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: Indication-specific

or No fixed maximum; titrated to TSH target

& routes: Oral

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Betamethasone (valerate, dipropionate, sodium phosphate, acetate) (1) · Dexamethasone (1) · Hydrocortisone (cortisol) (1) · Levothyroxine (1) · Medroxyprogesterone acetate (MPA) (1) · Methylprednisolone (1) · Norethindrone (norethisterone outside US) (1) · Prednisolone (and prednisolone sodium phosphate, acetate, etc.) (1) · Thyroid (desiccated) (1)

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Aygestin (5 mg, Rx); Camila, Errin, Heather, Jolivette, Nor-QD, Ortho Micronor, Sharobel (0.35 mg POPs); component of many COCs (1) · Celestone (oral/injectable), Diprolene/Diprosone (topical), Luxiq (foam), Celestone Soluspan (depot IM) (1) · Cortef (oral), Solu-Cortef (IV), many topical brands (Cortizone, OTC); Plenadren, Alkindi (modified-release for adrenal insufficiency) (1) · Decadron (historical), Dexpak (taper pack), Hemady, Ozurdex (intravitreal) (1) · Medrol (oral), Solu-Medrol (IV/IM), Depo-Medrol (depot injection) (1) · Prelone, Pediapred, Orapred ODT, Millipred, Veripred (1) · Provera (oral), Depo-Provera (IM contraceptive), Depo-SubQ Provera 104 (SC) (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1)

high-potency)]] (2) · with mineralocorticoid activity)]] (1) · [[:Category:Corticosteroids|Corticosteroid]] (5) · [[:Category:Glucocorticoids|Glucocorticoid (intermediate-acting)]] (2) · [[:Category:Glucocorticoids|Glucocorticoid (long-acting (2) · [[:Category:Glucocorticoids|Glucocorticoid (short-acting (1) · [[:Category:Hormonal_contraceptives|Hormonal contraceptive (Depo)]] (1) · [[:Category:Hormonal_contraceptives|Hormonal contraceptive]] (1) · [[:Category:Hormone_replacement|Hormone replacement]] (2) · [[:Category:Immunosuppressants|Immunosuppressant]] (3) · [[:Category:Progestins|Progestin (synthetic progestogen)]] (1) · [[:Category:Progestogens|Progestin (synthetic progestogen)]] (1) · [[:Category:Sex_hormones|Sex hormone]] (2) · [[:Category:Thyroid_hormones|Thyroid hormone]] (2) · [[:Category:Topical_corticosteroids|Topical corticosteroid (high-to-super-high potency depending on ester)]] (1) · [[:Category:Topical_corticosteroids|Topical corticosteroid]] (1)

None (3) · Synthetic T4 (thyroxine); peripherally deiodinated to T3 (triiodothyronine), the active hormone. '"`UNIQ--vote-00000031-QINU`"' Narrow therapeutic index; brand-to-generic switches can shift TSH and require re-titration'"`UNIQ--ref-00000032-QINU`"'. (1) · '"`UNIQ--vote-00000016-QINU`"' Brand-to-brand and lot-to-lot variability in T3:T4 ratio is greater than with synthetic levothyroxine, which is why endocrine guidelines prefer the synthetic'"`UNIQ--ref-00000017-QINU`"'. (1) · '"`UNIQ--vote-00000860-QINU`"' Activates the glucocorticoid receptor to broadly remodel inflammatory, immune, and metabolic transcription. Unlike prednisone, it does not require hepatic activation, making it the preferred oral choice in severe hepatic dysfunction'"`UNIQ--ref-00000861-QINU`"'. (1) · '"`UNIQ--vote-000008BE-QINU`"' Preferred over prednisone in advanced hepatic dysfunction where hepatic 11β-HSD1 activation is impaired. Liquid formulations are the workhorse pediatric oral corticosteroid for asthma and croup'"`UNIQ--ref-000008BF-QINU`"'. (1) · '"`UNIQ--vote-00001014-QINU`"' 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)'"`UNIQ--ref-00001015-QINU`"'. (1) · '"`UNIQ--vote-000013EE-QINU`"' Higher-dose Aygestin (5 mg) achieves more reliable ovulation suppression and is used for endometriosis and DUB. POP requires strict daily timing because the 24-hour cervical-mucus effect window is narrower than COC'"`UNIQ--ref-000013EF-QINU`"'. (1)

