betamethasone + neomycin

Action and Spectrum

Actions and Spectrum: 

betamethasone is a synthetic corticosteroid. Its primary mechanism of action is anti-inflammatory and immunosuppressive. When applied topically, it is absorbed through the skin and works by binding to glucocorticoid receptors in skin cells. This binding modulates gene expression, leading to the suppression of the inflammatory response. It reduces redness, itching, and swelling associated with various skin conditions. 

neomycin is an antibiotic that belongs to the aminoglycoside class. Its mechanism of action is to inhibit bacterial protein synthesis. neomycin binds to the bacterial ribosome, disrupting the production of essential proteins needed for bacterial growth and replication. This antibacterial action helps prevent or treat bacterial infections in the skin. 

betamethasone’s activity is limited to its anti-inflammatory and immunosuppressive effects. It does not have direct antibacterial or antifungal properties. neomycin primarily targets gram-negative bacteria, including strains such as Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. It is less effective against gram-positive bacteria and does not have antifungal or antiviral properties. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Nephrotoxicity 

Sneezing 

Rebound congestion 

Local skin burning 

Allergic contact dermatitis 

Ototoxicity 

Visual disturbance 

Epistaxis 

Nasal irritation and dryness 

Pruritus 

Hypertrichosis 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Hypersensitivity or Allergy: Patients with a known hypersensitivity or allergy to betamethasone, neomycin, or any other ingredients in the medication should not use it. Allergic reactions can range from mild skin irritation to severe allergic dermatitis. 
• Fungal or Viral Skin Infections: This combination medication is inappropriate for treating fungal or viral skin infections (such as herpes or chickenpox). It can exacerbate some viral infections and should be avoided in such cases. 
• Perioral Dermatitis: betamethasone can exacerbate perioral dermatitis, a skin condition characterized by redness and bumps around the mouth and nose. The use of topical corticosteroids like betamethasone in these cases is generally contraindicated. 
• Tuberculosis of the Skin: If a patient has skin tuberculosis, corticosteroids like betamethasone can worsen the condition. It is essential to rule out tuberculosis before using this medication. 
• Acne Vulgaris: Topical corticosteroids like betamethasone can worsen acne, so it is typically contraindicated in cases of acne vulgaris. 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

betamethasone is a synthetic corticosteroid with potent anti-inflammatory and immunosuppressive properties. It works by binding to glucocorticoid receptors in skin cells, modulating gene expression, and ultimately suppressing the inflammatory response. This reduces redness, itching, and swelling associated with skin conditions. 

neomycin is an antibiotic from the aminoglycoside class. Its mechanism of action involves inhibiting bacterial protein synthesis. neomycin binds to the bacterial ribosome, disrupting the production of essential proteins in bacteria, leading to cell death. 

Pharmacodynamics:  

Combining betamethasone and neomycin in a topical medication provides a synergistic effect. betamethasone reduces inflammation and relieves symptoms, while neomycin helps prevent or treat bacterial infections that may be present or may develop due to the underlying skin condition. 

Pharmacokinetics: 

Absorption 

betamethasone can be absorbed through normal intact skin, meaning it can enter the bloodstream to some extent when applied topically. 

neomycin is more readily absorbed from wounds and inflamed skin than intact skin. In areas with compromised skin barriers, such as wounds or inflammation, neomycin absorption is enhanced. 

Distribution 

When applied topically, betamethasone can cross the placenta, meaning it has the potential to enter the fetal circulation if used during pregnancy. However, the systemic absorption of topically applied betamethasone is generally minimal when used appropriately. neomycin is distributed to various tissues and is known to concentrate in the renal cortex, the kidney’s outer part. 

Metabolism 

The liver primarily metabolizes betamethasone. Metabolism is essential in breaking down the drug for elimination from the body. 

Elimination and Excretion 

Both betamethasone and neomycin are excreted from the body via the kidneys. The half-life of neomycin is relatively short, typically around 2-3 hours. 

Adminstartion

Administration: 

Topical administration 

The administration of a combined betamethasone and neomycin medication is typically in the form of topical cream or ointment. Apply a thin, even layer of the combined betamethasone and neomycin cream or ointment to the affected skin. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: betamethasone + neomycin 

Why do we use betamethasone + neomycin? 

The combined medication of betamethasone and neomycin is typically used topically to treat various skin conditions. Here are some common uses: 

• Dermatitis: This combination medication can be used to treat various forms of dermatitis, including atopic dermatitis (eczema), contact dermatitis (from irritants or allergens), and seborrheic dermatitis. It helps reduce inflammation, itching, and redness associated with these conditions. 
• Psoriasis: betamethasone and neomycin can be applied to psoriatic plaques to help manage the symptoms of psoriasis, including reducing inflammation and scaling. 
• Allergic Reactions: It can alleviate itching and redness associated with allergic skin reactions, such as hives (urticaria) or allergic contact dermatitis. 
• Insect Bites: The combination can relieve itching and inflammation caused by insect bites or stings. 
• Skin Irritations: betamethasone and neomycin are sometimes prescribed for various irritations, including mild rashes and redness. 
• Eczema with Secondary Infections: In cases of eczema (atopic dermatitis) with secondary bacterial infections, this combination can address both the inflammation and the bacterial infection.