Betamethasone Dipropionate by is a Prescription medication manufactured, distributed, or labeled by Versapharm Incorporated, Akorn Operating Company LLC, Hi-Tech Pharmacal Co., Inc.. Drug facts, warnings, and ingredients follow.
Betamethasone dipropionate lotion USP (augmented), 0.05% is a corticosteroid indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses in patients 13 years of age and older. (1)
Most common adverse reactions (<1%) are: erythema, folliculitis, pruritus, and vesiculation. (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact VersaPharm Inc. – An Akorn Company at 1-877-254-4381 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling.
Revised: 10/2019
Apply a few drops of betamethasone dipropionate lotion USP (augmented), 0.05% to the affected skin areas once or twice daily and massage lightly until the lotion disappears.
Therapy should be discontinued when control is achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary. Betamethasone dipropionate lotion USP (augmented), 0.05% is a super-high-potency topical corticosteroid. Treatment with betamethasone dipropionate lotion USP (augmented), 0.05% should be limited to 2 consecutive weeks and amounts should not exceed 50 mL per week because of the potential for the drug to suppress the hypothalamic-pituitary-adrenal (HPA) axis [see Warnings and Precautions (5.1)].
Betamethasone dipropionate lotion USP (augmented), 0.05% should not be used with occlusive dressings unless directed by a physician.
Avoid use on the face, groin, or axillae, or if skin atrophy is present at the treatment site.
Avoid contact with eyes. Wash hands after each application.
Betamethasone dipropionate lotion USP (augmented), 0.05% is for topical use only. It is not for oral, ophthalmic, or intravaginal use.
Betamethasone dipropionate lotion USP (augmented), 0.05% can produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression with the potential for glucocorticosteroid insufficiency. This may occur during treatment or after withdrawal of treatment. Factors that predispose to HPA axis suppression include the use of high-potency steroids, large treatment surface areas, prolonged use, use of occlusive dressings, altered skin barrier, liver failure, and young age.
Evaluation for HPA axis suppression may be done by using the adrenocorticotropic hormone (ACTH) stimulation test.
In a trial evaluating the effects of betamethasone dipropionate lotion USP (augmented), 0.05% on the HPA axis, betamethasone dipropionate lotion USP (augmented), 0.05% was applied once daily at 7 mL per day for 21 days to diseased scalp and body skin in subjects with scalp psoriasis, betamethasone dipropionate lotion USP (augmented), 0.05% was shown to lower plasma cortisol levels below normal limits in 2 out of 11 subjects. HPA axis suppression in these subjects was transient and returned to normal within a week. In one of these subjects, plasma cortisol levels returned to normal while treatment continued.
If HPA axis suppression is documented, gradually withdraw the drug, reduce the frequency of application, or substitute with a less potent corticosteroid. Infrequently, signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.
Cushing's syndrome and hyperglycemia may also occur with topical corticosteroids. These events are rare and generally occur after prolonged exposure to excessively large doses, especially of high-potency topical corticosteroids.
Pediatric patients may be more susceptible to systemic toxicity due to their larger skin surface to body mass ratios [see Use in Specific Populations (8.4)].
Use of topical corticosteroids, including betamethasone dipropionate lotion USP (augmented), 0.05% may increase the risk of posterior subcapsular cataracts and glaucoma. Cataracts and glaucoma have been reported postmarketing with the use of topical corticosteroid products, including betamethasone dipropionate lotion USP (augmented), 0.05% [see Adverse Reactions (6.2)].
Avoid contact of betamethasone dipropionate lotion USP (augmented), 0.05% with eyes. Advise patients to report any visual symptoms and consider referral to an ophthalmologist for evaluation.
Allergic contact dermatitis with corticosteroids is usually diagnosed by observing failure to heal rather than noting a clinical exacerbation. Such an observation should be corroborated with appropriate diagnostic patch testing. If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
In controlled clinical trials, adverse reactions associated with the use of betamethasone dipropionate lotion USP (augmented), 0.05% reported at a frequency of less than 1% included erythema, folliculitis, pruritus, and vesiculation.
