What is Diprospan® used for?
Diprospan® is commonly used for the treatment of acute and chronic corticosteroid-responsive disorders, such as:
- Musculoskeletal and soft tissue conditions including rheumatoid arthritis, osteoarthritis, bursitis, ankylosing spondylitis, epicondylitis, radiculitis, coccydynia, sciatica, lumbago, torticollis, ganglion cyst, exostosis and fasciitis
- Allergic conditions including chronic bronchial asthma (adjunctive therapy for status asthmaticus), hay fever, angioneurotic edema, allergic bronchitis, seasonal or perennial allergic rhinitis, drug reactions, serum sickness and insect bites
- Dermatologic conditions including atopic dermatitis (nummular eczema), neurodermatitis (circumscribed lichen simplex), contact dermatitis, severe solar dermatitis, urticaria, hypertrophic lichen planus, necrobiosis lipoidica diabeticorum, alopecia areata, discoid lupus erythematosus, psoriasis, keloids, pemphigus, dermatitis herpetiformis and cystic acne
- Collagen diseases including disseminated lupus erythematosus, scleroderma, dermatomyositis and periarteritis nodosa
- Neoplastic diseases including palliative management of leukemias and lymphomas in adults and acute leukemia of childhood
- Other conditions including adrenogenital syndrome, ulcerative colitis, regional ileitis, sprue, podiatric conditions (bursitis under heloma durum, hallux rigidus, digiti quinti varus), affections requiring subconjunctival injection, corticosteroid-responsive blood dyscrasias, nephritis and nephrotic syndrome
How should I take Diprospan®?
Diprospan® is recommended for IM injection in conditions responsive to systemic corticosteroids.
How do I store Diprospan®?
Diprospan® is best stored in the refrigerator. To prevent drug damage, do not freeze. There may be different brands of Diprospan® that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush Diprospan® down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Precautions & warnings
What should I know before using Diprospan®?
This drug is contraindicated in case of:
- Patients have systemic fungal infections.
- Patients have sensitivity reactions to betamethasone or to other corticosteroids.
- Patients are allergic to any ingredients of Diprospan®.
Also, these are special precautions that you may notice:
- Diprospan® is not for IV or SC use. Strict aseptic technique is mandatory in its use.
- Diprospan® contains 2 betamethasone esters, one of which, betamethasone sodium phosphate, disappears rapidly from the injection site. The potential for systemic effect produced by this soluble portion of Diprospan® should, therefore be taken into account by the physician when using this preparation.
- Diprospan® should be administered IM with caution to patients with idiopathic thrombocytopenic purpura. IM injection of corticosteroids should be given deep into large muscle masses to avoid local tissue atrophy.
- Soft tissue, intralesional and intra-articular administration of a corticosteroid may produce systemic as well as local effects.
- Examination of any joint fluid present is necessary to exclude a septic process. Local injection into previously infected joint is to be avoided. A marked increase in pain and local swelling, further restriction of joint motion, fever and malaise are suggestive of septic arthritis. If the diagnosis of sepsis is confirmed, appropriate antimicrobial therapy should be instituted.
- Corticosteroids should not be injected into unstable joints, infected areas or intervertebral spaces. Repeated injections into joints of osteoarthritis may increase joint destruction. Avoid injecting corticosteroids directly into the substance of tendons because delayed appearance of tendon rupture has resulted.
- Following intra-articular corticosteroid therapy, care should be taken by the patient to avoid overuse of the joint in which symptomatic benefit has been obtained.
- Because rare instances of anaphylactoid reactions have occurred in patients receiving parenteral corticosteroid therapy, appropriate precautionary measure should be taken prior to administration, especially when the patient has a history of allergy to any drug.
- With long-term corticosteroid therapy, transfer from parenteral to oral administration should be considered after weighing the potential benefits and risks.
- Dosage adjustments may be required for remission or exacerbation of the disease process, the patient’s individual response to therapy and exposure of the patient to emotional or physical stress e.g., serious infection, surgery or injury. Monitoring may be necessary for up to 1 year following cessation of long-term or high-dose corticosteroid therapy.
- 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 restriction 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. However, immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy e.g., for Addison’s disease.
- Patients who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chickenpox or measles and, if exposed, to obtain medical advice. This is of particular importance in children.
- Corticosteroid therapy in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for management in conjunction with an appropriate antituberculous regimen.
- If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary since reactivation of the disease may occur. During prolonged corticosteroid therapy, patients should receive chemoprophylaxis. If rifampin is used in a chemoprophylactic program, its enhancing effect on metabolic hepatic clearance of corticosteroids should be considered; adjustment in corticosteroid dosage may be required.
- The lowest possible dose of corticosteroid should be used to control the condition under treatment; when dosage reduction is possible, it should be gradual.
- Drug-induced secondary adrenocortical insufficiency may result from too rapid corticosteroid withdrawal and may be minimized by gradual dosage reduction. Such relative insufficiency may persist for months after discontinuation of therapy; therefore, if stress occurs during that period, corticotherapy should be re-instituted. If the patient is receiving corticosteroids already, dosage may have to be increased. Since mineralocorticoid secretion may be impaired, salt and/or a mineral corticosteroid should be administered concurrently.
