Betamethasone is a corticosteroid of medium potency. It is used to treat a variety of skin, joints, and other inflammatory conditions. See side effects and other details of betamethasone (systemic) here.

Betamethasone Uses:

• Betamethasone Intramuscular Uses:

  • It is used to control severe allergic conditions that are unresponsive to conventional treatments. Important allergic conditions include asthma, dermatitis, drug reactions, allergic rhinitis, serum sickness, and transfusion reactions.
  • Skin conditions such as Severe erythema multiforme (Stevens-Johnson syndrome), Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, and pemphigus.
  • Endocrine disorders such as congenital adrenal hyperplasia, hypercalcemia associated with cancer, and nonsuppurative thyroiditis.
  • Gastrointestinal diseases such as acute flare-up of ulcerative colitis
  • Hematologic disorders including AIHA (autoimmune hemolytic anemia), Diamond-Blackfan anemia, pure red cell aplasia, and selected cases of secondary thrombocytopenia
  • Neoplastic diseases including lymphoproliferative disorders and for palliative treatment in cancers.
  • Nervous system disorders such as an acute exacerbation of multiple sclerosis, cerebral edema associated tumors or metastasis and craniotomy.
  • Ophthalmic diseases like  sympathetic ophthalmia, uveitis, temporal arteritis, and other inflammatory conditions that may not respond to topical corticosteroids
  • Renal diseases such as nephrotic syndrome and systemic lupus erythematosus.
  • Respiratory diseases like Berylliosis, eosinophilic pneumonia, sarcoidosis, and fulminating or disseminated pulmonary tuberculosis (with concurrent antituberculous chemotherapy)
  • Rheumatic disorders like acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, dermatomyositis, polymyositis, and systemic lupus erythematosus.
  • Other conditions include Trichinosis with neurologic or myocardial involvement, tuberculous meningitis, and tuberculous pericarditis.

• Intra-articular or soft tissue administration:

  • It is administered as an intraarticular injection in patients with acute gouty arthritis, and active synovitis in Rheumatoid arthritis and osteoarthritis.
  • It may also be administered locally in acute and subacute bursitis, tenosynovitis, and epicondylitis.

• Intralesional administration:

  • It is used intralesional in the following conditions:
    • Alopecia areata
    • Discoid lupus erythematosus
    • keloids
    • Granuloma annulare,
    • Lichen planus,
    • Lichen simplex chronicus (neurodermatitis)
    • Psoriatic plaques
    • Necrobiosis lipoidica diabeticorum

• It is also used as an Off Label medicine to accelerate fetal lung maturation.

Betamethasone Dosage in Adults:

Note: The dose is expressed as the combined amount of the active and the vehicle drug. 1 mg is equivalent to 0.5 mg betamethasone sodium phosphate and betamethasone acetate.

The Usual Betamethasone dose ranges from 0.25 to 9 mg intramuscularly.

Betamethasone dose in the treatment of Antenatal fetal maturation:

• 12 mg Intramuscular administered as two doses every 24 hours.
• A single course is recommended for women between 24 and 34 weeks of gestation.
• These also include women with ruptured membranes or multiple gestations, who may deliver within 7 days.
• A single repeat course of betamethasone may be considered in some women who are at risk of delivering within 7 days and have a pregnancy less than 34 weeks of gestation who had a course of antenatal corticosteroids greater than 14 days prior.

Betamethasone dose in the treatment of Bursitis (other than of foot), tenosynovitis, and peri-tendinitis:

• 3 to 6 mg Intrabursal equivalent to 0.5 to 1 mL for one dose.
• Many patients require more than one dose.

Betamethasone Use in Dermatologic disorders:

• 2 mg/cm² intralesional (0.2 mL/cm² ) for one dose.
• The maximum dose is 6 mg (1 mL) weekly.

Betamethasone dose in the treatment of foot disorders:

• 5 mg to 6 mg Intra-articular (0.25 to 1 mL) per dose at 3 to 7-day intervals.

