Medical term:

Celestone


betamethasone

Betnelan (CA), Celestone

betamethasone acetate and sodium phosphate

Celestone Soluspan

Pharmacologic class: Glucocorticoid (inhalation)

Therapeutic class: Antiasthmatic, antiinflammatory (steroidal)

Pregnancy risk category C

Action

Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines

Availability

Solution for injection: 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml

Suspension for injection (acetate, phosphate): 6 mg (total)/ml

Syrup: 0.6 mg/5 ml

Tablets: 0.6 mg

Tablets (effervescent): 0.5 mg

Tablets (extended-release): 1 mg

Indications and dosages

➣ Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery

Adults: 0.6 to 7.2 mg/day P.O. as single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate suspension.

➣ Bursitis or tenosynovitis

Adults: 1 ml of suspension intrabursally

➣ Rheumatoid arthritis or osteoarthritis

Adults: 0.5 to 2 ml of suspension intra-articularly

Off-label uses

• Respiratory distress syndrome

Contraindications

• Hypersensitivity to drug

• Breastfeeding

Precautions

Use cautiously in:

• systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability

• patients receiving systemic corticosteroids

• pregnant patients

• children younger than age 6.

Administration

• Give as a single daily dose before 9:00 A.M.

• Give oral dose with food or milk.

• Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy).

☞ Don't give betamethasone acetate I.V.

• Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours.

☞ To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing.

• Know that drug may be given with other immunosuppressants.

Adverse reactions

CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure

CV: hypertension, thrombophlebitis, thromboembolism

EENT: cataracts, burning and dryness of eyes, rebound nasal congestion, sneezing, epistaxis, nasal septum perforation, difficulty speaking, oropharyngeal or nasopharyngeal fungal infections

GI: nausea, vomiting, anorexia, dry mouth, esophageal candidiasis, peptic ulcers

Metabolic: decreased growth, hyperglycemia, cushingoid appearance, adrenal insufficiency or suppression

Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis

Respiratory: cough, wheezing, bronchospasm

Skin: facial edema, rash, contact dermatitis, acne, ecchymosis, hirsutism, petechiae, urticaria, angioedema

Other: loss of taste, bad taste, weight gain or loss, Churg-Strauss syndrome, increased susceptibility to infection, hypersensitivity reaction

Interactions

Drug-drug. Amphotericin B, loop and thiazide diuretics, ticarcillin: additive hypokalemia

Barbiturates, phenytoin, rifampin: stimulation of betamethasone metabolism, causing decreased drug effects

Digoxin: increased risk of digoxin toxicity

Fluoroquinolones (such as ciprofloxacin, norfloxacin): increased risk of tendon rupture

Hormonal contraceptives: blockage of betamethasone metabolism

Insulin, oral hypoglycemics: increased betamethasone dosage requirement, diminished hypoglycemic effects

Live-virus vaccines: decreased antibody response to vaccine, increased risk of neurologic complications

Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects

Drug-diagnostic tests. Calcium, potassium: decreased levels

Cholesterol, glucose: increased levels

Nitroblue tetrazolium test for bacterial

infection: false-negative result

Drug-herbs. Echinacea: increased immune-stimulating effects

Ginseng: increased immune-modulating effects

Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers

Patient monitoring

• Monitor weight daily and report sudden increase, which suggests fluid retention.

• Monitor blood glucose level for hyperglycemia.

• Assess serum electrolyte levels for sodium and potassium imbalances.

• Watch for signs and symptoms of infection (which drug may mask).

Patient teaching

• Advise patient to report signs and symptoms of infection.

• Tell patient to report visual disturbances (long-term drug use may cause cataracts).

• Instruct patient to eat low-sodium, high potassium diet.

☞ Advise patient to carry medical identification describing drug therapy.

• Inform female patients that drug may cause menstrual irregularities.

☞ Caution patient not to stop taking drug abruptly.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

betamethasone (systemic)

(bay-ta-meth-a-sone) ,

Betaject

(trade name),

Celestone

(trade name)

Classification

Therapeutic: anti inflammatories steroidal
Pharmacologic: corticosteroids
Pregnancy Category: C

Indications

Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity.Used systemically and locally in a wide variety of chronic diseases including:
  • Inflammatory,
  • Allergic,
  • Hematologic,
  • Neoplastic,
  • Autoimmune disorders.
Replacement therapy in adrenal insufficiency.Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn.

Action

In pharmacologic doses, suppresses inflammation and the normal immune response.
Has numerous intense metabolic effects (see Adverse Reactions and Side Effects).
Suppresses adrenal function at chronic doses of 0.6 mg/day.
Has negligible mineralocorticoid activity.

Therapeutic effects

Suppression of inflammation and modification of the normal immune response.
Replacement therapy in adrenal insufficiency.

Pharmacokinetics

Absorption: Sodium phosphate salt is rapidly absorbed after IM administration. Acetate salt is slowly but completely absorbed after IM administration. Absorption from local sites (intra-articular, intralesional) is slow but complete.
Distribution: Widely distributed; crosses the placenta and probably enters breast milk.
Metabolism and Excretion: Metabolized mostly by the liver.
Half-life: 3–5 hr (plasma), 36–54 hr (tissue); adrenal suppression lasts 3.25 days.

