Betnovate Rd Cream
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Betnovate RD Cream.
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Betamethasone Valerate B.P. Equivalent to Betamethasone 0.025%.
Excipients with known effect:
Chlorocresol Cetostearyl alcohol
For the full list of excipients, see section 6.1
3. PHARMACEUTICAL FORM
Cream.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Betamethasone valerate ready diluted (Betnovate RD) preparations are indicated for maintenance treatment once an acute episode has been treated effectively with a continuous course of betamethasone valerate (Betnovate).
Betamethasone valerate is a potent topical corticosteroid indicated for adults, elderly and children over 1 year for the relief of the inflammatory and pruritic manifestations of steroid responsive dermatoses. These include the following: Atopic dermatitis (including infantile atopic dermatitis)
Nummular dermatitis (discoid eczema)
Prurigo nodularis
Psoriasis (excluding widespread plaque psoriasis)
Lichen simplex chronicus (neurodermatitis) and lichen planus
Seborrhoeic dermatitis
Irritant or allergic contact dermatitis
Discoid lupus erythematosus
Adjunct to systemic steroid therapy in generalised erythroderma
Insect bite reactions
4.2 Posology and method of administration
Route of administration: Cutaneous
Creams are especially appropriate for moist or weeping surfaces.
Once an acute episode has been treated effectively with a continuous course of betamethasone valerate, improvement may be maintained with a small amount of ready diluted betamethasone valerate applied once or twice a day.
This regimen should be combined with routine daily use of emollients. The condition and the benefits and risks of continued treatment must be reevaluated on a regular basis.
Paediatric population
Betamethasone valerate is contraindicated in children under one year of age. Children are more likely to develop local and systemic side effects of topical corticosteroids and, in general, require shorter courses and less potent agents than adults; therefore, courses should be limited to five days and occlusion should not be used.
Care should be taken when using betamethasone valerate to ensure the amount applied is the minimum that provides therapeutic benefit.
Elderly
Clinical studies have not identified differences in responses between the elderly and younger patients. The greater frequency of decreased hepatic or renal function in the elderly may delay elimination if systemic absorption occurs. Therefore the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit.
Renal / Hepatic Impairment
In case of systemic absorption (when application is over a large surface area for a prolonged period) metabolism and elimination may be delayed therefore increasing the risk of systemic toxicity. Therefore the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit.
4.3 Contraindications
Hypersensitivity to the active substance or any of the excipients listed in section 6.1.
The following conditions should not be treated with betamethasone valerate:
• Untreated cutaneous infections
o Rosacea
Acne vulgaris o Pruritus without inflammation o Perianal and genital pruritus o Perioral dermatitis
o
Betamethasone valerate is contraindicated in dermatoses in infants under one year of age, including dermatitis.
4.4 Special warnings and precautions for use
Betamethasone valerate should be used with caution in patients with a history of local hypersensitivity to other corticosteroids. Local hypersensitivity reactions (see section 4.8) may resemble symptoms of the condition under treatment.
Manifestations of hypercortisolism (Cushing’s syndrome) and reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, leading to glucocorticosteroid insufficiency, can occur in some individuals as a result of increased systemic absorption of topical steroids. If either of the above are observed, withdraw the drug gradually by reducing the frequency of application, or by substituting a less potent corticosteroid. Abrupt withdrawal of treatment may result in glucocorticosteroid insufficiency (see section 4.8).
Betnovate contains chlorocresol which may cause allergic reactions and cetostearyl alcohol which may cause local skin reactions (e.g. contact dermatitis).
Risk factors for increased systemic effects are:
o Potency and formulation of topical steroid
o Duration of exposure
o Application to a large surface area
o Use on occluded areas of skin e.g. on intertriginous areas or under occlusive dressings (in infants the nappy may act as an occlusive dressing)
o Increasing hydration of the stratum corneum o Use on thin skin areas such as the face
o Use on broken skin or other conditions where the skin barrier may be impaired
o In comparison with adults, children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic adverse effects. This is because children have an immature skin barrier and a greater surface area to body weight ratio compared with adults.
Paediatric population
In infants and children under 12 years of age, treatment courses should be limited to five days and occlusion should not be used; long-term continuous topical corticosteroid therapy should be avoided where possible, as adrenal suppression can occur.
Infection risk with occlusion
Bacterial infection is encouraged by the warm, moist conditions within skin folds or caused by occlusive dressings. When using occlusive dressings, the skin should be cleansed before a fresh dressing is applied.
Use in Psoriasis
Topical corticosteroids should be used with caution in psoriasis as rebound relapses, development of tolerances, risk of generalised pustular psoriasis and development of local or systemic toxicity due to impaired barrier function of the skin have been reported in some cases. If used in psoriasis careful patient supervision is important.
Application to the face
Prolonged application to the face is undesirable as this area is more susceptible to atrophic changes; therefore, treatment courses should be limited to five days and occlusion should not be used.
Application to the eyelids
If applied to the eyelids, care is needed to ensure that the preparation does not enter the eye, as cataract and glaucoma might result from repeated exposure.
Concomitant infection
Appropriate antimicrobial therapy should be used whenever treating inflammatory lesions which have become infected. Any spread of infection requires withdrawal of topical corticosteroid therapy and administration of appropriate antimicrobial therapy.
Chronic leg ulcers
Topical corticosteroids are sometimes used to treat the dermatitis around chronic leg ulcers. However, this use may be associated with a higher occurrence of local hypersensitivity reactions and an increased risk of local infection.
4.5. Interactions with other Medicaments and other forms of Interaction
Co-administered drugs that can inhibit CYP3A4 (e.g. ritonavir, itraconazole) have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure. The extent to which this interaction is clinically relevant depends on the dose and route of administration of the corticosteroids and the potency of the CYP3A4 inhibitor.
