Dosing requirements are variable and must be individualized on the basis of the specific disease, its severity and the response of the patient.
The initial dose should be maintained or adjusted until a satisfactory response is observed. If a satisfactory clinical response does not occur after a reasonable period of time, treatment with Betoid injection should be discontinued and other appropriate therapy initiated.
Systemic Administration: For systemic therapy, treatment is initiated with 1-2 mL in most conditions and repeated as necessary. Administration is by deep intramuscular (IM) injection in the gluteal region. Dosage and frequency of administration will depend on the severity of the patient's condition and the therapeutic response. Two mL might be required initially in a severe illness eg, lupus erythematosus or status asthmaticus which has been resolved by appropriate life-saving procedures.
A wide variety of dermatologic conditions respond effectively to an IM injection of 1 mL Betoid injection, repeated according to the response of the condition.
In respiratory tract disorders, onset of relief from symptoms has occurred within a few hours after IM injection of Betoid. Effective control of symptoms with 1-2 mL is obtained in bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis.
Treatment of Acute or Chronic Bursitis: Results are obtained with 1-2 mL IM injection of Betoid injection, repeated as necessary.
Local Administration: Concomitant use of a local anesthetic is rarely necessary. If co-administration of a local anesthetic is desired, Betoid injection may be mixed (in the syringe, not the vial) with 1 or 2% procaine HCl or lidocaine, using formulations which do not contain parabens. Similar local anesthetics may also be used. Anesthetics containing methylparaben, propylparaben, phenol, and others, should be avoided. The required dose of Betoid injection is first withdrawn from the vial into the syringe. The local anesthetic is then drawn in, and the syringe is shaken briefly.
In acute subdeltoid, subacromial, olecranon, and prepatellar bursitis, an intrabursal injection of 1-2 mL of Betoid may relieve pain and restore full range of movement within a few hours. Chronic bursitis may be treated with reduced dosage once acute symptoms are controlled. In acute tenosynovitis, tendinitis and peritendinitis, 1 injection of Betoid should alleviate the condition. In chronic forms of these conditions, it may be necessary to repeat the injection as the patient's condition requires.
Following 0.5-2 mL intra-articular administration of Betoid injection, relief from pain, soreness and stiffness associated with rheumatoid arthritis and osteoarthritis may be experienced within 2-4 hrs. Duration of relief, which varies widely in both diseases, is ≥4 weeks in the majority of cases.
An intra-articular injection of Betoid is well tolerated in the joint and periarticular tissues.
Recommended doses for intra-articular injection are: Large joints (knee, hip, shoulder): 1-2 mL; medium joints (elbow, wrist, ankle): 0.5-1 mL; small joints (foot, hand chest): 0.25-0.5 mL.
Dermatologic conditions may respond to intralesional administration of Betoid injection. Response of some lesions not treated directly may be due to a slight systemic effect of the drug. In intralesional treatment, an intradermal dosage of 0.2 mL/cm2 of Betoid injection evenly injected with a tuberculin syringe and a 26-gauge needle is recommended. The total amount of Betoid injected at all sites each week should not exceed 1 mL.
Betoid injection may be used effectively in disorders of the foot that are responsive to corticosteroid therapy. Bursitis under heloma durum may be controlled with 2 successive injections of 0.25 mL each. In some conditions eg, hallux rigidus, digiti quinti varus and acute gouty arthritis, onset of relief may be rapid.
A tuberculin syringe with a 25-gauge needle is suitable for most injections. Recommended doses at intervals of approximately 1 week: Bursitis under heloma durum or molle 0.25-0.5 mL; bursitis under calcaneal spur 0.5 mL; bursitis over hallux rigidus 0.5 mL; Bursitis over digiti quinti; varus 0.5 mL; synovial cyst 0.25-0.5 mL; Morton's neuralgia (metatarsalgia) 0.25-0.5 mL; tenosynovitis 0.5 mL; periostitis of cuboid 0.5 mL; acute gouty arthritis 0.5-1 mL.
After a favorable response is obtained, the proper maintenance dosage should be determined by decreasing the initial dose in small decrements at appropriate time intervals until the lowest dose which will maintain an adequate clinical response is determined.
Exposure of the patient to stressful situations unrelated to the existing disease may necessitate an increased dose of Betoid injection. If the drug is to be discontinued after long-term therapy, the dose should be decreased gradually.
There are many other medicines that can interact with steroids. Below is only a partial list of these medicines:
This list is not complete and there may be other drugs that can interact with Betoid. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
Concurrent use of phenobarbital, phenytoin, rifampin or ephedrine may enhance the metabolism of corticosteroids, reducing their therapeutic effects.
Patients receiving both a corticosteroid and an estrogen should be observed for excessive corticosteroid effects.
Concurrent use of corticosteroids with potassium-depleting diuretics may enhance hypokalemia. Concurrent use of corticosteroids with cardiac glycosides may enhance the possibility of arrhythmias or digitalis toxicity associated with hypokalemia. Corticosteroids may enhance the potassium depletion caused by amphotericin B. In all patients taking any of these drug therapy combinations, serum electrolyte determinations, particularly potassium levels, should be monitored closely.
Concurrent use of corticosteroids with coumarin-type anticoagulants may increase or decrease the anticoagulant effects, possibly requiring adjustment in dosage.
Combined effects of nonsteroidal anti-inflammatory drugs or alcohol with glucocorticosteroids may result in an increased occurrence or increased severity of gastrointestinal ulceration.
Corticosteroids may decrease blood salicylate concentrations. Acetylsalicylic acid should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia.
Dosage adjustments of an antidiabetic drug may be necessary when corticosteroids are given to diabetics.
Concomitant glucocorticosteroid therapy may inhibit the response to somatotropin. Doses of Betoid in excess of 300-450 mcg (0.3-0.45 mg)/m2 of body surface per day should be avoided during administration of somatotropin.
Laboratory Tests: Corticosteroids may affect the nitro-blue tetrazolium test for bacterial infection and produce false-negative results.
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Information checked by Dr. Sachin Kumar, MD Pharmacology