betamethasone (topical)

Absorption: Minimal. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may increase systemic absorption.

Distribution: Remains primarily at site of action.

Metabolism/Excretion: Usually metabolized in skin; modified to resist local metabolism and have a prolonged local effect.

Half-Life: 3–5 hr (plasma), 36–54 hr (tissue); adrenal suppression lasts 3.25 days.

Time/Action Profile ⬆ ⬇

(response depends on condition being treated)

ROUTE	ONSET	PEAK	DURATION
Topical	min-hrs	hrs-days	hrs-days

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity or known intolerance to corticosteroids or components of vehicles (ointment or cream base, preservative, alcohol);
Untreated bacterial or viral infections.

Use Cautiously in:

Hepatic impairment;
Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition);
Pre-existing skin atrophy;
OB: Chronic high-dose use during pregnancy may result in adrenal suppression in mother and growth suppression in children;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children at greater risk for adrenal and growth suppression.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae

EENT: cataracts, glaucoma

Endo: adrenal suppression (use of occlusive dressings, long-term therapy)

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

(Adults and Children ≥12 yr): Apply to affected area(s) 1–3 times daily (depends on preparation and condition being treated); Sernivo—Apply to affected areas twice daily.
(Children ): Apply to affected area(s) once daily (avoid augmented products).

Availability ⬆ ⬇

(Generic available)

Aerosol Foam: 0.12%
Cream: 0.05%; 0.1%
Gel: 0.05%
Lotion: 0.05%; 0.1%
Ointment: 0.05%; 0.1%
Spray (Sernivo): 0.05%
In combination with: calcipotriene (Enstilar, Taclonex, Wynzora), clotrimazole. See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Pedi: Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.
- May cause increased serum and urine glucose concentrations if significant absorption occurs.

Implementation ⬆ ⬇

Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments. Gels, aerosols, and lotions are useful in hairy areas.
Apply ointment, cream, andgel sparingly as a thin film to clean skin. Wash hands immediately after application. Apply occlusive dressing only if specified by physician or other health care professional.
- Apply lotion or gel to hair by parting hair and applying a small amount to affected area. Rub in gently. Protect area from washing, clothing, or rubbing until medication has dried. Hair may be washed as usual but not immediately after applying medication.
- Use aerosol foam by shaking well and spraying on cool surface, holding container inverted 3–6 in. away. Then use fingers to apply foam to affected area(s). Do not spray directly onto hands, as foam will begin to melt.
- Shake spray before using. Spray affected area and rub in gently. Discontinue if control not achieved or after 4 wk of use.

Patient/Family Teaching ⬆ ⬇

Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. Apply missed doses as soon as remembered unless almost time for the next dose.
Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
Advise parents of pediatric patients not to apply tight-fitting diapers or plastic pants on a child treated in the diaper area; these garments work like an occlusive dressing and may cause more of the drug to be absorbed.
Advise patient to consult health care professional before using medicine for condition other than indicated.
Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Caution women that medication should not be used extensively, in large amounts, or for protracted periods in patients who are pregnant or planning to become pregnant.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