Time/action profile (anti-inflammatory activity)

ROUTEONSETPEAKDURATION
IM (sodium phosphate/acetate)1–3 hrunknown1 wk

Contraindications/Precautions

Contraindicated in: Active untreated infections (may be used in patients being treated for tuberculous meningitis); Traumatic brain injury (high doses may ↑ mortality); Lactation: Avoid chronic use; Some products contain bisulfites and should be avoided in patients with known hypersensitivity.
Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time); Hypothyroidism; Cirrhosis; Ulcerative colitis; Stress (surgery, infections); supplemental doses may be needed; Potential infections may mask signs (fever, inflammation); Obstetric: Safety not established; Pediatric: Chronic use will result in ↓ growth; use lowest possible dose for shortest period of time.

Adverse Reactions/Side Effects

Adverse reactions/side effects are much more common with high-dose/long-term therapy

Central nervous system

  • depression (most frequent)
  • euphoria (most frequent)
  • headache
  • ↑ intracranial pressure (children only)
  • personality changes
  • psychoses
  • restlessness

Ear, Eye, Nose, Throat

  • cataracts
  • ↑ intraocular pressure

Cardiovascular

  • hypertension (most frequent)

Gastrointestinal

  • peptic ulceration (life-threatening)
  • anorexia (most frequent)
  • nausea (most frequent)
  • vomiting

Dermatologic

  • acne (most frequent)
  • ↓ wound healing (most frequent)
  • ecchymoses (most frequent)
  • fragility (most frequent)
  • hirsutism (most frequent)
  • petechiae (most frequent)

Endocrinologic

  • adrenal suppression (most frequent)
  • hyperglycemia

Fluid and Electrolyte

  • fluid retention (long-term high doses)
  • hypokalemia
  • hypokalemic alkalosis

Hematologic

  • thromboembolism (life-threatening)
  • thrombophlebitis

Metabolic

  • weight gain
  • weight loss

Musculoskeletal

  • muscle wasting (most frequent)
  • osteoporosis (most frequent)
  • avascular necrosis of joints
  • muscle pain

Miscellaneous

  • cushingoid appearance (moon face, buffalo hump) (most frequent)
  • ↑ susceptibility to infection

Interactions

Drug-Drug interaction

Additive hypokalemia withthiazide and loopdiuretics, or amphotericin B.Hypokalemia may ↑ risk of digitalis glycoside toxicity.May ↑ requirement for insulins or oral hypoglycemic agents.Phenytoin,phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness. Oral contraceptives may block metabolism.↑ risk of adverse GI effects with NSAIDs (including aspirin).At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ risk of adverse reactions from live-virus vaccines.

Route/Dosage

Intramuscular (Adults) 0.5–9 mg/day as betamethasone sodium phosphate/acetate suspension in 1–2 divided doses. Prevention of respiratory distress syndrome in newborn—12 mg daily for 2–3 days before delivery (unlabeled).
Intramuscular (Children) Adrenocortical insufficiency—17.5 mcg/kg (500 mcg/m2)/day in 3 divided doses every 3rd day or 5.8–8.75 mcg/kg (166–250 mcg/m2)/day as a single dose. Other uses—20.8–125 mcg/kg (0.625–3.75 mg/m2) of the base q 12–24 hr.

Availability (generic available)

Suspension for injection (sodium phosphate and acetate): 6 mg (total)/mL

Nursing implications

Nursing assessment

  • Indicated for many conditions. Assess involved systems before and periodically during therapy.
  • Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy.
  • Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur.
  • Pediatric: Children should have periodic growth evaluations.
  • Lab Test Considerations: Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum glucose evaluated. May ↓ WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations.
    • Guaiac-test stools. Promptly report presence of guaiac-positive stools.
    • May ↑ serum cholesterol and lipid values. May decrease uptake of thyroid 123I or 131I.
    • Suppress reactions to allergy skin tests.
    • Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.

Potential Nursing Diagnoses

Risk for infection (Side Effects)
Disturbed body image (Side Effects)

Implementation

  • If dose is ordered daily or every other day, administer in the morning to coincide with the body’s normal secretion of cortisol.
  • Intramuscular: Shake suspension well before drawing up. Do not dilute with other solution or admix. Do not administer suspensions IV.

Patient/Family Teaching

  • Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
    • Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
    • Caution patient to avoid vaccinations without first consulting health care professional.
    • Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occurPatient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
    • Advise patient to notify health care professional of medication regimen before treatment or surgery.
    • Discuss possible effects on body image. Explore coping mechanisms.
    • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
    • Advise patient to carry identification describing disease process and medication regimen in the event of an emergency in which patient cannot relate medical history.
    • Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
  • Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see ). Alcohol should be avoided during therapy.

Evaluation/Desired Outcomes

  • Decrease in presenting symptoms with minimal systemic side effects.
  • Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
  • Management of symptoms in adrenal insufficiency.
Drug Guide, © 2015 Farlex and Partners

Celestone

A trade name for BETAMETHASONE.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

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