preloder

Betamethasone Valerate


Dosing

Adult Dose

:
Dermatosis of scalp, Inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses of the scalp:
(0.12% Foam)
inflammatory pruritic to scalp

twice daily

; reassess diagnosis if no improvement after 2 weeks.

Disorder of skin, Inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses:
(

0.1% Cream

or

ointment

)
Apply thin film to affected area 1 to 3 times daily

(0.1% Lotion)
Apply a few drops to

affected area twice daily

, may increase dosage in stubborn cases; apply once daily after improvement

Pediatric Dose

:
Disorder of skin, Inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses:
(0.1% Cream or ointment)
Apply a thin film to affected area 1 to 3 times daily; limit to the least amount compatible with effective therapy
(

0.1% Lotion

)
Apply a few drops to

affected area twice daily

, may increase dosage in stubborn cases; apply once daily after improvement; limit to the least amount compatible with effective therapy

Tight foreskin:
Apply 0.1% or 0.2% cream

twice daily

for 60 days (off-label dosage)

Mechanism of Action
Topical corticosteroids possess anti-inflammatory, antipruritic, and vasoconstrictive activity. The exact mechanism of the anti-inflammatory activity is unknown. Corticosteroids may induce proteins (lipocortins) that inhibit phospholipase A2, thus interfering with the release of arachidonic acid, a common precursor of the inflammatory mediators prostaglandins and leukotrienes.
Adverse Effect
Common
Dermatologic:
Burning sensation
Itching
Stinging of skin

Serious
Endocrine metabolic:
Cushing’s syndrome
Hyperglycemia
Hypothalamic-pituitary-adrenal axis dysfunction
Suppression

Contraindication

Hypersensitivity to betamethasone valerate

, other corticosteroids, or any component of the product
Phamacokinetics
Distribution:
Plasma Protein binding: Varying degrees; 64%
Volume of Distribution (Vd): 84 L (range, 75 to 90 L)

Metabolism:
Hepatic: Extensive

Excretion:
Bile: Some topical corticosteroids

Renal:
Substantial
4.8% unchanged
Renal clearance: 9.5 mL/min

Elimination:
5.6 hours

Precaution
Dermatologic:
Failure to heal may be a sign of allergic contact dermatitis; discontinue if occurs

Endocrine and metabolic:
Reversible hypothalamic-pituitary-adrenal

axis suppression

and possible glucocorticosteroid insufficiency may occur; dosage adjustment or discontinuation may be necessary

Endocrine and metabolic:
Cushing syndrome may occur

Endocrine and metabolic:
Hyperglycemia may occur

Renal:
Glucosuria may occur

Special populations:
Pediatric patients may have increased risk of systemic toxicity due to higher skin surface area to body mass ratio; dosage adjustment may be necessary

Pregnancy Category
C (FDA)
Breast Feeding
Infant risk cannot be ruled out.
Monitoring
Improvement in inflammation or pruritus may indicate efficacy
Hypothalamic-pituitary-adrenal

axis suppression

; periodically in patients applying

large doses

to large surface areas

How to Take or Administration
Topical application:
(0.12% Foam)
Invert can and dispense a small amount onto a saucer or other cool surface; pick up small amounts and massage into affected areas on the scalp .

(0.12% Foam)
Do not dispense directly into hands as melting will occur upon contact with warm skin.

(0.1% Lotion)
Apply nozzle close to affected area and squeeze bottle for most

effective use

; massage lightly until lotion disappears
Do not

use

with occlusive dressing unless directed by a physician

Dosage Form
Topical Foam:
0.12 %

Treatment
Acute ingestion is rarely a clinical problem; effects rarely occur with administration of less than three weeks duration. An adolescent ingested 30 mg dexamethasone and subsequently developed acute adrenal insufficiency. Patient recovered following administration of methylprednisolone.

CHRONIC EXPOSURE:
Six infants (aged 3 to 8 months) who were treated with large amounts (up to 10 tubes for 1.5 to 5 months) of topical corticosteroids for diaper dermatitis developed Cushing’s syndrome and adrenocortical insufficiency. Hepatomegaly and hepatosteatosis were observed in 5 and 3 patients, respectively.

Patient Counselling or Clinical Teaching
Warn patient to report symptoms of Cushing syndrome or hyperglycemia.
Instruct patient to report symptoms of hypothalamic-pituitary-adrenal (HPA)

axis suppression

.
Side effects may include local irritation, burning, pruritus, dryness, and stinging.
Recommend patient avoid occlusive dressings over treated areas unless instructed to do so by physician.
Category of Betamethasone Valerate :
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