Betamethasone

Corticosteroid, Glucocorticoid (long-acting, high-potency), Topical corticosteroid (high-to-super-high potency depending on ester)

Betamethasone (valerate, dipropionate, sodium phosphate, acetate)

Celestone (oral/injectable), Diprolene/Diprosone (topical), Luxiq (foam), Celestone Soluspan (depot IM)

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Summary

Classes

Corticosteroid, Glucocorticoid (long-acting, high-potency), Topical corticosteroid (high-to-super-high potency depending on ester)

Pharmacy

Starting dose

Antenatal: Celestone Soluspan 12 mg IM q24h × 2 doses; topical: pea-sized amount BID; intra-articular varies by joint

Preparations

0.6 mg/5 mL oral solution; Celestone Soluspan 6 mg/mL IM/IA (mix of sodium phosphate + acetate); 0.05% and 0.1% topical cream/ointment/lotion/foam (various salts); augmented betamethasone 0.05% (super-high potency)

US FDA Max

Indication-specific

Pharmacology

Routes

Oral, IM, IA, topical

Onset

Hours

Duration

Biologic 36-54 hours (long-acting)

Half-life

Plasma ~5 hours; biologic ~36-54 hours

Bioavailability

Oral ~70%; depot IM provides sustained release over weeks

Pregnancy

Antenatal use (12 mg IM × 2 doses 24h apart) is one of the most evidence-based interventions in obstetrics — reduces neonatal respiratory distress syndrome and mortality in threatened preterm delivery between 24 and 34 weeks. Other uses weigh benefit against fetal HPA suppression.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Betamethasone is a synthetic fluorinated glucocorticoid (the 9α-fluoro group enhances activity), structurally similar to dexamethasone with ~25× the potency of hydrocortisone, virtually no mineralocorticoid activity, and one of the longest biologic half-lives in routine use.▲0▼ Activates the glucocorticoid receptor to broadly remodel inflammatory, immune, and metabolic transcription. The dipropionate, valerate, and augmented dipropionate ester forms determine topical potency (high to super-high).