Symptoms: Excessive or prolonged use of topical corticosteroids can suppress pituitary-adrenal function, resulting in secondary adrenal insufficiency and produce manifestations of hypercorticism, including Cushing's disease.
A single overdose of Gentamicin (Bethagen) would not be expected to produce symptoms. Excessive or prolonged use of topical antibiotics may lead to overgrowth of lesions by fungi or nonsusceptible organisms.
Treatment: Appropriate symptomatic treatment is indicated. Acute hypercorticoid symptoms are usually reversible. Treat electrolyte imbalance, if necessary. In case of chronic toxicity, slow withdrawal of corticosteroids is advised.
If overgrowth by nonsusceptible organisms occur, stop treatment with Bethagen and institute appropriate therapy.
may cause your vision to blur temporarily after applying them into the eye. Do not drive or operate machinery until this has worn off.
Consult your doctor if after seven days of treatment with this medicine there is little or no improvement in your symptoms.
should not be used for longer than seven days, unless under expert supervision. If prolonged therapy is needed, you should have regular check-ups with your doctor so they can monitor you for adverse reactions. After more prolonged treatment (over six to eight weeks), the drops should be withdrawn slowly to avoid relapse of the condition.
Intensive or prolonged application of corticosteroids to the eye may lead to an increase in the pressure inside the eye, glaucoma, damage to the optic nerve or the formation of cataracts. Your eye specialist will want you to have regular eye check-ups to monitor for these types of side effects if you use this medicine for long periods of time.
Each container of this medicine should discarded four weeks after the first opening, because after this time the drops may be contaminated with germs. You may find it helpful to write the date of opening on the pack. Dispose of carefully, preferably by returning to your pharmacy.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
The safety of this medicine for use during pregnancy and breastfeeding has not been established. It is not recommended for use during pregnancy or breastfeeding. Consult your doctor for further advice.
If irritation or sensitization develops with the use of Bethagen, treatment should be discontinued and appropriate therapy should be instituted.
Any of the side effects that are reported following systemic use of corticosteroids, including adrenal suppression, may also occur with topical corticosteroids, especially in infants and children.
Systemic absorption of topical corticosteroids will be increased if extensive body surface areas are treated or if occlusive technique is used. Suitable precautions should be taken under these conditions or when long-term use is anticipated, particularly in infants and children.
Cross-allergenicity among aminoglycosides has been demonstrated.
Systemic absorption of topically applied Gentamicin (Bethagen) may be increased if extensive body surface areas are treated, especially over prolonged periods or in the presence of dermal disruption. In these cases, the undesirable effects which occur following systemic use of Gentamicin (Bethagen) may potentially occur. Cautious use is recommended under these conditions, particularly in infants and children.
Prolonged use of topical antibiotics occasionally allows overgrowth of nonsusceptible organisms, including fungi. If this occurs or if irritation, sensitization or superinfection develops, treatment with Gentamicin (Bethagen) should be discontinued and appropriate therapy should be instituted.
Bethagen is not for ophthalmic use.
Use in pregnancy & lactation: Since safety of topical corticosteroid use in pregnant women has not been established, drugs of this class should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Drugs of this class should not be used extensively in large amounts or for prolonged periods of time in pregnant patients.
Since it is not known whether topical administration of corticosteroids can result in sufficient systemic adsorption to produce detectable quantities in breast milk, a decision should be made to discontinue nursing or to discontinue the drug, taking into account the importance of Bethagen to the mother.
Use in children: Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and to exogenous corticosteroid effects than mature patients because of greater absorption due to a large skin surface area to body weight ratio.
Hypothalamic-pituitary-adrenal axis suppression, Cushing's syndrome, linear growth retardation, delayed weight gain and intracranial hypertension have been reported in children receiving topical corticosteroids. Manifestations of adrenal suppression in children include low plasma cortisol levels and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include a bulging fontanelle, headache and bilateral papilledema.
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Information checked by Dr. Sachin Kumar, MD Pharmacology