness, headache, lethargy, seizures, and vomiting. Notify physician of these signs immediately.
Be alert for signs of low potassium levels (hypokalemia) and metabolic acidosis, including hyperventilation, cardiac arrhythmias, dizziness, and confusion. Notify physician immediately if these signs occur.
Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.
Monitor signs of hyperglycemia (confusion; drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing; polyuria; loss of appetite; unusual thirst). Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.
Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or weight loss.
Implement resistive exercises and weight-bearing activities to minimize muscle wasting and osteoporosis. Use caution to prevent musculoskeletal damage in patients with preexisting muscle and bone loss.
Protect skin from breakdown, especially over bony prominences.
Advise patient that wound healing may be delayed; instruct patient to check skin regularly and report any nonhealing sores.
Advise patient that corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
Advise patients on long-term treatment to consult physician before stopping this medication. Stopping the medication suddenly may result in adrenocortical shock (severe hypotension, hypoglycemia, weakness, vomiting). If these signs appear, notify the physician immediately; may be life threatening.
Instruct patient to report any loss of vision that might indicate cataracts or increased intraocular pressure.
Advise patient about possible “cushingoid” appearance, including puffiness in the face (moon face), increased fat in the torso, thin arms and legs, abdominal skin striations, bruising, and deposition of fat at the posterior base of the neck (buffalo hump). Discuss possible effects on body image, and help patient explore coping mechanisms.
Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache or skin reactions (acne, hair growth).
Absorption: Well absorbed after oral administration. Sodium phosphate salt is rapidly absorbed after IM administration. Acetate salt is slowly but completely absorbed after IM administration. Absorption from local sites (intra-articular, intralesional) is slow but complete.
Distribution: Widely distributed; crosses the placenta and probably enters breast milk.
Metabolism and Excretion: Metabolized mostly by the liver.
Half-life: 3–5 hr (plasma), 36–54 hr (tissue); adrenal suppression lasts 3.25 days.
TIME/ACTION PROFILE (anti-inflammatory activity)
|ROUTE ||ONSET ||PEAK ||DURATION |
|PO ||unknown ||1–2 hr ||3.25 days |
|IM, IV (sodium phosphate) ||rapid ||unknown ||unknown |
|IM (acetate/sodium phosphate) ||1–3 hr ||unknown ||1 wk |
Contraindicated in: Active untreated infections (may be used in patients being treated for tuberculous meningitis); Traumatic brain injury (high doses may ↑ mortality); Lactation: Avoid chronic use; Some products contain bisulfites and should be avoided in patients with known hypersensitivity.
Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time); Hypothyroidism; Cirrhosis; Ulcerative colitis; Stress (surgery, infections); supplemental doses may be needed; Potential infections may mask signs (fever, inflammation); OB: Safety not established; Pedi: Chronic use will result in decreased growth; use lowest possible dose for shortest period of time.
Drug-Drug: Additive hypokalemia with thiazide and loop diuretics or amphotericin B. Hypokalemia may ↑ risk of digitalis glycoside toxicity. May ↑ requirement for insulins or oral hypoglycemic agents. Phenytoin, phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness. Oral contraceptives may block metabolism. ↑ risk of adverse GI effects with NSAIDs (including aspirin). At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
PO (Adults): 0.6–7.2 mg/day as single daily dose or in divided doses.
PO (Children): Adrenocortical insufficiency—17.5 mcg/kg (500 mcg/m2)/day in 3 divided doses. Other uses—62.5–250 mcg/kg (1.875–7.5 mg/m2)/day in 3 divided doses.
IM, IV (Adults): 0.5–9 mg IM as betamethasone sodium phosphate/acetate suspension. Prevention of respiratory distress syndrome in newborn—12 mg IM daily for 2–3 days before delivery (unlabeled).
IM (Children): Adrenocortical insufficiency—17.5 mcg/kg (500 mcg/m2)/day in 3 divided doses every 3rd day or 5.8–8.75 mcg/kg (166–250 mcg/m2)/day as a single dose. Other uses—20.8–125 mcg/kg (0.625–3.75 mg/m2) of the base q 12–24 hr.
Availability (generic available)
Syrup: 0.6 mg/5 mL. Suspension for injection (sodium phosphate and acetate): 6 mg (total)/mL.