Betamethasone Drops

1. Introduction

Betamethasone is a potent corticosteroid commonly used in eyes – ophthalmic, ear – otic, and nasal formulations to treat inflammatory and allergic conditions. It reduces inflammation, swelling, and irritation in affected areas by suppressing the immune response.

2. Indications

  • Ophthalmic (Eye):
    • Inflammatory conditions of the anterior segment of the eye (e.g., iritis, uveitis).
    • Allergic conjunctivitis.
    • Post-operative inflammation.
  • Otic (Ear):
    • Otitis externa (inflammation of the outer ear).
    • Eczema of the ear canal.
  • Nasal:
    • Allergic rhinitis.
    • Nasal polyps (adjunctive therapy).

3. Dosage

  • Eye Drops:
    • 1–2 drops in the affected eye(s) every 1–2 hours initially, then reduce frequency as inflammation improves.
  • Ear Drops:
    • 2–3 drops in the affected ear(s) 2–3 times daily.
  • Nasal Spray:
    • 1–2 sprays in each nostril twice daily, up to a maximum of 4 sprays per nostril per day.

Dosage duration depends on the severity of the condition and should not exceed the recommended duration without medical advice.

4. Administration

  • Eyes:
    • Wash hands before use.
    • Tilt the head back, pull the lower eyelid to form a pocket, and instil drops.
    • Avoid touching the dropper tip to the eye or any surface.
  • Ears:
    • Warm the bottle in hand to avoid dizziness caused by cold drops.
    • Tilt the head, instil drops, and keep the head tilted for a few minutes.
  • Nose:
    • Shake the bottle gently before use.
    • Tilt the head slightly forward, insert the nozzle, and spray while inhaling gently.

5. Forms Available

  • Eye Drops: 0.1% solution.
  • Ear Drops: 0.1% solution, often combined with antibiotics.
  • Nasal Spray: 50 mcg per spray.

6. Side Effects

6.1. Common Side Effects

  • Eyes: Temporary stinging or burning, blurred vision.
  • Ears: Mild irritation or discomfort in the ear.
  • Nose: Nasal irritation or dryness.

6.2. Less Common Side Effects

  • Eyes: Increased intraocular pressure, sensitivity to light.
  • Ears: Redness or swelling in the ear canal.
  • Nose: Epistaxis (nosebleeds).

6.3. Rare but Serious Side Effects

  • Eyes: Cataracts, secondary eye infections, glaucoma.
  • Ears: Allergic reactions or worsening of infections.
  • Nose: Nasal septum perforation (with prolonged use).

7. Warnings

  • Eyes: Avoid in untreated eye infections, such as herpes simplex or fungal infections. Prolonged use may cause glaucoma or cataracts.
  • Ears: Do not use if the eardrum is perforated. Avoid in untreated bacterial or fungal infections.
  • Nose: Prolonged use may cause adrenal suppression or nasal septum perforation.

8. Precautions

  • Monitor for signs of infection, as corticosteroids may mask symptoms.
  • Use with caution in patients with a history of glaucoma (eyes) or recurrent infections (ears/nose).
  • Avoid long-term use unless directed by a healthcare provider.

9. Interactions

  • Eyes: Concomitant use with anticholinergic drugs (e.g., atropine) may increase intraocular pressure.
  • Ears: No significant interactions reported.
  • Nose: CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase systemic corticosteroid exposure.

10. Monitoring Parameters

  • Eyes: Monitor intraocular pressure with prolonged use (>10 days).
  • Ears: Assess for resolution of inflammation and absence of infection.
  • Nose: Symptom relief and signs of nasal irritation or bleeding.

11. Use in Children

  • Use with caution and under medical supervision, especially for prolonged treatment.
  • Avoid prolonged use to minimise the risk of systemic corticosteroid effects.

12. Use in Pregnancy

  • Limited data available.
  • Use only if the potential benefit outweighs the risk, especially during the first trimester.

13. Use in Elderly

  • Monitor for increased susceptibility to side effects, such as glaucoma (eyes) and systemic absorption (nose).

14. Use in Kidney Disease

  • No dosage adjustments required; systemic absorption is minimal with local use.

15. Use in Liver Disease

  • No dosage adjustments required; systemic absorption is minimal.

16. Patient Counselling Points

  • Instruct proper administration techniques for eye, ear, or nasal use.
  • Advise against sharing bottles to avoid contamination or cross-infection.
  • Inform about potential side effects such as stinging or irritation and the need to report persistent symptoms.
  • Emphasise that prolonged use requires medical monitoring.
  • Store at room temperature and avoid contaminating the dropper or nozzle.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
BetnesolGlaxoSmithKline$5–10 (5 mL, eye/ear drops)
CelestoneMerck$10–15 (5 mL, eye/ear drops)
NasacortSanofi$15–20 (120 sprays, nasal spray)
Generic OptionsVarious$3–8 (eye/ear drops)

18. FAQs (15 Questions)

  1. What is betamethasone used for in the eyes, ears, and nose?
    It is used to treat inflammation and allergic conditions of the eyes, ears, and nose.
  2. How does betamethasone work?
    It suppresses the immune response and reduces inflammation, swelling, and irritation.
  3. Can betamethasone eye drops cause blurry vision?
    Yes, temporary blurry vision is a common side effect.
  4. Can betamethasone ear drops be used if the eardrum is perforated?
    No, it should not be used if the eardrum is perforated.
  5. Can betamethasone nasal spray cause nosebleeds?
    Yes, epistaxis (nosebleeds) is a potential side effect, especially with prolonged use.
  6. Is betamethasone safe for children?
    It is safe under medical supervision but should be used cautiously and for the shortest duration.
  7. Can pregnant women use betamethasone?
    Use only if the potential benefit outweighs the risk, particularly during the first trimester.
  8. How long does it take for betamethasone to work?
    Symptom relief can usually be seen within a few days of use.
  9. How should betamethasone be stored?
    Store at room temperature, away from direct sunlight and moisture.
  10. What happens if I miss a dose?
    Administer the missed dose as soon as you remember, but skip it if it’s close to the next dose.
  11. Can I use betamethasone for an eye infection?
    No, it should not be used for untreated bacterial, fungal, or viral eye infections.
  12. Can betamethasone cause allergic reactions?
    Rarely, hypersensitivity reactions like rash, itching, or swelling may occur.
  13. Does betamethasone interact with other medications?
    Yes, CYP3A4 inhibitors may increase its systemic absorption.
  14. How often can I use betamethasone nasal spray?
    It is usually used twice daily, up to a maximum of 4 sprays per nostril daily.
  15. Can I stop using betamethasone once symptoms improve?
    Discontinue only as directed by a healthcare provider to avoid symptom recurrence.