Betamethasone tablets

Generic Name

Betamethasone

Brand Names

Betnesol Tablets

Celestone (available in some countries)

Generic versions available in multiple formulations

Drug Class

Systemic corticosteroid

Glucocorticoid receptor agonist

Mechanism of Action

Betamethasone is a synthetic fluorinated corticosteroid with potent anti-inflammatory and immunosuppressive activity

It binds to cytoplasmic glucocorticoid receptors and modulates gene transcription in target tissues

Reduces production of pro-inflammatory cytokines such as interleukins and tumor necrosis factor

Inhibits the accumulation of inflammatory cells and decreases capillary permeability

Suppresses humoral immune responses and cell-mediated immunity

It has minimal mineralocorticoid activity compared to other steroids, thus fewer fluid-retaining effects

Indications

Approved/Primary Indications

Severe inflammatory or allergic conditions including:

Bronchial asthma exacerbations

Systemic lupus erythematosus

Rheumatoid arthritis

Severe eczema or dermatitis

Ankylosing spondylitis

Ulcerative colitis and Crohn’s disease flares

Adrenal insufficiency (in combination with mineralocorticoid)

Sarcoidosis with organ involvement

Autoimmune thrombocytopenia

Nephrotic syndrome relapse

Off-label/Occasional Uses

Cerebral edema (adjunctive treatment in selected cases)

Certain cancers for anti-inflammatory effect

Fetal lung maturation (as injection form, not oral)

Severe drug hypersensitivity reactions when oral route preferred over IV

Formulations Available

Betamethasone oral tablets: usually 0.5 mg

Also available in injectable, topical, and inhaled forms

Oral tablet use is uncommon in many countries due to preference for other systemic corticosteroids

Dosing and Administration

Typical Adult Dose

Initial: 0.5–5 mg per day orally in divided doses or single dose depending on condition severity

In severe cases, doses up to 8 mg or more may be used temporarily

Maintenance: Taper down gradually to the lowest effective dose (e.g., 0.25–1 mg/day)

Alternate-day therapy may be considered for chronic inflammatory diseases

Pediatric Dose

Based on body surface area or weight

Typical range: 17–250 micrograms/kg/day

Specialist input required due to risk of growth suppression and adrenal suppression

Duration of Therapy

Short-term use: high dose for a few days, then tapered

Long-term use: lowest effective dose for maintenance

Always taper gradually to avoid adrenal insufficiency

Contraindications

Systemic fungal infections

Hypersensitivity to betamethasone or other corticosteroids

Administration of live or live-attenuated vaccines in immunosuppressed patients

Untreated serious infections unless life-saving steroid therapy is required

Precautions

Risk of adrenal suppression with long-term use

Immunosuppression may mask signs of infection

May reactivate latent infections (e.g., tuberculosis, hepatitis B)

Caution in patients with peptic ulcers, diabetes, hypertension, osteoporosis, glaucoma, cataracts, or psychiatric illness

Avoid abrupt discontinuation after prolonged therapy

Consider bone protection (e.g., bisphosphonates) if used chronically

Monitor growth and development in children

Monitor intraocular pressure in long-term use

May alter thyroid function and glucose tolerance

Adverse Effects

Common (Dose and Duration Dependent)

Weight gain

Fluid retention

Increased appetite

Hypertension

Hyperglycemia

Insomnia

Mood swings or anxiety

Gastric irritation

Endocrine and Metabolic

Cushingoid appearance (moon face, buffalo hump)

Adrenal suppression

Glucose intolerance or overt diabetes mellitus

Growth suppression in children

Hypokalemia and metabolic alkalosis

Musculoskeletal

Muscle wasting

Osteoporosis

Avascular necrosis (especially of femoral head)

Myopathy

Gastrointestinal

Peptic ulceration

Pancreatitis (rare)

GI bleeding

Neuropsychiatric

Euphoria or depression

Psychosis or mania (high doses)

Sleep disturbances

Ophthalmic

Cataracts (especially posterior subcapsular)

Glaucoma

Blurred vision

Immune

Increased susceptibility to infections

Delayed wound healing

Reactivation of latent infections

Dermatologic

Acne

Thin skin, easy bruising

Striae, delayed healing

Rare but Serious

Severe infections (pneumocystis, disseminated fungal infections)

Adrenal crisis upon abrupt withdrawal

Severe psychiatric reactions

Pregnancy and Lactation

Pregnancy

Crosses placenta; may affect fetal growth

Generally considered safe when needed for maternal or fetal indications, but only if benefits outweigh risks

Long-term use in pregnancy linked to possible fetal adrenal suppression or cleft palate

Lactation

Excreted in breast milk in low amounts

Considered compatible with breastfeeding in short-term low doses

Monitor infant for signs of adrenal suppression with high doses or prolonged use

Use in Special Populations

Elderly

More susceptible to osteoporosis, hypertension, and diabetes

Monitor closely; consider bone-protection measures

Renal Impairment

No dose adjustment typically needed

Use caution in fluid-overloaded states

Hepatic Impairment

May have increased corticosteroid effects due to reduced clearance

Monitor for signs of steroid toxicity

Drug Interactions

NSAIDs

Increased risk of GI bleeding and ulceration

Antidiabetic drugs

Reduced efficacy; hyperglycemia risk increased

Rifampicin, phenytoin, carbamazepine

May reduce steroid efficacy by hepatic enzyme induction

Ketoconazole, erythromycin

May increase steroid concentration and effects

Vaccines

Live vaccines contraindicated

Inactivated vaccines may have reduced efficacy

Diuretics

Increased risk of hypokalemia

Anticoagulants

Effect may be increased or decreased unpredictably

Monitoring Parameters

Blood pressure

Blood glucose (especially in diabetics)

Electrolytes (particularly potassium)

Weight and signs of fluid retention

Bone mineral density for long-term users

Signs of infection or adrenal suppression

Mental status (especially in elderly or psychiatric patients)

Patient Counseling Points

Take with food to reduce stomach irritation

Do not stop medication abruptly if taken for more than 1–2 weeks

Report symptoms of infection, vision changes, unusual mood changes, or muscle weakness

Inform dentist or surgeon of corticosteroid use before procedures

Watch for signs of high blood sugar (e.g., thirst, frequent urination)

May cause increased appetite and weight gain

Use calcium and vitamin D supplementation if on long-term therapy

Store tablets in a dry place away from sunlight and heat

Keep out of reach of children and never share this medication with others