The hormonal drug Dirospan is a ready-made medicinal suspension. It can be purchased in ampoules or disposable syringes. The product is a clear solution, sometimes with a yellowish tint. It contains suspended particles that, when shaken, transform the liquid into a stable suspension.
The medicine belongs to glucosteroids. Diprospan injections, the instructions indicate this, include betamethasone. It is the main active ingredient. In the manufacture of the medicine, a complex of auxiliary components is used that enhance the effect of the medicine. A single dose of 1 ml contains 5 mg of betamethosone. The medicine is characterized by anti-inflammatory, antitoxic, antiallergic, antishock, and immunosuppressive effects. In addition, it has a pronounced effect on metabolism.
Indications
Diprospan injections, the instructions indicate this, are used for a wide range of pathologies. The effectiveness of the product has been proven in the treatment of diseases of the musculoskeletal system. It alleviates the condition of patients with rheumatoid arthritis, osteoarthritis, bursitis, etc.
Diprospan is indicated, the instructions emphasize attention, also in other situations. It is often used in therapy:
- Allergic pathologies. In particular, it is used to stabilize the condition of patients suffering from bronchial asthma and hay fever. The drug allows you to quickly remove the symptoms of rhinitis when it occurs seasonally, as well as relieve an allergic reaction to medications and insect bites.
- Dermatological diseases. The effectiveness of the product has been proven in practice against dermatitis, eczema, neurodermatitis, urticaria, etc.
- Systemic connective tissue pathologies, including lupus erythematosus and scleroderma.
- Hemoblastosis. The medicine is used in the complex therapy of leukemia and lymphomas in adults.
Diprospan, the instructions for use indicate this, can be used in severe conditions of patients. It is prescribed for toxic, traumatic, cardiogenic, surgical, burn shock. The drug is indicated for severe anaphylactoid and allergic reactions, cerebral edema that occurs during radiation therapy or after surgery, hepatic coma, thyrotoxic crisis.
Diprospan, 7 mg/ml (2 mg+5 mg/ml), suspension for injection, 1 ml, 1 pc.
Diprospan® is recommended to be administered intramuscularly
if necessary, systemic intake of glucocorticoids into the body;
directly into the affected soft tissue or in the form of intra-articular and periarticular injections for arthritis, in the form of intra-
articular injections for various dermatological diseases and in the form of injections into the lesion for some foot diseases.
The dosage regimen and route of administration are determined individually, depending on the indications, severity of the disease and patient response.
For systemic therapy, the initial dose of Diprospan in most cases is 1–2 ml. The administration is repeated as necessary, depending on the patient's condition.
The drug is administered intramuscularly, deeply:
- in severe conditions requiring emergency measures, the initial dose is 2 ml;
— for various dermatological diseases, as a rule, it is enough to administer 1 ml of Diprospan® suspension;
- for diseases of the respiratory system; the onset of action of the drug occurs within several hours after intramuscular injection of the suspension; for bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis, a significant improvement in the condition is achieved after administration of 1–2 ml of Diprospan®;
— for acute and chronic bursitis, the initial dose for intramuscular administration is 1–2 ml of suspension. If necessary, several repeated injections are performed.
If a satisfactory clinical response does not occur after a certain period of time, Diprospan® should be discontinued and other therapy should be prescribed.
When administered locally, simultaneous use of a local anesthetic drug is necessary only in rare cases. If desired, use 1 or 2% solutions of procaine hydrochloride or lidocaine that do not contain methylparaben, propylparaben, phenol and other similar substances. In this case, mixing is carried out in a syringe, first drawing the required dose of Diprospan® suspension into the syringe from the bottle. Then the required amount of local anesthetic is taken from the ampoule into the same syringe and shaken for a short period of time.
For acute bursitis (subdeltoid, subscapular, ulnar and prepatellar), the introduction of 1-2 ml of suspension into the synovial bursa after a few hours relieves pain and restores joint mobility. After stopping the exacerbation of chronic bursitis, smaller doses of the drug are used.
For acute tenosynovitis, tendinitis and peritendinitis, 1 injection of Diprospan® improves the patient's condition; for chronic ones, the injection is repeated depending on the patient’s response. Injecting the drug directly into the tendon should be avoided.
