Fluid and electrolyte disturbances:   sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension.

Musculoskeletal:   muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones.

Gastrointestinal:   peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis, hiccups, increased appetite, indigestion

Dermatologic:   impaired wound healing; thin, fragile skin; petechiae and ecchymoses; facial erythema; increased sweating; may suppress reactions to skin tests.

Neurological:   convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache.

Endocrine:   menstrual irregularities; development of cushingoid state; suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery, or illness; decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; increased requirements of insulin or oral hypoglycemic agents in diabetics.

Ophthalmic:   posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos.

Metabolic:   negative nitrogen balance due to protein catabolism.

Central Nervous System: Insomnia, nervousness

Other:   anaphylactoid or hypersensitivity and hypotensive or shock-like reactions.

Increased Effect/Toxicity - Inhibitors of CYP3A4 (including erythromycin, diltiazem, itraconazole, ketoconazole, quinidine, and verapamil) may decrease metabolism of betamethasone.

Decreased Effect - May induce cytochrome P450 enzymes, which may lead to decreased effect of any drug metabolized by P450 (ex: barbiturates, phenytoin, rifampin). Decreased effectiveness of salicylates when taken with betamethasone.

Ethanol/Nutrition/Herb Interactions:

Ethanol - Avid ethanol (may enhance gastric mucosal irritation).

Food - Betamethasone interferes with calcium absorption.

Herb/Nutraceutical - Avoid cat's claw, Echinacea (have immunostimulant properties).

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