What are the uses and dosages of betamethasone (corticosteroid)?

From the Guidelines

Betamethasone is recommended for use in pregnant women at risk of late preterm delivery, with a dose of 2 doses of 12 mg of intramuscular betamethasone 24 hours apart, for patients with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation who are at high risk of preterm birth within the next 7 days and before 37 weeks of gestation, as supported by the Society for Maternal-Fetal Medicine Consult Series #58 1.

The use of betamethasone in this context has been shown to reduce neonatal morbidity, particularly respiratory morbidity, as demonstrated in the Antenatal Late Preterm Steroids trial. The recommended dose and administration schedule are based on the highest quality evidence available, with a Grade 1A recommendation for its use in this specific patient population.

Key points to consider when using betamethasone in this context include:

• The importance of careful patient selection, with consideration of the risks and benefits of antenatal corticosteroid administration 1
• The need for thorough counseling of patients regarding the potential risks and benefits of antenatal corticosteroid administration, including the uncertainty of long-term risks 1
• The recommendation against the use of antenatal corticosteroids for fetal lung maturity in pregnant patients with a low likelihood of delivery before 37 weeks of gestation, as well as in patients with pregestational diabetes mellitus due to the risk of worsening neonatal hypoglycemia 1

In terms of dosing, the typical adult dose of injectable betamethasone sodium phosphate/betamethasone acetate suspension is 0.5-9 mg injected into joints, soft tissues, or lesions, while oral betamethasone is usually prescribed at 0.5-7.5 mg daily, often starting with a higher dose and tapering gradually. However, in the context of antenatal corticosteroid use, the recommended dose is 2 doses of 12 mg of intramuscular betamethasone 24 hours apart, as specified in the Society for Maternal-Fetal Medicine Consult Series #58 1.

It is essential to note that the use of betamethasone in other contexts, such as in the treatment of sudden sensorineural hearing loss or as an antiemetic in oncology, may involve different dosing regimens and administration schedules, as outlined in other guidelines and studies 1. However, in the context of antenatal corticosteroid use, the recommended dose and administration schedule should be followed to minimize risks and maximize benefits for both the mother and the fetus.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The initial dosage of parenterally administered Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension may vary from 0.25 to 9 mg per day depending on the specific disease entity being treated. In pediatric patients, the initial dose of betamethasone may vary depending on the specific disease entity being treated. The range of initial doses is 0.02 to 0.3 mg/kg/day in three or four divided doses (0.6 to 9 mg/m2bsa/day). Bursitis, Tenosynovitis, Peritendinitis In acute subdeltoid, subacromial, olecranon, and prepatellar bursitis, one intrabursal injection of 1 mL Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension can relieve pain and restore full range of movement Rheumatoid Arthritis and Osteoarthritis Following intra-articular administration of 0.5 to 2 mL of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension, relief of pain, soreness, and stiffness may be experienced.

The uses of betamethasone include:

• Bursitis
• Tenosynovitis
• Peritendinitis
• Rheumatoid Arthritis
• Osteoarthritis
• Acute exacerbations of multiple sclerosis

The dosages of betamethasone are:

• 0.25 to 9 mg per day for parenteral administration
• 0.02 to 0.3 mg/kg/day in three or four divided doses for pediatric patients
• 1 mL for intrabursal injection in acute bursitis
• 0.5 to 2 mL for intra-articular administration in rheumatoid arthritis and osteoarthritis
• 30 mg daily for a week, followed by 12 mg every other day for a month in acute exacerbations of multiple sclerosis 2

From the Research

Uses of Betamethasone

• Betamethasone is used as an antenatal corticosteroid to accelerate fetal lung maturation in pregnant women at risk of preterm delivery 3.
• It is also used to enhance fetal lung maturity and improve neonatal outcomes 4, 5.
• Betamethasone can be used to induce lung maturation in fetal sheep 6.

Dosages of Betamethasone

• The clinical dose of betamethasone is 12 mg/70 kg or 170 microg/kg intramuscularly twice 24 hours apart 4.
• A half dose of betamethasone (6 mg/70 kg or 85 microg/kg) has been shown to produce maximal lung maturational effects in fetal sheep 4.
• A single maternal dose of 0.5-mg/kg betamethasone acetate can effectively induce fetal lung maturation in sheep with minimal fetal exposure 6.
• Doses of 0.2 mg/kg or 0.5 mg/kg betamethasone have been used in studies to evaluate the effect of dose and route of administration on postnatal lung function 7.