Intra-articular administration of Diprospan in a dose of 0.5–2 ml relieves pain and limited joint mobility in rheumatoid arthritis and osteoarthritis within 2–4 hours after administration. The duration of therapeutic action varies significantly and can be 4 or more weeks.
Recommended doses of the drug when administered into large joints are from 1 to 2 ml, into medium joints - 0.5-2 ml, into small joints - 0.25-0.5 ml.
For some dermatological diseases, intravenous injection of Diprospan ® directly into the lesion is effective, the dose is 0.2 ml/cm2. The lesion is punctured evenly using a tuberculin syringe and a needle with a diameter of about 0.9 mm. The total amount of the drug administered in all areas should not exceed 1 ml for 1 week.
Recommended single doses of the drug (with an interval between injections of 1 week) for bursitis: for callus 0.25–0.5 ml (usually 2 injections are effective), for a spur - 0.5 ml, for limited mobility of the big toe - 0 .5 ml, for a synovial cyst - 0.25-0.5 ml, for tenosynovitis - 0.5 ml, for acute gouty arthritis - 0.5-1.0 ml. For administration, it is recommended to use a tuberculin syringe with a needle with a diameter of about 1 mm.
After achieving a therapeutic effect, the maintenance dose is selected by gradually reducing the initial dose by reducing the concentration of betamethasone in the solution administered at appropriate intervals. The reduction is continued until the minimum effective dose is reached.
If a stressful situation (not related to the disease) occurs or threatens to occur, it may be necessary to increase the dose of Diprospan®.
Discontinuation of the drug after long-term therapy is carried out by gradually reducing the dose.
The patient's condition is monitored for at least a year after completion of long-term therapy or after use in high doses.
Contraindications
Diprospan injections, the instructions for use warn about this, have an absolute contraindication - hypersensitivity to betamethasone or any of the auxiliary components. There are many other contraindications for the use of the drug, so you need to know why diprospan is dangerous.
The drug is not prescribed for the treatment of diseases of the skeletal system in the presence of septic and infectious lesions of the joint, as well as in the presence of periarticular osteoporosis or intra-articular bone fracture. The drug cannot be used in the post-vaccination period. It is unacceptable to treat diabetes mellitus, hypothyroidism and hypertension. Before using the product, the doctor must exclude other possible risks that are associated with contraindications.
The drug can be prescribed for the treatment of severe infectious diseases only in combination with other targeted drugs in specific therapy regimens. You should stop using the medicine if you have pathologies of the digestive system, such as peptic ulcers, diverticulitis, gastritis, etc. Treatment of children with the drug is possible only after 3 years. Pregnancy and lactation are conditional contraindications, since studies of the effect of the drug on the woman’s body in such conditions have not been conducted.
Diprospan
International name: Betamethasone
Group affiliation: Glucocorticosteroid
Description of the active substance (INN): Betamethasone
Dosage form: solution for injection, suspension for injection
Pharmacological action: GCS inhibits the release of interleukin1, interleukin2, interferon gamma from lymphocytes and macrophages. It has anti-inflammatory, antiallergic, desensitizing, antishock, antitoxic and immunosuppressive effects. Suppresses the release of ACTH and beta-lipotropin by the pituitary gland, but does not reduce the level of circulating beta-endorphin. Inhibits the secretion of TSH and FSH. Increases the excitability of the central nervous system, reduces the number of lymphocytes and eosinophils, increases the number of red blood cells (stimulates the production of erythropoietin). Interacts with specific cytoplasmic receptors and forms a complex that penetrates the cell nucleus and stimulates the synthesis of mRNA; the latter induces the formation of proteins, incl. lipocortin, mediating cellular effects. Lipocortin inhibits phospholipase A2, suppresses the release of arachidonic acid and suppresses the synthesis of endoperoxides, Pg, leukotrienes, which contribute to inflammation, allergies, etc. Protein metabolism: reduces the amount of protein in plasma (due to globulins) with an increase in the albumin/globulin ratio, increases the synthesis of albumins in liver and kidneys; enhances protein catabolism in muscle tissue. Lipid metabolism: increases the synthesis of higher fatty acids and TG, redistributes fat (fat accumulation mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia. Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase, leading to an increase in the flow of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, leading to the activation of gluconeogenesis. Water-electrolyte metabolism: retains Na+ and water in the body, stimulates the excretion of K+ (MCS activity), reduces the absorption of Ca2+ from the gastrointestinal tract, “washes out” Ca2+ from the bones, increases the excretion of Ca2+ by the kidneys. The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils; inducing the formation of lipocortin and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes and organelle membranes (especially lysosomal ones). The antiallergic effect develops as a result of suppression of the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, T- and B-lymphocytes, mast cells, decreased sensitivity of effector cells to allergy mediators, inhibition of antibody formation, changes the body's immune response. In COPD, the action is based mainly on inhibition of inflammatory processes, inhibition of development or prevention of swelling of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of the bronchial epithelium, deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucous membrane. Increases the sensitivity of beta-adrenergic receptors of small and medium-caliber bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by inhibiting or reducing its production. Antishock and antitoxic effects are associated with an increase in blood pressure (due to an increase in the concentration of circulating catecholamines and restoration of the sensitivity of adrenergic receptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane protective properties, and activation of liver enzymes involved in the metabolism of endo- and xenobiotics. The immunosuppressive effect is due to inhibition of the release of cytokines (interleukin1, interleukin2; interferon gamma) from lymphocytes and macrophages. Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous corticosteroids. Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation. Betamethasone disodium phosphate is a readily soluble compound that is well absorbed after parenteral administration into tissues and provides a rapid effect. Betamethasone dipropionate has a slower absorption. By combining these salts it is possible to create drugs with both short-term (but rapid) and long-term effects. Depending on the method of application (IV, IM, intra-articular, periarticular, IV), a general or local effect is achieved.
Indications: Shock (burn, traumatic, surgical, toxic, cardiogenic) when other therapy is ineffective. Allergic reactions (acute, severe forms), blood transfusion shock, anaphylactic shock, anaphylactoid reactions. Brain swelling (including due to a brain tumor or associated with surgery, radiation therapy or head trauma). Bronchial asthma (severe form), status asthmaticus. Systemic connective tissue diseases (SLE, rheumatoid arthritis). Acute adrenal insufficiency. Thyrotoxic crisis. Acute hepatitis, hepatic coma. Poisoning with cauterizing liquids (reducing inflammation and preventing cicatricial contractions).
Contraindications: For parenteral administration for short-term use for “vital” indications, the only contraindication is hypersensitivity. For intra-articular administration: previous arthroplasty, pathological bleeding (endogenous or caused by the use of anticoagulants), intra-articular bone fracture, infectious (septic) inflammatory process in the joint and periarticular infections (including a history), as well as a general infectious disease expressed periarticular osteoporosis, absence of signs of inflammation in the joint (the so-called “dry” joint, for example, in osteoarthritis without synovitis), severe bone destruction and joint deformation (sharp narrowing of the joint space, ankylosis), joint instability as a result of arthritis, aseptic necrosis of the epiphyses forming the joint bones. With caution. Parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently suffered, including recent contact with a patient) - herpes simplex, herpes zoster (viremic phase), chicken pox, measles; amebiasis, strongyloidiasis (established or suspected); systemic mycosis; active and latent tuberculosis. Use for severe infectious diseases is permissible only against the background of specific therapy. Post-vaccination period (a period of 8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination. Immunodeficiency conditions (including AIDS or HIV infection). Gastrointestinal diseases - gastric and duodenal ulcers, esophagitis, gastritis, acute or latent peptic ulcers, recently created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis. Diseases of the cardiovascular system, incl. recent myocardial infarction (in patients with acute and subacute myocardial infarction, the necrosis focus may spread, the formation of scar tissue may slow down and, as a result, the heart muscle will rupture), decompensated CHF, arterial hypertension, hyperlipidemia). Endocrine diseases - diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease. Severe chronic renal and/or liver failure, nephrourolithiasis. Hypoalbuminemia and conditions predisposing to its occurrence. Systemic osteoporosis, myasthenia gravis, acute psychosis, obesity (III-IV stage), poliomyelitis (except for the form of bulbar encephalitis), open- and closed-angle glaucoma, pregnancy, lactation. For intra-articular administration: the general serious condition of the patient, the ineffectiveness (or short duration) of the action of 2 previous injections (taking into account the individual properties of the GCS used).
