Betamethasone

CLINICAL USE


Corticosteroid:

  • Suppression of inflammatory and allergic disorders
  • Congenital adrenal hyperplasia

    DOSE IN NORMAL RENAL FUNCTION

    Oral: 0.5–5 mg dailyInjection: 4–20 mg repeated up to 4 times in 24 hours

    PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :392.5
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :65
  • %Excreted unchanged in urine &nbsp &nbsp : 5

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :1.4

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :5.5/–

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unknown dialysability. Dose as in normal renal function
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Antibacterials: metabolism accelerated by rifampicin; metabolism possibly inhibited by erythromycin
  • Anticoagulants: efficacy of coumarins may be altered
  • Anti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidoneAntifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazoleA
  • ntivirals: concentration possibly increased by ritonavir
  • Ciclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroids
  • Cytotoxics: increased risk of haematological toxicity with methotrexate
  • Diuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diuretics
  • Vaccines: high-dose corticosteroids can impair immune response to vaccines; avoid concomitant use with live vaccines

    ADMINISTRATION

    Reconstition

    –

    Route

    Orally, IV, IM, topically

    Rate of Administration

    IV bolus: over half to one minute

    Comments

    Can be added to glucose 5% or sodium chloride 0.9%

    OTHER INFORMATION

  • 750 micrograms betamethasone ≡ 5 mg prednisolone
  • Even when applied topically, sufficient corticosteroid may be absorbed to give a systemic effec
  • tEffects of betamethasone on sodium and water retention are less than those of prednisolone and approximately equal to those of dexamethasone
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