Betamethasone Side Effects
For the Consumer
Applies to betamethasone: oral solution, parenteral suspension for injection
Side effects include:
Intra-articular and soft-tissue injection: Soft-tissue atrophy, hypopigmentation or hyperpigmentation, facial erythema, thin, fragile skin.
For Healthcare Professionals
Applies to betamethasone: compounding powder, injectable solution, injectable suspension, oral syrup, oral tablet
Corticosteroid complications are primarily dose and duration of therapy dependent. Adverse effects have occurred less frequently at physiologic or lower pharmacologic dosages.
Adverse effects associated with duration of corticosteroid therapy include those occurring during short-term therapy (up to three weeks) or those occurring during long-term therapy (greater than three weeks).
Short-term effects have included sodium retention-related weight gain and fluid accumulation, hyperglycemia and glucose intolerance, hypokalemia, gastrointestinal upset and ulceration, reversible depression of the hypothalamic-pituitary-adrenal axis, and mood changes including mild euphoria and insomnia, nervousness, restlessness, mania, catatonia, depression, delusions, hallucinations, and violent behavior.
Long-term effects have included hypothalamic-pituitary-adrenal activity suppression, Cushingoid appearance, hirsutism or virilism, impotence, menstrual irregularities, peptic ulcer disease, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, and vertebral compression fractures.[Ref]
Cardiovascular side effects have included hypertension and congestive heart failure due to long-term fluid retention as well as direct vascular effects.[Ref]
Endocrine side effects have included decreased glucose tolerance and hyperglycemia resulting in diabetes-like symptoms. Hypothalamic-pituitary-adrenal activity has been suppressed up to 12 months following long-term corticosteroid administration. Cushingoid appearance commonly has occurred with chronic therapy. Hirsutism or virilism, impotence, and menstrual irregularities may occur.[Ref]
Corticosteroid therapy may induce glucose intolerance by reducing the utilization of glucose in tissues and increasing hepatic glucose output. Diabetes mellitus requiring diet modifications and hypoglycemic agents has developed in some patients.
Adrenal suppression can persist for up to twelve months after long-term corticosteroid therapy. Giving corticosteroids once a day or once every other day may reduce adrenal suppression. After corticosteroid therapy has been tapered, supplemental corticosteroid therapy during times of physical stress may be required.[Ref]
Gastrointestinal side effects have included gastrointestinal upset, nausea, vomiting, and peptic ulcer disease. Pancreatitis, ulcerative esophagitis, gastrointestinal perforation, and hemorrhage also have been reported.[Ref]
Gastrointestinal effects have most commonly included nausea, vomiting, dyspepsia, and anorexia. Peptic ulcer disease has been associated with long-term corticosteroid therapy, but is relatively uncommon. Routine prophylactic therapy was not warranted in all individuals. Aluminum/magnesium-containing antacids generally have been used to manage GI complaints without significant drug interactions.[Ref]
Metabolic side effects have included hypernatremia (rare), hypokalemia, fluid retention, negative nitrogen balance and increased blood urea nitrogen concentration. Glucocorticoids have been reported to decrease the secretion of thyrotropin (TSH).[Ref]
Musculoskeletal side effects have included myopathy, osteoporosis, vertebral compression fractures, tendon rupture (particularly the Achilles tendon), and aseptic necrosis of bone. Aseptic necrosis has been reported most often to affect the femoral head.[Ref]
Corticosteroid myopathy has presented as weakness and wasting of the proximal limb and girdle muscles and generally has resolved following cessation of therapy.
Corticosteroids inhibit intestinal absorption and increase urinary excretion of calcium leading to bone resorption and bone loss. Postmenopausal females are at risk of loss of bone density. Sixteen percent of elderly patients treated with corticosteroids for 5 years may experience vertebral compression fractures.[Ref]
Immunologic side effects have included impairment in cell-mediated immunity and increased susceptibility to bacterial, viral, fungal and parasitic infections. Immune response to skin tests has been suppressed. Rare cases of anaphylaxis have been reported in patients receiving parenteral corticosteroids.[Ref]
Ocular side effects have included increased intraocular pressure, glaucoma, and posterior subcapsular cataracts.[Ref]
One study reviewing the use of intranasal steroids in 286,078 patients found no increased risk of cataracts.[Ref]
Dermatologic side effects have included an increased ease in bruising, ecchymosis, petechiae striae, delayed wound healing, and acne.[Ref]
Psychiatric side effects have included psychoses, personality or behavioral changes, and pseudotumor cerebri.[Ref]
Hematologic side effects have included thrombocytopenia, lymphopenia, and platelet alterations resulting in thrombolic events.[Ref]
Pseudorheumatism or glucocorticoid-withdrawal syndrome not related to adrenal insufficiency has occurred on withdrawal of corticosteroids. Patients experienced anorexia, nausea, vomiting, lethargy, headache, fever, arthralgias, myalgias, and postural hypotension. Symptoms resolved when corticosteroid therapy was reinstated.[Ref]
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Not all side effects for betamethasone may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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