Side effects: The incidence and severity of side effects depend on the duration of use, the size of the dose used and the ability to comply with the circadian rhythm of the prescription. From the endocrine system: decreased glucose tolerance, “steroid” diabetes mellitus or manifestation of latent diabetes mellitus, suppression of adrenal function, Itsenko-Cushing syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia, stretch marks) , delayed sexual development in children. From the digestive system: nausea, vomiting, pancreatitis, “steroid” gastric and duodenal ulcers, erosive esophagitis, bleeding and perforation of the gastrointestinal tract, increased or decreased appetite, flatulence, hiccups. In rare cases, there is an increase in the activity of liver transaminases and alkaline phosphatase. From the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of CHF, ECG changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle. From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions. From the senses: sudden loss of vision (with parenteral administration in the head, neck, nasal turbinates, scalp, deposition of drug crystals in the vessels of the eye is possible), posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, tendency to develop secondary bacterial , fungal or viral eye infections, trophic changes in the cornea, exophthalmos. From the metabolic side: increased excretion of Ca2+, hypocalcemia, increased body weight, negative nitrogen balance (increased protein breakdown), increased sweating. Caused by MCS activity - fluid and Na+ retention (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue). From the musculoskeletal system: slowing of growth and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur), rupture of muscle tendons, “steroid” myopathy, decreased muscle mass (atrophy). From the skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, stretch marks, tendency to develop pyoderma and candidiasis. Allergic reactions: generalized (skin rash, skin itching, anaphylactic shock), local allergic reactions. Other: development or exacerbation of infections (the appearance of this side effect is facilitated by jointly used immunosuppressants and vaccination), leukocyturia, flushing syndrome, convulsions. With intracranial administration - nosebleeds. When administered intra-articularly - increased pain in the joint. Overdose. Symptoms: nausea, vomiting, sleep disorders, euphoria, agitation, depression. With long-term use in high doses - osteoporosis, fluid retention in the body, increased blood pressure and other signs of hypercortisolism, including Itsenko-Cushing syndrome, secondary adrenal insufficiency. Treatment: against the background of gradual drug withdrawal, maintenance of vital functions, correction of electrolyte balance, antacids, phenothiazines, Li+ preparations; for Itsenko-Cushing syndrome - aminoglutethimide.
Method of administration and dosage: The method of administration and dosage regimen depend on the severity and nature of the disease. Betamethasone disodium phosphate - IV stream (slowly) or drip, single dose - 4-8 mg (1-2 ml), if necessary - up to 20 mg; maintenance dose - 2-4 mg. The infusion solution is diluted in 0.9% NaCl solution or dextrose solution. Prepare immediately before use. Unused solutions are stored in the refrigerator for no more than 24 hours. Betamethasone dipropionate - deep intramuscularly, at an initial dose of 4-8 mg for severe diseases (SLE, status asthmaticus). For children aged 1 to 5 years, the initial dose is 2 mg, for children 6-12 years old - 4 mg. For the prevention of hyaline-membranous disease of newborns during premature birth - IM, 8 mg 48-72 hours before birth (at least 24 hours), the injection is repeated after 24 hours. Intra-articular and periarticular: very large joints (pelvic) - 4 -8 mg, large joints (knee, ankle, shoulder) - 4 mg, medium joints (elbow, wrist) - 2-4 mg, small joints (interphalangeal, sternoclavicular, metacarpophalangeal) - 1-2 mg (0.25-0.5 ml). IV or intrawound administration for the treatment of skin diseases - 0.2 ml/sq.cm, but not more than 4 mg/week. Local infiltration: for bursitis - 1-2 mg (for acute form up to 8 mg), for synovial cyst and synovitis - 1-2 mg, for tendonitis - 2 mg, for myositis, fibrositis, peritendinitis, periarticular inflammation - 2-4 mg ; administration is repeated every 1-2 weeks. If necessary, 2 mg is administered subconjunctivally.