1.6 mcg/kg/d in young healthy adults; 25-50 mcg/d in elderly or cardiac disease, titrated by TSH at 6-8 weeks (1) · 30 mg PO daily (1/2 grain); titrate by TSH at 6-8 weeks; 60 mg desiccated thyroid is approximately equivalent to 88-100 mcg levothyroxine (1) · Antenatal: Celestone Soluspan 12 mg IM q24h × 2 doses; topical: pea-sized amount BID; intra-articular varies by joint (1) · Contraception: Depo-Provera 150 mg IM every 13 weeks; Depo-SubQ 104 mg SC every 12-13 weeks; oral cycling: 5-10 mg PO daily ×5-10 days for amenorrhea (1) · Indication-specific: 0.5-9 mg PO/IV daily for inflammation; 4 mg IV q6h for cerebral edema; 40 mg PO once weekly in MM; 6 mg PO/IV daily ×10 days for severe COVID-19; 0.6 mg/kg PO single dose for croup (max 16 mg) (1) · Pediatric 1-2 mg/kg/d (max 60 mg) PO for asthma exacerbation; adult dosing similar to prednisone milligram-for-milligram (~1:1 potency) (1) · Physiologic replacement 15-25 mg/d divided (e.g., 10 mg AM, 5 mg noon, 5 mg afternoon); stress dose 50-100 mg IV q6-8h; adrenal crisis 100 mg IV then 50-100 mg q6h; topical 0.5-2.5% applied 2-4×/d (1) · PO Medrol Dosepak (5-day taper from 24 mg to 4 mg) is the prototypic short-course outpatient regimen; IV pulse 1 g daily for 3-5 days for MS relapse; intra-articular 4-80 mg per joint q1-5 weeks (1) · POP: 0.35 mg PO daily continuously (no placebo week); high-dose 5 mg Aygestin for amenorrhea/endometriosis 5-10 mg/d (1)

0.35 mg POP tablets; 5 mg tablets (Aygestin); component of COCs and combination HRT (1) · 0.5, 0.75, 1, 1.5, 2, 4, 6 mg tablets; oral solution; 4, 10, 20, 100 mg/mL IV; intravitreal implant (Ozurdex) (1) · 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) (1) · 15, 30, 60, 90, 120, 180, 240, 300 mg tablets (1/4 to 5 grains; 1 grain = 60 mg) (1) · 2, 4, 8, 16, 32 mg oral tablets; 40, 125, 500, 1000 mg IV vials; Depo-Medrol 20, 40, 80 mg/mL IM depot (1) · 2.5, 5, 10 mg oral tablets; Depo-Provera 150 mg/mL IM; Depo-SubQ Provera 104 mg/0.65 mL (1) · 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tablets; oral capsule and IV/IM also available (1) · 5 mg tablets; 5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL oral solutions (sweetened pediatric); 5 mg/5 mL syrup; ophthalmic 0.12%, 1% suspensions and 1% solution (1) · 5, 10, 20 mg oral tablets; 100, 250, 500, 1000 mg IV (Solu-Cortef); 0.5%, 1%, 2.5% topical creams/ointments; rectal foam and enemas (1)

Contraception within 48 hours of starting (POP); endometrial effects days (1) · Contraceptive within 24 hours if given in first 5 days of cycle; otherwise backup for 7 days (1) · Hours (4) · IV pulse: hours; PO: hours; intra-articular: days (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1)

