Betamethasone: English spelling of betamethason
Betamethasone is the English spelling of the highly potent synthetic glucocorticoid betamethason. In English-language literature and many brand names (e.g. Diprosone, Celestone) this form is found. In Germany and Austria the German spelling betamethason is common. Pharmacologically the same substance is meant.
Betamethasone is among the most potent glucocorticoids. It is used systemically (oral, intramuscular, intravenous), topically (skin creams, ointments, lotions, eye drops) and intra-articularly. Its potency is about 25 to 30 times that of hydrocortisone with very low mineralocorticoid activity.
Mechanism of action
Betamethasone binds to intracellular glucocorticoid receptors and influences transcription of numerous genes. Main effects:
- Anti-inflammatory through inhibition of phospholipase A2 and synthesis of prostaglandins, leukotrienes, cytokines
- Immunosuppressive through reduction of T cell and macrophage function
- Antiproliferative in skin, useful in chronic inflammatory skin diseases
- Vasoconstriction in microcirculation
Compared with prednisolone, betamethasone has markedly higher anti-inflammatory potency, longer biological half-life (36 to 54 hours) and almost no mineralocorticoid action. The lack of salt retention makes it particularly suitable for parenteral use in paediatric lung maturation induction and acute emergencies.
Indications
- Topical: inflammatory skin diseases such as psoriasis, atopic dermatitis, lichen ruber, lichen sclerosus, allergic contact dermatitis
- Intra-articular: acute flares of rheumatic disease, tendinitis, bursitis
- Intramuscular: systemic allergic reactions, acute flares of inflammatory disease
- Antenatal lung maturation induction: in threatened preterm birth between 24 and 34 weeks of gestation
- Ophthalmology: inflammatory eye diseases
- Cerebral oedema: in intracranial tumours or metastases
Dosing and administration
Topical: apply cream or ointment thinly once or twice daily to affected skin. Treatment duration as short as possible, depending on location and steroid potency.
Intramuscular or intra-articular: 4 to 8 mg, repeat after 1 to 4 weeks based on clinical course.
Antenatal lung maturation: 12 mg intramuscularly on day 1 and day 2, standard protocol.
Cerebral oedema: initial 8 to 16 mg intravenously, then individual adjustment.
Topical preparations should not be used over large areas or under occlusion, as systemic absorption rises. Use sparingly on face and skin folds.
Side effects
Topical, common: skin atrophy, telangiectasia, striae, perioral dermatitis, acne, rosacea worsening, hypopigmentation, impaired wound healing.
Systemic, common: Cushing-syndrome-like signs (moon face, central obesity), hyperglycaemia, hypertension, osteoporosis, muscle atrophy, mood changes, sleep disturbance, gastrointestinal complaints.
Rare: aseptic bone necrosis, cataract, glaucoma, susceptibility to infection, pancreatitis, anaphylactic reactions.
With antenatal lung maturation: rarely relevant maternal side effects, transient fetal effects on heart rate possible.
Important: with prolonged systemic therapy, do not stop abruptly but taper to avoid adrenal insufficiency.
Interactions
- Strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir, erythromycin): level increase, potentiated effect
- Strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, phenobarbital): level fall, possible loss of effect
- NSAIDs: increased risk of gastrointestinal ulcers
- Anticoagulants: possible effect changes
- Diuretics: additive hypokalaemia
- Antidiabetics: hyperglycaemia, adjust diabetes therapy
- Live vaccines: contraindicated with high-dose systemic therapy
Special considerations
Pregnancy: systemic only on clear indication. Antenatal lung maturation induction is well established and demonstrably reduces neonatal complications.
Breastfeeding: passage into milk possible, low doses usually acceptable.
Children: growth retardation possible with prolonged systemic therapy. Topical use in infants and toddlers should be cautious.
Diabetes: close blood glucose monitoring.
Hypertension: regular blood pressure monitoring.
Infections: steroids can mask infections. With acute infection, careful weighing.
Osteoporosis prophylaxis: with long-term systemic therapy, calcium and vitamin D substitution, possibly bisphosphonates.
Patient counselling: realistic expectations, education about steroid phobia and correct topical use improve adherence and reduce side effects.
Related substances
- Betamethason, German spelling of the same substance
- Betamethasone valerate, mid-strength ester
- Betamethasone dipropionate, high-potency ester
- Prednisolone acetate, ester with depot effect
- Fluticasone, highly potent inhaled and topical glucocorticoid
- Fluocinolone, another potent topical glucocorticoid
Frequently asked questions
Betamethasone or betamethason?
English betamethasone, German betamethason. Identical substance.
How long can I use a cortisone cream?
High-potency glucocorticoids like betamethasone should usually not be used continuously for more than 2 weeks; on the face and skin folds for shorter periods. With chronic skin diseases, interval therapy is sensible, e.g. twice a week for maintenance.
What does antenatal lung maturation achieve?
In threatened preterm birth between 24 and 34 weeks of gestation, two doses of betamethasone reduce the frequency and severity of neonatal respiratory distress syndrome, intraventricular haemorrhage and necrotising enterocolitis. It is one of the most important obstetric measures.
Why not stop abruptly?
Prolonged systemic glucocorticoid therapy suppresses the hypothalamic-pituitary-adrenal axis. Abrupt cessation can lead to adrenal insufficiency with weakness, blood pressure drop and, in severe cases, life-threatening crisis. Stepwise tapering over weeks is therefore essential.
Sources
- EMA European Medicines Agency
- BfArM Federal Institute for Drugs and Medical Devices
- AWMF guidelines dermatology and preterm birth
- Gelbe Liste betamethason monograph
Legal notice and disclaimer
The information on this page is provided for general information purposes only and does not constitute medical advice, diagnosis or treatment recommendation. It does not replace the advice of a licensed physician or pharmacist. Medicines should only be used after a doctor's prescription or pharmacy supply. All information is based on summaries of product characteristics and accepted scientific sources at the time of writing; the current SmPC of the manufacturer is always decisive. Sanoliste accepts no liability for completeness, timeliness or accuracy. In a medical emergency, dial the emergency number 112.