betamethasone (Celestone, Celestone Soluspan, Betaject, Betamethasone IM/PO)
Classes: Corticosteroids
Dosing and uses of Celestone, Celestone Soluspan (betamethasone)
Adult dosage forms and strengths
injectable suspension
- 6mg/mL
oral solution
- 0.6mg/5mL
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.
Pediatric dosage forms and strengths
injectable suspension
- 6mg/mL
oral solution
- 0.6mg/5mL
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
Celestone, Celestone Soluspan (betamethasone) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of Celestone, Celestone Soluspan (betamethasone)
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