Biologic 12-36 hours (intermediate-acting) (1) · Biologic 12-36 hours (intermediate-acting); Depo-Medrol depot weeks (1) · Biologic 36-54 hours (long-acting) (1) · Biologic 36-72 hours (long-acting) (1) · Biologic ~8-12 hours (short-acting) (1) · Depot IM 13 weeks (designed); often persists longer (1) · Steady-state at 4-6 weeks (2) · ~24 hours per dose (strict timing required for POP — within 3-hour window each day) (1)

Plasma 2-3 hours; biologic ~18-36 hours'"`UNIQ--ref-00000867-QINU`"' (1) · Plasma 2-3 hours; biologic ~18-36 hours'"`UNIQ--ref-000008C4-QINU`"' (1) · Plasma ~1-2 hours; biologic ~8-12 hours'"`UNIQ--ref-00000AD1-QINU`"' (1) · Plasma ~3-4.5 hours; biologic ~36-72 hours'"`UNIQ--ref-00000E2B-QINU`"' (1) · Plasma ~5 hours; biologic ~36-54 hours'"`UNIQ--ref-0000101A-QINU`"' (1) · T4 ~7 days; T3 ~1 day'"`UNIQ--ref-0000001A-QINU`"' (1) · ~50 days (Depo-Provera; long depot release)'"`UNIQ--ref-00000F20-QINU`"' (1) · ~7 days (euthyroid); longer in hypothyroidism (~9-10 days), shorter in hyperthyroidism'"`UNIQ--ref-00000036-QINU`"' (1) · ~8 hours'"`UNIQ--ref-000013F5-QINU`"' (1)

40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' (1) · Oral ~70%; depot IM provides sustained release over weeks'"`UNIQ--ref-0000101B-QINU`"' (1) · Oral ~90%; depot IM essentially 100% over the dosing interval'"`UNIQ--ref-00000F21-QINU`"' (1) · Variable; reduced by food, calcium, iron, PPIs'"`UNIQ--ref-0000001B-QINU`"' (1) · ~65% (oral)'"`UNIQ--ref-000013F6-QINU`"' (1) · ~70% (oral)'"`UNIQ--ref-000008C5-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-00000E2C-QINU`"' (1) · ~80-99% (oral)'"`UNIQ--ref-00000868-QINU`"' (1) · ~96% (oral)'"`UNIQ--ref-00000AD2-QINU`"' (1)

None (1) · Contraindicated in known pregnancy (Aygestin); the 0.35 mg POP is not teratogenic and does not need to be discontinued before conception planning.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Contraindicated in known pregnancy.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · First-line in pregnancy; dose typically increased 25-30% due to estrogen-driven rise in TBG and fetal demand. Lactation safe at physiologic doses.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Synthetic levothyroxine is the standard-of-care in pregnancy; desiccated thyroid use in pregnancy is not well studied.'"`UNIQ--ref-0000001C-QINU`"' (1) · Use when benefits outweigh; small association with oral clefts debated.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Use when benefits outweigh; small association with oral clefts in first trimester debated.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Use when benefits outweigh; widely used at physiologic doses for adrenal insufficiency.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Used in antenatal lung maturation (24-34 weeks gestation; 6 mg IM q12h × 4 doses); broader use weighs benefits against fetal HPA suppression.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

OTC (low-dose topicals) and [[USLegal:Prescription only|Rx-only]] (other forms) in US (1) · [[USLegal:Prescription only|Rx-only]] in US (6) · [[USLegal:Prescription only|Rx-only]] in US (note: norgestrel 0.075 mg POP is now OTC as Opill since 2023, but norethindrone POP remains Rx) (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries a '''Boxed Warning''' for bone mineral density loss with prolonged use (≥2 years; partially reversible after discontinuation)'"`UNIQ--ref-00000F22-QINU`"' (1)

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Betamethasone

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