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Betamethasone sodium phosphate parenteral

Updated 2 Feb 2023 | Glucocorticoid therapy


Injections of Betamethasone sodium phosphate.

Drugs List

  • betamethasone 4mg/1ml injection
  • Therapeutic Indications


    Adrenal insufficiency - cortical
    Inflammatory or allergic conditions
    Shock - severe (adjunct)
    Soft tissue lesion
    Status asthmaticus

    Used systemically in conditions where parenteral corticosteroid therapy may be necessary, for example:
    - Status asthmaticus (adjunctive)
    - Acute allergic reactions including anaphylactic reactions (adjunctive)
    - Severe shock due to accidental or surgical trauma or infection
    - Acute adrenal crisis in Addison's disease or Simmond's disease, hypopituitarism following adrenalectomy and when adrenocortical function has been suppressed by prolonged corticosteroid therapy
    Betamethasone sodium phosphate is also used locally for soft tissue injuries, for example:
    - Tennis elbow
    - Tenosynovitis
    - Bursitis


    Betamethasone is a glucocorticoid approximately 8 to 10 times as active as prednisolone.

    Adverse reactions may be minimised by using the lowest effective dose for the minimum period and by administering the daily requirement as a single morning dose, or a single morning dose on alternate days. This is particularly important in children. Divided dosage may be employed and the lowest dose to produce an acceptable response should be administered.


    Systemic therapy
    4mg to 20mg administered by slow intravenous injection over 30 to 60 seconds. This may be repeated 3 or 4 times in 24 hours. Betamethasone may also be administered at the same dose by deep intramuscular injection or as an intravenous infusion.

    Other routes
    4mg to 8mg injected locally may be used when treating soft tissue lesions and repeated on 2 or 3 occasions depending on the patient's response. A single subconjunctival injection of 0.5 to 1ml has also been administered.


    Consider administration of a single dose on alternate days.

    Systemic therapy
    Children aged 6 to 12 years: 4mg intravenously.
    Children aged 1 to 6 years: 2mg intravenously.
    Infants aged up to 1 year: 1mg intravenously.

    These doses may be repeated 3 or 4 times in 24 hours, depending on the patient's response.

    Other routes
    When treating soft tissue lesions, children may require smaller doses than the adult doses.

    Additional Dosage Information

    Betamethasone withdrawal
    Gradual withdrawal of therapy will be required in patients who have received more than 1mg betamethasone (approximate physiological dose) for greater than 3 weeks. How dose reduction should be carried out depends upon on the likelihood of disease relapse on withdrawal and likelihood of hypothalamic-pituitary-adrenal (HPA) suppression. If disease is unlikely to relapse but HPA suppression is uncertain, a rapid reduction of dosage to 1mg daily may be effected, then dose reduction should be slowed down to allow the HPA-axis to recover.

    Abrupt withdrawal of betamethasone therapy of up to 3 weeks duration is appropriate if the disease is unlikely to relapse. Abrupt withdrawal of doses up to 6mg daily for up to 3 weeks is unlikely to lead to clinically relevant adrenal suppression.


    For systemic use it may be administered by:
    Slow intravenous injection
    Intravenous infusion
    Deep intramuscular injection
    Local sites administration including subconjunctival injection and soft tissue sites injections.


    Uncontrolled systemic infection

    Precautions and Warnings

    Children under 18 years
    Family history of diabetes mellitus
    Family history of glaucoma
    Fluid retention
    Congestive cardiac failure
    Diabetes mellitus
    Epileptic disorder
    Herpes simplex keratitis
    History of peptic ulcer
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    History of tuberculosis
    Myasthenia gravis
    Peptic ulcer
    Recent myocardial infarction
    Renal impairment
    Severe affective disorders
    Severe hepatic impairment
    Thromboembolic disorder

    Administration of live vaccines is not recommended
    Consider increased dose during intercurrent illness/trauma/surgery
    Consider reintroducing steroids temporarily during illness/trauma/surgery
    Disease reactivation may occur in patients with latent TB
    Exposure to measles may require prophylaxis with normal immunoglobulin
    May mask symptoms or signs of infections
    Not all routes are licensed for all age groups
    Passive immunisation of chicken pox / herpes zoster may be required
    Contains sodium metabisulfite. Caution,may cause allergic reactions
    Clinical presentations of infections may be atypical
    Frequent review needed to titrate dose to disease activity
    If visual disturbances occur, perform ophthalmic evaluation
    Monitor regularly the height of children receiving prolonged treatment
    Neonates exposed in utero: Monitor for adrenal suppression
    Post menopausal women at increased risk of osteoporosis
    Pregnancy: Monitor closely patients with pre-eclampsia or fluid retention
    Prolonged or high dose may lead to adrenal suppression
    Psychological changes may occur during initiation & withdrawal of treatment
    Supervise patient closely during drug withdrawal
    Adrenal cortical atrophy may persist for years after stopping drug
    Antibody response to vaccines may be reduced
    Breastfeeding: Risk of adrenal suppression in breastfed infant
    Corticosteroids may cause growth retardation in children under 18 years
    Oversuppression of immune system may increase susceptibility to infection
    Patient should report worrying psychological changes esp. suicidal thoughts
    Sudden withdrawal may be inadvisable -see product information/SPC
    Advise patient not to take St John's wort concurrently
    Advise patients to avoid aspirin and NSAID use
    Advise patient to avoid exposure to measles
    Advise patient to seek urgent medical attention if exposed to measles
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    Consider issuing Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention

    Passive immunisation with varicella zoster immunoglobulin (VZIG) is needed by exposed non-immune patients who are receiving systemic corticosteroids or who have has them in the past 3 months; this should be given within 10 days of exposure to chicken pox. Corticosteroids should not be stopped and the dose may need to be increased.

    The treatment of elderly patients particularly if long term, needs to be planned bearing in mind the more serious consequences of the common side effects of corticosteroids in old age, especially osteoporosis, diabetes, hypokalaemia, hypertension, susceptibility to infection and thinning of skin. Close clinical supervision is necessary to avoid life threatening reactions.

    Pregnancy and Lactation


    Use betamethasone with caution during pregnancy.

    The manufacturer states that corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks. Patients with normal pregnancies may be treated as though they were in the non-gravid state. Animal studies have shown abnormal foetal development. Available data following use in human pregnancy does not indicate developmental effects, however, a possible association cannot be excluded.

    When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of intrauterine growth retardation. Hypoadrenalism may occur in the neonate following prenatal exposure but usually resolves spontaneously following birth and is rarely clinically important. Myocardial hypertrophy and gastroesophageal reflux have been reported in association with in-utero exposure to betamethasone. It is recommended that foetal growth should be observed sonographically if the maternal treatment occurs over many weeks.


    Use betamethasone with caution during breastfeeding.

    The manufacturer states that the presence of betamethasone in human breast milk is unknown but due to its molecular weight, transfer is expected. It is recommended to wait at least 4 hours after administration before breastfeeding (Schaefer, 2015). Infants of mothers taking higher doses may have a degree of adrenal suppression, but the benefits of breastfeeding are likely to outweigh any theoretical risk.

    LactMed suggests that local injections of betamethasone would not be expected to cause adverse effects in breastfed infants. However, a temporary loss of milk supply may occur.

    Side Effects

    Abdominal distension
    Acute pancreatitis
    Aggravation of schizophrenia
    Avascular osteonecrosis
    Behavioural disturbances
    Blurred vision
    Cognitive impairment
    Corneal thinning
    Cushing's syndrome
    Cushingoid facies
    Cutaneous atrophy
    Elevated serum LDL cholesterol
    Emotional lability
    Exacerbation of epilepsy
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Growth retardation (children)
    Hypersensitivity reactions including anaphylaxis
    Hypokalaemic alkalosis
    Impaired healing
    Increase in HDL cholesterol
    Increased appetite
    Increased I.C.P. with papilloedema in children (pseudotumour cerebri)
    Increased intra-ocular pressure
    Increased susceptibility and severity of infections
    Menstrual disturbances
    Myocardial rupture
    Negative calcium balance
    Negative nitrogen balance
    Negative protein balance
    Oesophageal ulceration
    Peptic ulceration with perforation and haemorrhage
    Posterior subcapsular cataracts
    Potassium loss
    Proximal myopathy
    Psychological dependence
    Recurrence of dormant tuberculosis
    Reduced carbohydrate tolerance
    Scleral thinning
    Sleep disturbances
    Sodium/water retention
    Stevens-Johnson syndrome
    Suicidal tendencies
    Suppression of clinical signs of infection
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Vertebral and long bone fractures
    Weight gain
    Withdrawal syndrome - see product information

    Withdrawal Symptoms and Signs

    Withdrawal symptoms due to a rapid reduction of corticosteroids may lead to adrenal insufficiency, hypotension and death.

    A withdrawal syndrome may occur which include the following:
    Itchy skin nodules
    Loss of weight


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Summary of Product Characteristics: Betamethasone 4mg/ml Solution for Injection. RPH Pharmaceuticals AB. Revised March 2018.

    NICE - Evidence Services
    Available at:
    Last accessed: 08 November 2019

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Betamethasone. Last revised: 31 October 2018
    Last accessed: 08 November 2019

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