Special instructions : Mixing with an equal volume of solutions of local anesthetics (1% solution of procaine hydrochloride or 1% solution of lidocaine hydrochloride) in a syringe (but not in an ampoule) is allowed. Do not use for the treatment of hyaline membrane disease of newborns, inject into unstable joints, infected areas and intervertebral spaces. Before and during steroid therapy, it is necessary to monitor a general blood count, glycemia and glucosuria, and plasma electrolyte levels. When treating during intercurrent infections, septic conditions, tuberculosis, antibiotic treatment is carried out simultaneously. Children who during the treatment period were in contact with patients with measles or chickenpox are prescribed specific Ig prophylactically. During pregnancy and lactation, it is prescribed taking into account the expected therapeutic effect and negative effect on the fetus. In children during the growth period, GCS should be used only according to absolute indications and under the particularly careful supervision of the attending physician. It must be taken into account that in patients with hypothyroidism the clearance of GCS is reduced, and in patients with thyrotoxicosis it is increased.
Interaction: Reduces the effectiveness of insulin, oral hypoglycemic and antihypertensive drugs, anticoagulants (coumarin and indandione derivatives, heparin, streptokinase and urokinase); weakens the effect of diuretics, the activity of vaccines (due to decreased antibody production); reduces the content of salicylates in the blood; reduces the concentration of praziquantel in the blood serum. Rifampicin, phenytoin, barbiturates weaken the effect (being inducers of “liver” microsomal enzymes, they increase the metabolic rate); hormonal contraceptives increase effectiveness. Increase the risk of side effects: NSAIDs and ethanol (erosive and ulcerative lesions and bleeding from the gastrointestinal tract); androgens, estrogens, oral contraceptives, anabolic steroids (hirsutism, acne); antipsychotic drugs, immunosuppressants (increasing the likelihood of developing infections, as well as lymphomas and other lymphoproliferative diseases), bucarban, azathioprine (cataracts); m-anticholinergics, antihistamines, tricyclic antidepressants, nitrates (increased intraocular pressure); diuretics (hypokalemia), digitalis glycosides (arrhythmias associated with hypokalemia), ritodrine (possibility of developing pulmonary edema in pregnant women). Increases the risk of hepatotoxicity of paracetamol. Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis. Increases the toxicity of asparaginase (possibly increasing its hypoglycemic effect and the risk of developing neuropathy and impaired erythropoiesis). Reduces the metabolism of cyclosporine, increases its toxicity. Increases (with long-term therapy) the content of folic acid. Increases the metabolism of isoniazid, mexiletine (especially in “fast acetylators”), which leads to a decrease in their plasma concentrations. Mitotane and other inhibitors of adrenal cortex function may necessitate an increase in the dose of GCS. Hypokalemia caused by GCS can increase the severity and duration of muscle blockade due to muscle relaxants. Accelerates the elimination of ASA, reduces its level in the blood (when betamethasone is discontinued, the concentration of salicylates in the blood increases and the risk of side effects increases). Reduces the effect of somatropin. Increases the severity of the hyperglycemic effect of streptozocin. When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infections.
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Side effects
Side effects when using the drug Diprospan occur when contraindications and the doctor-recommended regimen of use are violated. In this case, negative reactions can occur from various systems of the human body.
The most common side effects that occur are:
- Increased blood pressure.
- Arrhythmia.
- Headache.
- Increased sweating.
- Insomnia.
- Muscle weakness.
- Deterioration of the condition of the skin.
- Depression.
- Nervousness.
But also when taking the drug, more serious side reactions may occur that pose a threat to health. They are all given in the instructions for use of the drug. If they occur, the use of diprospan should be abandoned.
Instructions for use
The drug is intended for intramuscular administration. It cannot be injected into a vein or subcutaneously. In this case, the injection is carried out deep into a large muscle. It is important to prevent the drug from getting into other tissues to prevent their possible atrophy. In severe conditions that require emergency measures, 2 ml of the drug is prescribed.
To the question: how often can diprospan be injected intramuscularly, the attending physician must answer in each specific case. He will also select the necessary dosage for the treatment of a particular pathology. Diprospan injections should be used based on the information provided in the instructions for use.
Uncontrolled use of a hormonal drug can lead to an overdose, which is dangerous with various negative consequences for the body. Severe vomiting, nervous agitation, and a jump in blood pressure may occur.
Reviews when the drug is prescribed correctly are always positive. Patients focus on rapid relief and elimination of painful symptoms. The affordable price of the drug is also attractive.
Diprospan ampoules should be stored at room temperature in a dark place out of reach of children. This drug has many analogues, but only a doctor should select a replacement.