- Corticosteroid effect is enhanced in patients with hypothyroidism or in those with 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 infections; diverticulitis; fresh intestinal anastomoses; active or latent peptic ulcer; renal insufficiency; hypertension; osteoporosis; and myasthenia gravis.
- Since complications of glucocorticosteroid treatment are dependent on dose, size and duration of treatment, a risk/benefit decision must be made with each patient.
- Since corticosteroid administration can disturb growth rates and inhibit endogenous corticosteroid production in infants and children, the growth and development of these patients receiving prolonged therapy should be followed carefully.
- Corticosteroids may alter the motility and number of spermatozoa in some patients.
Is it safe during pregnancy or breastfeeding?
There isn’t enough information about the safety of using this medication during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.
What side effects can occur from Diprospan®?
Some side effects may occur when using this drug, including:
- Fluid and electrolyte disturbances such as sodium retention, potassium loss, hypokalemic alkalosis, fluid retention, congestive heart failure in susceptible patients, hypertension
- Musculoskeletal such as muscle weakness, corticosteroid myopathy, loss of muscle mass, aggravation of myasthenic symptoms in myasthenia gravis, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones, tendon rupture, joint instability (from repeated intra-articular injections)
- Gastrointestinal such as peptic ulcer with possible subsequent perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis
- Dermatologic such as impaired wound healing, skin atrophy, thin fragile skin, petechiae and ecchymoses, facial erythema, increased sweating, suppressed reactions to skin tests, reactions e.g., allergic dermatitis, urticaria, angioneurotic edema
- Neurologic such as convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache
- Endocrine such as menstrual irregularities; development of cushingoid state; suppression of fetal intrauterine or childhood growth; 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 such as posterior subcapsular cataracts; increased intraocular pressure, glaucoma; exophthalmos
- Metabolic such as negative nitrogen balance due to protein catabolism
- Psychiatric such as euphoria, mood swings; severe depression to frank psychotic manifestations; personality changes; insomnia
- Others such as anaphylactoid or hypersensitivity and hypotensive or shock-like reactions
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.
What drugs may interact with Diprospan®?
Diprospan® may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.
These products may interact with this drug, including:
- Potassium-depleting diuretics
- Cardiac glycosides
- Amphotericin B
- Coumarin-type anticoagulants
- Nonsteroidal anti-inflammatory drugs
- Acetylsalicylic acid
- Antidiabetic drug
Does food or alcohol interact with Diprospan®?
Diprospan® may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
What health conditions may interact with Diprospan®?
Diprospan® may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.
The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using Diprospan®.
What is the dose of Diprospan® for an adult?
The recommended dose may include:
- For systemic therapy, treatment is initiated with 1-2 ml in most conditions and repeated as necessary. Administration is by deep IM injection in the gluteal region.
- 2 ml might be required initially in severe illness e.g., lupus erythematosus or status asthmaticus which has been resolved by appropriate life-saving procedures.
- A wide variety of dermatologic conditions respond effectively to an IM injection of 1 ml, repeated according to the response of the condition.
- In respiratory tract disorders, onset of relief from symptoms has occurred within a few hours after IM injection.
- Effective control of symptoms with 1-2 ml is obtained in bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis.
- In the treatment of acute or chronic bursitis, excellent results are obtained with 1-2 ml IM injection, repeated as necessary.
- An intra-articular injection of Diprospan® is well tolerated in the joint and periarticular tissues. Recommended doses are:
- Large joints (knee, hip, shoulder), 1-2 ml
- Medium joints (elbow, wrist, ankle), 0.5-1 ml
- Small joints (foot, hand, chest), 0.25-0.5 ml
Diprospan® may be used effectively in disorders of the foot that are responsive to corticosteroid therapy. Bursitis under heloma durum may be controlled with 2 successive injections of 0.25 mL each.
In some conditions e.g., hallux rigidus, digiti quinti varus and acute gouty arthritis, onset of relief may be rapid. A tuberculin syringe with a 25-gauge needle is suitable for most injections. Recommended doses at intervals of approximately 1 week:
- Bursitis under heloma durum or molle, 0.25-0.5 ml
- Bursitis under calcaneal spur, 0.5 ml
- Bursitis over hallux rigidus, 0.5 ml
- Bursitis over digiti quinti varus, 0.5 ml
- Synovial cyst, 0.25-0.5 ml
- Morton’s neuralgia (metatarsalgia), 0.25-0.5 ml
- Tenosynovitis, 0.5 ml
- Periostitis of cuboid, 0.5 ml
- Acute gouty arthritis, 0.5-1 ml
After a favorable response is obtained, the proper maintenance dosage should be determined by decreasing the initial dose in small decrements at appropriate time intervals until the lowest dose which will maintain an adequate clinical response is determined.
Exposure of the patient to stressful situations unrelated to the existing disease may necessitate an increased dose of Diprospan®. If the drug is to be discontinued after long-term therapy, the dose should be decreased gradually.
What is the dose of Diprospan® for a child?
The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.
How is Diprospan® available?
Diprospan® is available in the following dosage forms and strengths:
- Diprospan® injection, 1 ml ampule and 2 ml ampule
What should I do in case of an emergency or overdose?
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.
What should I do if I miss a dose?
If you miss a dose of Diprospan®, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.
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