Because adverse reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Postmarketing reports for local adverse reactions to topical corticosteroids may also include: skin atrophy, striae, telangiectasias, burning, irritation, dryness, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, hypertrichosis, and miliaria.
Hypersensitivity reactions, consisting of predominantly skin signs and symptoms, e.g., contact dermatitis, pruritus, bullous dermatitis, and erythematous rash have been reported.
Ophthalmic adverse reactions of cataracts, glaucoma, increased intraocular pressure, and central serous chorioretinopathy have been reported with the use of topical corticosteroids, including topical betamethasone products.
Risk Summary
There are no available data on betamethasone dipropionate lotion USP (augmented), 0.05% use in pregnant women to identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes.
Observational studies suggest an increased risk of low birthweight infants with the use of greater than 300 grams of potent or very potent topical corticosteroid during a pregnancy. Advise pregnant women that betamethasone dipropionate lotion USP (augmented), 0.05% may increase the risk of having a low birthweight infant and to use betamethasone dipropionate lotion USP (augmented), 0.05% on the smallest area of skin and for the shortest duration possible.
In animal reproduction studies, increased malformations, including umbilical hernias, cephalocele, and cleft palate, were observed after intramuscular administration of betamethasone dipropionate to pregnant rabbits. The available data do not allow the calculation of relevant comparisons between the systemic exposure of betamethasone dipropionate in animal studies to the systemic exposure that would be expected in humans after topical use of betamethasone dipropionate lotion USP (augmented), 0.05% (see Data).
The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Data
Animal Data
Betamethasone dipropionate has been shown to cause malformations in rabbits when given by the intramuscular route at doses of 0.05 mg/kg. The abnormalities observed included umbilical hernias, cephalocele, and cleft palate.
Risk Summary
There are no data regarding the excretion of betamethasone dipropionate in breast milk, the effects on the breastfed infant, or the effects on milk production after topical application of betamethasone dipropionate lotion USP (augmented), 0.05% to women who are breastfeeding.
It is possible that topical administration of large amounts of betamethasone dipropionate could result in sufficient systemic absorption to produce detectable quantities in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for betamethasone dipropionate lotion USP (augmented), 0.05% and any potential adverse effects on the breastfed infant from betamethasone dipropionate lotion USP (augmented), 0.05% or from the underlying maternal condition.
Clinical Considerations
To minimize potential exposure to the breastfed infant via breast milk, use betamethasone dipropionate lotion USP (augmented), 0.05% on the smallest area of skin and for the shortest duration possible while breastfeeding. Advise breastfeeding women not to apply betamethasone dipropionate lotion USP (augmented), 0.05% directly to the nipple and areola to avoid direct infant exposure [see Use in Specific Populations (8.4)].
Use of betamethasone dipropionate lotion USP (augmented), 0.05% in pediatric patients younger than 13 years of age is not recommended due to the potential for HPA axis suppression [see Warnings and Precautions (5.1)].
In an open-label HPA axis safety trial in subjects 3 months to 12 years of age with atopic dermatitis, betamethasone dipropionate cream USP (augmented), 0.05% was applied twice daily for 2 to 3 weeks over a mean body surface area of 58% (range 35% to 95%). In 19 of 60 (32%) evaluable subjects, adrenal suppression was indicated by either a ≤5 mcg/dL pre-stimulation cortisol, or a cosyntropin post-stimulation cortisol ≤18 mcg/dL and/or an increase of <7 mcg/dL from the baseline cortisol. Out of the 19 subjects with HPA axis suppression, 4 subjects were tested 2 weeks after discontinuation of betamethasone dipropionate cream USP (augmented), 0.05% and 3 of the 4 (75%) had complete recovery of HPA axis function. The proportion of subjects with adrenal suppression in this trial was progressively greater, the younger the age group.
Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of systemic toxicity when treated with topical drugs. They are, therefore, also at greater risk of HPA axis suppression and adrenal insufficiency upon the use of topical corticosteroids.
Rare systemic effects such as Cushing's syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension have been reported in pediatric patients, especially those with prolonged exposure to large doses of high potency topical corticosteroids.
Local adverse reactions including skin atrophy have also been reported with use of topical corticosteroids in pediatric patients.
Avoid use of betamethasone dipropionate lotion USP (augmented), 0.05% in the treatment of diaper dermatitis.
Clinical trials of betamethasone dipropionate lotion USP (augmented), 0.05% included 56 subjects who were 65 years of age and over and 9 subjects who were 75 years of age and over. There was a numerical difference for application site reactions (most frequently reported events were burning and stinging) which occurred in 15% (10/65) of geriatric subjects and 11% (38/342) of subjects less than 65 years of age. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. However, greater sensitivity of some older individuals cannot be ruled out.
Betamethasone dipropionate lotion USP (augmented), 0.05% contains betamethasone dipropionate USP, a synthetic adrenocorticosteroid, for topical use. Betamethasone, an analog of prednisolone, has a high degree of corticosteroid activity and a slight degree of mineralocorticoid activity. Betamethasone dipropionate is the 17, 21-dipropionate ester of betamethasone.
Chemically, betamethasone dipropionate is 9-fluoro-11β,17,21-trihydroxy-16β-methylpregna-1,4-diene-3,20-dione 17,21-dipropionate, with the empirical formula C28H37FO7, a molecular weight of 504.6, and the following structural formula:
It is a white to creamy-white, odorless powder insoluble in water; freely soluble in acetone and in chloroform; sparingly soluble in alcohol.
Each gram of betamethasone dipropionate lotion USP (augmented), 0.05% contains 0.643 mg betamethasone dipropionate USP (equivalent to 0.5 mg betamethasone), in a colorless, clear to translucent lotion base of hydroxypropyl cellulose; isopropyl alcohol (30%); phosphoric acid used to adjust the pH; propylene glycol; purified water; and sodium phosphate monobasic monohydrate.
Corticosteroids play a role in cellular signaling, immune function, inflammation, and protein regulation; however, the precise mechanism of action of betamethasone dipropionate lotion USP (augmented), 0.05% in corticosteroid responsive dermatoses is unknown.
Vasoconstrictor Assay
Trials performed with betamethasone dipropionate lotion USP (augmented), 0.05% indicate that it is in the super-high range of potency as demonstrated in vasoconstrictor trials in healthy subjects when compared with other topical corticosteroids. However, similar blanching scores do not necessarily imply therapeutic equivalence.
No pharmacokinetic trials have been conducted with betamethasone dipropionate lotion USP (augmented), 0.05%.
The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle, the integrity of the epidermal barrier, and the use of occlusive dressings.
Topical corticosteroids can be absorbed through normal intact skin. Inflammation and/or other disease processes in the skin may increase percutaneous absorption. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids [see Dosage and Administration (2)].
Once absorbed through the skin, topical corticosteroids enter pharmacokinetic pathways similar to systemically administered corticosteroids. Corticosteroids are bound to plasma proteins in varying degrees, are metabolized primarily in the liver, and excreted by the kidneys. Some of the topical corticosteroids and their metabolites are also excreted into the bile.
Long-term animal studies have not been performed to evaluate the carcinogenic potential of betamethasone dipropionate. Betamethasone was negative in the bacterial mutagenicity assay (Salmonella typhimurium and Escherichia coli), and in the mammalian cell mutagenicity assay (CHO/HGPRT). It was positive in the in vitro human lymphocyte chromosome aberration assay, and equivocal in the in vivo mouse bone marrow micronucleus assay.
Studies in rabbits, mice, and rats using intramuscular doses up to 1, 33, and 2 mg/kg, respectively, resulted in dose-related increases in fetal resorptions in rabbits and mice.
The safety and efficacy of betamethasone dipropionate lotion USP (augmented), 0.05% for the treatment of corticosteroid-responsive dermatoses have been evaluated in two randomized vehicle controlled trials, one in scalp psoriasis and one in seborrheic dermatitis. A total of 263 subjects, of whom 131 received betamethasone dipropionate lotion USP (augmented), 0.05%, were included in these trials. These trials evaluated betamethasone dipropionate lotion USP (augmented), 0.05% applied once daily for 21 days.
Betamethasone dipropionate lotion USP (augmented), 0.05% was shown to be effective in relieving the signs and symptoms of corticosteroid responsive dermatoses.
Betamethasone dipropionate lotion USP (augmented), 0.05% is a colorless, clear to translucent lotion supplied in 30-mL (29 g) (NDC: 61748-480-30) and 60-mL (58 g) (NDC: 61748-480-60) plastic bottles.
Advise the patient to read the FDA-approved patient labeling (Patient Information).
Inform patients of the following:
Patient Information Betamethasone Dipropionate Lotion USP (Augmented), 0.05% (BAY-ta-METH-a-sone) |
Important information: Betamethasone dipropionate lotion USP (augmented), 0.05% is for use on skin only. Do not use betamethasone dipropionate lotion USP (augmented), 0.05% in your eyes, mouth, or vagina. |
What is betamethasone dipropionate lotion USP (augmented), 0.05%? Betamethasone dipropionate lotion USP (augmented), 0.05% is prescription corticosteroid medicine used on the skin (topical) for the relief of redness, swelling, heat, pain (inflammation) and itching, caused by certain skin problems in people 13 years of age and older.
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Do not use betamethasone dipropionate lotion USP (augmented), 0.05% if you are allergic to betamethasone dipropionate or any of the ingredients in betamethasone dipropionate lotion USP (augmented), 0.05%. See the end of this leaflet for a complete list of ingredients in betamethasone dipropionate lotion USP (augmented), 0.05%. |
Before using betamethasone dipropionate lotion USP (augmented), 0.05%, tell your healthcare provider about all of your medical conditions, including if you:
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take other corticosteroid medicines by mouth, or injection or use other products on your skin or scalp that contain corticosteroids. Do not use other products containing a steroid medicine with betamethasone dipropionate lotion USP (augmented), 0.05% without talking to your healthcare provider first. |
How should I use betamethasone dipropionate lotion USP (augmented), 0.05%?
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What are the possible side effects of betamethasone dipropionate lotion USP (augmented), 0.05%? Betamethasone dipropionate lotion USP (augmented), 0.05% may cause serious side effects, including:
The most common side effects of betamethasone dipropionate lotion USP (augmented), 0.05% include: redness of the skin, inflamed hair follicles, itching and blistering. These are not all of the possible side effects of betamethasone dipropionate lotion USP (augmented), 0.05%. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. |
How should I store betamethasone dipropionate lotion USP (augmented), 0.05%?
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General information about the safe and effective use of betamethasone dipropionate lotion USP (augmented), 0.05%. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use betamethasone dipropionate lotion USP (augmented), 0.05% for a condition for which it was not prescribed. Do not give betamethasone dipropionate lotion (augmented), 0.05% to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about betamethasone dipropionate lotion USP (augmented), 0.05% that is written for health professionals. |
What are the ingredients in betamethasone dipropionate lotion USP (augmented), 0.05%? Active ingredient: augmented betamethasone dipropionate, USP Inactive ingredients: hydroxypropyl cellulose; isopropyl alcohol (30%); phosphoric acid used to adjust the pH; propylene glycol; purified water; and sodium phosphate monobasic monohydrate. Marketed by: VersaPharm, Inc. – An Akorn Company Lake Forest, IL 60045 Manufactured by: Hi-Tech Pharmacal Co., Inc. – An Akorn Company Amityville, NY 11701 BDLA00N Rev. 07/2019 |
This Patient Information has been approved by the U.S. Food and Drug Administration.
NDC: 61748-480-30
Betamethasone
Dipropionate
Lotion USP
(Augmented),
0.05%*
(*Strength expressed as
Betamethasone)
For topical use only.
Not for oral,ophthalmic,
or intravaginal use.
DO NOT USE IN EYES
Rx Only
30 mL
BETAMETHASONE DIPROPIONATE
betamethasone dipropionate lotion, augmented |
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Labeler - VersaPharm Inc. - An Akorn Company (956741896) |
Establishment | |||
Name | Address | ID/FEI | Business Operations |
---|---|---|---|
Hi-Tech Pharmacal Co. Inc. (subsidiary of Akorn Inc) | 101196749 | MANUFACTURE(61748-480) , PACK(61748-480) , ANALYSIS(61748-480) |