• The dose is based upon condition:

  • Bursitis:

    • 5 mg - 3 mg (0.25 to 0.5 mL)

  • Tenosynovitis:

    • 3 mg (0.5 mL)

  • Acute gouty arthritis:

    • 3 mg to 6 mg (0.5 to 1 mL)

Betamethasone dose in the treatment of Multiple sclerosis:

Note: High dose pulse methylprednisolone is recommended for acute exacerbations of multiple sclerosis.

• 30 mg Intramuscular once a day for 1 week, followed by 12 mg on alternate days for 4 weeks.

Betamethasone dose in the treatment of Rheumatoid and osteoarthritis:

• 3 mg to 12 mg Intra-articular (0.5 to 2 mL) for one dose.

• The dose is based upon the joint size:

  • Very large (hip joint):

    • 6 - 12 mg (1 - 2 mL)

  • Large (knee, ankle, or shoulder joint):

    • 6 mg (1 mL)

  • Medium (elbow or wrist joint):

    • 3 mg - 6 mg (0.5 - 1 mL)

  • Small (inter- or metacarpophalangeal or sternoclavicular):

    • 5 mg - 3 mg (0.25 - 0.5 mL)

Betamethasone Dosage in Children:

General dosing for the treatment of inflammatory and allergic conditions:

• Infants, Children, and Adolescents:
  • 0.02 to 0.3 mg/kg/day Intramuscular initially or (0.6 to 9 mg/m²/day) in 3 or 4 divided doses

Betamethasone dose in the treatment of severe Infantile hemangioma: 

• Infants and Children:

  • The dosage depends upon the size of lesion:

    • A dose of 1.5 - 18 mg/dose is administered every 8 - 14 weeks as in combination with triamcinolone into multiple divided injections.

Betamethasone Use in Pregnancy

• Betamethasone crosses over the placental barriers and is partially metabolized by the placental enzymes to inactive metabolites.
• Pregnant females who use corticosteroids may experience neonatal hypoadrenalism. This may require monitoring after delivery.
• Pregnant women should receive the lowest doses and for the shortest duration of corticosteroids. Safely administered intra-articular injections are possible.
• Preterm deliveries are more likely for mothers who are pregnant with corticosteroids.
• If given promptly, corticosteroids can reduce the risk of these diseases in neonates:
  • Intraventricular hemorrhage,
  • Necrotizing enterocolitis
  • The Neonatal Mortality Rate is
  • Respiratory distress syndrome
• A single dose of betamethasone 12mg is given to pregnant women at high risk for preterm labor. Two doses are administered every 24 hours.
• It is not recommended after 36 weeks gestation or with concomitant Tocolytic Agents.
• Women with multiple gestations, intrauterine infections, gestational diabetes and women who have had previous cesarean sections should avoid it.
• It is not recommended to repeat courses if you are pregnant or had betamethasone for more than 14 days.

Side effects of Betamethasone

• Cardiovascular:

  • Bradycardia
  • Cardiac Arrhythmia
  • Cardiomegaly
  • Circulatory Shock
  • Edema
  • Embolism (Fat)
  • Hypertension
  • Hypertrophic Cardiomyopathy
  • Myocardial Rupture (Following Recent MI)
  • Syncope
  • Tachycardia
  • Thromboembolism
  • Thrombophlebitis
  • Vasculitis

• Central Nervous System:

  • Abnormal Sensory Symptoms
  • Arachnoiditis
  • Depression
  • Emotional Lability
  • Euphoria
  • Headache
  • Increased Intracranial Pressure
  • Insomnia
  • Malaise
  • Meningitis
  • Myasthenia
  • Neuritis
  • Neuropathy
  • Paraplegia
  • Paresthesia
  • Personality Changes
  • Pseudotumor Cerebri
  • Psychic Disorder
  • Seizure
  • Spinal Cord Compression
  • Vertigo

• Dermatologic:

