INFORMATION FOR HEALTH PROFESSIONALS
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Tablets
A wide variety of diseases may sometimes require corticosteroid therapy. Some of the principal indications are:-
Betnesol Tablets are best taken dissolved in water, but they can be swallowed whole without difficulty. The lowest dosage that will produce an acceptable result should be used, when it is possible to reduce the dosage, this must be accomplished by stages. During prolonged therapy, dosage may need to be increased temporarily during periods of stress or in exacerbations of illness.
The dose used will depend upon the disease, its severity, and the clinical response obtained. The following regimens are for guidance only. Divided dosage is usually employed.
Short-term treatment: 2 to 3mg daily for the first few days, subsequently reducing the daily dosage by 250 or 500 µg (0.25 or 0.5mg) every two to five days, depending upon the response.
Rheumatoid arthritis: 500 µg (0.5mg) to 2mg daily. For maintenance therapy the lowest effective dosage is used.
Most other conditions: 1.5 to 5mg daily for one to three weeks, then reducing to the minimum effective dosage. Larger doses may be needed for mixed connective tissue diseases and ulcerative colitis.
Fractions of the adult dosage may be used (e.g. 75% at 12 years, 50% at 7 years and 25% at 1 year) but clinical factors must be given due weight.
Systemic infections, unless specific anti-infective therapy is employed.
Live virus immunisation.
Hypersensitivity to any component of the tablets.
Administration of corticosteroids may impair the ability to resist and counteract infection e.g. where there is a previous history of tuberculosis; in addition clinical signs and symptoms of infection are suppressed.
Chickenpox is of particular concern since this normally minor illness may be fatal in immunosuppressed patients. Patients (or parents of children) without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and, if exposed, they should 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 used them within the previous three months. This should be given within ten days of exposure to chickenpox. If a diagnosis of chickenpox is confirmed, the illness warrants specialist care and urgent treatment. Corticosteroids should not be stopped and the dose may need to be increased.
Corticosteroid treatment is likely to reduce the response of the pituitary-adrenal axis to stress, and relative insufficiency may persist for up to a year after withdrawal of prolonged therapy.
Because of the possibility of fluid retention, care must be taken when corticosteroids are administered to patients with congestive heart failure.
Corticosteroids may worsen diabetes mellitus, osteoporosis, hypertension, glaucoma and epilepsy.
Care should be taken when there is a history of severe affective disorders (especially a previous history of steroid psychosis), previous steroid myopathy or peptic ulceration.
In patients with liver failure blood levels of corticosteroid may be increased, as with other drugs which are metabolised in the liver.
Systemic corticosteroids may cause growth retardation in infancy, childhood and adolescence. Treatment should be limited to the minimum dosage for the shortest possible time. In order to minimise suppression of the HPA axis and growth retardation consideration should be given to administration of a single dose on alternate days.
Treatment of elderly patients, particularly if long term, should be planned bearing in mind the more serious consequences of the common side effects of corticosteroids in old age, especially osteoporosis, diabetes, hypertension, susceptibility to infection and thinning of the skin.
When treatment is to be discontinued, the dose should be reduced gradually over a period of several weeks or months depending on the dosage and duration of the therapy.
In rare cases reduction or withdrawal of oral corticosteroid therapy may unmask underlying eosinophilic conditions (e.g. Churg Strauss syndrome) in patients with asthma.
Steroids may reduce the effects of anticholinesterases in myasthenia gravis, cholecystographic x-ray media, salicylates and non-steroidal anti-inflammatory agents.
The effect of steroids may be reduced by phenytoin, phenobarbitone, ephedrine and rifampicin.
Oestrogens may potentiate the effects of glucocorticoids and dosage adjustments may be required if oestrogens are added to or withdrawn from a stable dosage regimen.
The dosage of concomitantly administered anti-coagulants may have to be altered (usually decreased).
The use of corticosteroids during human pregnancy and lactation requires that the benefits be weighed against the possible risks associated with the product or with any alternative therapy.
There is insufficient evidence of safety in human pregnancy.
Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intrauterine growth retardation. The relevance of this finding to human beings has not been established, however, patients should avoid extensive use in pregnancy.
Hypoadrenalism may occur in the neonate.
Corticosteroids are excreted in small amounts in breast milk and infants of mothers taking pharmacological doses of steroids should be monitored carefully for signs of adrenal suppression.
Acute overdosage is very unlikely to occur, however in the case of chronic overdosage or misuse the features of Hypercortisolism, may appear and in this situation the product should be discontinued slowly.
36 months.
Store at a temperature not exceeding 30°C. Protect from light.
Prescription Only Medicine
GlaxoSmithKline NZ Limited
Quay Tower
Cnr Albert & Customs Street
Private Bag 106600
Downtown
Auckland
NEW ZEALAND
Phone: (09) 367 2900
Facsimile: (09) 367 2506
Date: 4 December 2002
Issue: 6
Betnesol ™ is a trade mark of the GlaxoSmithKline group of companies