4.6 Fertility, pregnancy and lactation
Fertility
There are no data in humans to evaluate the effect of topical corticosteroids on fertility.
Pregnancy
There are limited data from the use of betamethasone valerate in pregnant women.
Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. (see section 5.3).
The relevance of this finding to humans has not been established; however, administration of betamethasone valerate during pregnancy should only be considered if the expected benefit to the mother outweighs the risk to the foetus. The minimum quantity should be used for the minimum duration.
Lactation
The safe use of topical corticosteroids during lactation has not been established.
It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable amounts in breast milk. Administration of betamethasone valerate during lactation should only be considered if the expected benefit to the mother outweighs the risk to the infant.
If used during lactation betamethasone valerate should not be applied to the breasts to avoid accidental ingestion by the infant.
4.7 Effects on ability to drive and use machines
There have been no studies to investigate the effect of betamethasone valerate on driving performance or the ability to operate machinery. A detrimental effect on such activities would not be anticipated from the adverse reaction profile of topical betamethasone valerate.
4.8 Undesirable effects
Adverse drug reactions (ADRs) are listed below by MedDRA system organ class and by frequency. Frequencies are defined as: very common (>1/10), common (>1/100 and <1/10), uncommon (>1/1,000 and <1/100), rare (>1/10,000 and <1/1,000) and very rare (<1/10,000), including isolated reports.
Post-marketing data Infections and Infestations
Very rare Opportunistic infection
Immune System Disorders
Very rare Hypersensitivity, generalised rash
Hypothalamic-pituitary adrenal (HPA) axis suppression Cushingoid features (e.g. moon face, central obesity), delayed weight gain/growth retardation in children, osteoporosis, glaucoma, hyperglycaemia/glucosuria, cataract, hypertension, increased weight/obesity, decreased endogenous cortisol levels, alopecia, trichorrhexis
Endocrine Disorders
Very rare
Skin and Subcutaneous Tissue Disorders
Common Pruritus, local skin burning /skin pain
Very rare Allergic contact dermatitis /dermatitis,
erythema, rash, urticaria, pustular psoriasis, skin thinning* / skin atrophy*, skin wrinkling*, skin dryness*, striae*, telangiectasias*, pigmentation changes*,hypertrichosis, exacerbation of underlying symptoms
General Disorders and Administration Site Conditions
Very rare Application site irritation/pain
*Skin features secondary to local and/or systemic effects of hypothalamic-
pituitary adrenal (HPA) axis suppression.
Reporting of suspected reactions:
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
4.9. Overdose
Symptoms and signs
Topically applied betamethasone valerate may be absorbed in sufficient amounts to produce systemic effects. Acute overdosage is very unlikely to occur, however, in the case of chronic overdosage or misuse the features of hypercortisolism may occur (see section 4.8).
Treatment
In the event of overdose, betamethasone valerate should be withdrawn gradually by reducing the frequency of application, or by substituting a less potent corticosteroid because of the risk of glucocorticosteroid insufficiency. Further management should be as clinically indicated or as recommended by the national poisons centre, where available.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties ATC code
D07AC Corticosteroids, potent (group III)
Mechanism of action
Topical corticosteroids act as anti-inflammatory agents via multiple mechanisms to inhibit late phase allergic reactions including decreasing the density of mast cells, decreasing chemotaxis and activation of eosinophils, decreasing cytokine production by lymphocytes, monocytes, mast cells and eosinophils, and inhibiting the metabolism of arachidonic acid.
Pharmacodynamic effects
Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties.
5.2 Pharmacokinetic properties Absorption
Topical corticosteroids can be systemically absorbed from intact healthy skin. The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including the vehicle and the integrity of the epidermal barrier. Occlusion, inflammation and/or other disease processes in the skin may also increase percutaneous absorption.
The use ofpharmacodynamic endpoints for assessing the systemic exposure of topical corticosteroids is necessary because circulating levels are well below the level of detection.
Metabolism
Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. They are metabolised, primarily in the liver.
Elimination
Topical corticosteroids are excreted by the kidneys. In addition, some corticosteroids and their metabolites are also excreted in the bile.
5.3 Preclinical safety data
Reproductive toxicity
Subcutaneous administration of betamethasone valerate to mice or rats at doses >0.1 mg/kg/day or rabbits at doses >12 micrograms/kg/day during pregnancy produced foetal abnormalities including cleft palate and intrauterine growth retardation.
The effect on fertility of betamethasone valerate has not been evaluated in animals.
6. PHARMACEUTICAL PARTICULARS
6.1. List of excipients
Cetostearyl Alcohol B.P.
Cetomacrogol 1000 B.P.
White Soft Paraffin B.P.
Liquid Paraffin B.P.
Chlorocresol B.P.
Disodium Hydrogen Phosphate, Anhydrous Citric Acid Monohydrate B.P.
Purified Water B.P.
6.2. Incompatibilities
None known.
6.3. Shelf-life
36 months.
6.4. Special precautions for storage
Store below 25°C.
6.5. Nature and contents of container
100gm lacquered aluminium tubes with polypropylene screw caps.
6.6 Special precautions for disposal
No special requirements.
7. MARKETING AUTHORISATION HOLDER
Glaxo Wellcome UK Ltd trading as GlaxoSmithKline UK Stockley Park West,
Uxbridge,
Middlesex UB11 1BT.
8. MARKETING AUTHORISATION NUMBER(S)
PL 10949/0021
9. DATE OF FIRST AUTHORISATION / RENEWAL OF THE AUTHORISATION
1 April 1993
10 DATE OF REVISION OF THE TEXT
19/09/2013