  • Acne Vulgaris
  • Allergic Dermatitis
  • Atrophic Striae
  • Diaphoresis
  • Ecchymoses
  • Erythema
  • Exfoliation Of Skin
  • Fragile Skin
  • Hyperpigmentation
  • Hypertrichosis
  • Hypopigmentation
  • Skin Atrophy
  • Skin Rash
  • Subcutaneous Atrophy
  • Suppression Of Skin Test Reaction
  • Thinning Hair
  • Urticaria
  • Xeroderma

• Endocrine & Metabolic:

  • Amenorrhea
  • Calcinosis
  • Cushingoid State
  • Decreased Glucose Tolerance
  • Decreased Serum Potassium
  • Fluid Retention
  • Glycosuria
  • Growth Suppression in children
  • Hirsutism
  • HPA-Axis Suppression
  • Hypokalemic Alkalosis
  • Impaired Glucose Tolerance and Prediabetes
  • Insulin Resistance
  • Moon Face
  • Negative Nitrogen Balance
  • Protein Catabolism
  • Sodium Retention
  • Weight Gain

• Gastrointestinal:

  • Abdominal Distention
  • Change In Bowel Habits
  • Hiccups
  • Increased Appetite
  • Intestinal Perforation
  • Nausea
  • Pancreatitis
  • Peptic Ulcer
  • Ulcerative Esophagitis

• Genitourinary:

  • Bladder Dysfunction
  • Spermatozoa Disorder (Decreased Motility And Number)

• Hematologic & Oncologic:

  • Petechia

• Hepatic:

  • Hepatomegaly
  • Increased Liver Enzymes

• Hypersensitivity:

  • Anaphylactoid Reaction
  • Anaphylaxis
  • Angioedema

• Infection:

  • Infection (Decreased Resistance)
  • Sterile Abscess

• Local:

  • Injection Site Reaction (Intra-Articular Use).
  • Postinjection Flare (Intra-Articular Use)

• Neuromuscular & Skeletal:

  • Amyotrophy
  • Aseptic Necrosis Of Femoral Head
  • Aseptic Necrosis Of Humeral Head
  • Bone Fracture
  • Charcot Arthropathy
  • Lipoatrophy
  • Myopathy
  • Osteoporosis
  • Rupture Of Tendon
  • Steroid Myopathy

• Ophthalmic:

  • Blindness
  • Blurred Vision
  • Cataract
  • Exophthalmos
  • Glaucoma
  • Increased Intraocular Pressure
  • Papilledema

• Respiratory:

  • Pulmonary Edema

• Miscellaneous:

  • Wound Healing Impairment

How to Use Betamethasone?

• Topical applications may be used twice daily.
• It should be applied as a thin layer over the affected area.
• Long term and application over a larger surface area should be avoided.
• The injection may be used administered intramuscularly, intrabursal, or intradermal.
• The injection should be mixed with a local anesthetic in a syringe.
• 1% or 2% lignocaine or any other parabens-free local anesthetic is taken in a syringe followed by betamethasone from the vial.
• The mixture is then shaken briefly prior to the injection.
• It may be administered intramuscular or intrabursal but not into the tendon sheaths directly.
• The intradermal injection is administered using a 25-gauge 1 mL syringe.

Betamethasone Brand Names (International):

• Bei Shi Li
• Betacort
• Betagen
• Betanoid
• Betasone
• Betnelan
• Betnesol
• Bufencon
• Celestan Depot
• Celeston
• Celeston Chronodose
• Celestone
• Celestone Chronodose
• Celestone Soluspan
• Cidoten
• Corteroid
• Cortixyl
• Depot
• Dacam RL
• Diprofos Depot
• Diprophos
• Diprosone Depot
• Diprospan
• Flosetron
• Inflacor
• Lenasone
• Metamar
• Solu Celestan
• Vistamethasone
• Walacort
• X-Beta

Betamethasone Brand Names in Pakistan: