Betamethasone: Dosage adjustments may be required for remission or exacerbation of the disease process, patient's individual response to therapy and exposure of patient to emotional or physical stress eg, serious infection, surgery or injury.
Monitoring may be necessary for up to 1 year following cessation of long-term or high-dose corticosteroid therapy.
The lowest possible dose of corticosteroid should be used to control the condition under treatment. A gradual dosage reduction is recommended.
Corticosteroid effect is enhanced in patients with hypothyroidism or cirrhosis.
Cautious use of corticosteroids is advised in patients with ocular herpes simplex because of possible corneal perforation.
Psychic derangements may appear with corticosteroid therapy. Existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
Corticosteroids should be used with caution in nonspecific ulcerative colitis if there is a probability of impending perforation, abscess or other pyogenic infection; diverticulitis; fresh intestinal anastomoses; active or latent peptic ulcer; renal insufficiency; hypertension; osteoporosis and myasthenia gravis.
Since complications of glucocorticoid treatment are dependent on dosage and duration of therapy, a risk/benefit decision must be made with each patient.
Corticosteroids may mask some signs of infection and new infections may appear during use. When corticosteroids are used, decreased resistance and inability to localize infection may occur.
Prolonged corticosteroid use may produce posterior subcapsular cataracts (especially in children), glaucoma with possible damage to the optic nerves, and may enhance secondary ocular infections due to fungi or viruses.
Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restrictions and potassium supplementation may be considered. All corticosteroids increase calcium excretion.
While on corticosteroid therapy, patients should not be vaccinated against smallpox. Other immunization procedures should not be undertaken in patients receiving corticosteroids, especially high doses, because of possible hazards of neurological complications and lack of antibody response. Patients on immunosuppressants and corticosteroids should be warned to avoid exposure to chickenpox or measles, and if exposed, to seek medical advice. This is of particular importance in children.
Corticosteroid therapy in active tuberculosis patients should be restricted to those cases of fulminating or disseminated tuberculosis in which concomitant appropriate antituberculous regimen is used. If corticosteroids are indicated in patients with latent tuberculosis, close observation is necessary since reactivation of the disease may occur. During prolonged corticosteroid therapy, patients should receive chemoprophylaxis.
Corticosteroid therapy may alter the motility and number of spermatozoa.
Dexchlorpheniramine Maleate: Use with caution in patients with narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, prostatic hypertrophy or bladder neck obstruction, cardiovascular disease including hypertension, increased intraocular pressure or hyperthyroidism.
Effects on the Ability to Drive or Operate Machinery: Patients should be warned about engaging in activities requiring mental alertness eg, driving a car or operating appliances, machinery and others.
Use in pregnancy & lactation: Use of Celestamine during pregnancy, in nursing mothers or in women of childbearing age requires that the possible benefits of the drug be weighed against potential hazards to mother and fetus or infant.
Infants born of mothers who have received substantial corticosteroid doses during pregnancy should be carefully observed for signs of hypoadrenalism.
Use in children: Safety and effectiveness of Celestamine in children <2 years have not been established.
Betamethasone: Growth and development of children on prolonged corticosteroid therapy should be carefully monitored since corticosteroid administration can disturb growth rates and inhibit endogenous corticosteroid production in these patients.
Use in the elderly: Dexchlorpheniramine Maleate: Conventional antihistamines may cause dizziness, sedation and hypotension in patients >60 years.