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 :392.5

%Protein binding :65

%Excreted unchanged in urine : 5

Volume of distribution (L/kg) :1.4

half-life – normal/ESRD (hrs) :5.5/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in normal renal function

HD :Unknown dialysability. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :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

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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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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