Diprospan - instructions for use, analogs, reviews and release forms (suspension or solution in injection injections in ampoules (including for intra-articular administration)) of the drug for the treatment of inflammation in adults, children and in pregnancy

In this article, you can read the instructions for using the drug Diprospan. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Diprospan in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Diprospan in the presence of existing structural analogs.Use for the treatment of inflammatory diseases in adults, children, as well as during pregnancy and lactation.

Diprospan - Glucocorticosteroid (GCS) drug, has a high glucocorticoid and minor mineralocorticoid activity. The drug has anti-inflammatory, antiallergic and immunosuppressive effect, and also has a pronounced and diverse effect on various types of metabolism.

Pharmacokinetics

Betamethasone sodium phosphate (the active substance of the drug Diprospan) is readily soluble in water and after a / m injection rapidly undergoes hydrolysis and is almost immediately absorbed from the injection site, which provides a rapid onset of therapeutic action. Virtually completely eliminated within one day after administration. It is excreted mainly by the kidneys.

Indications

Treatment in adult conditions and diseases in which GCS therapy allows to achieve the necessary clinical effect (it must be taken into account that in some diseases SCS therapy is complementary and does not replace standard therapy):

• diseases of the musculoskeletal system and soft tissues, incl. Rheumatoid arthritis, osteoarthrosis, bursitis, ankylosing spondylitis, epicondylitis, cocciogeny, torticollis, ganglionic cyst, fasciitis;
• allergic diseases, incl. bronchial asthma, hay fever (hay fever), allergic bronchitis, seasonal or all-the-year-round rhinitis, drug allergy, serum sickness, reactions to insect bites;
• dermatological diseases, including atopic dermatitis, coin-like eczema, neurodermatitis, contact dermatitis, severe photodermatitis, urticaria, lichen planus, alopecia areata, discoid lupus erythematosus, psoriasis, keloid scars, pemphigus vulgaris, cystic acne;
• systemic connective tissue diseases, including systemic lupus erythematosus, scleroderma, dermatomyositis, nodular periarteritis;
• hemoblastoses (palliative therapy of leukemia and lymphomas in adults, acute leukemia in children);
• primary or secondary insufficiency of the adrenal cortex (with simultaneous simultaneous application of mineralocorticoids);
• other diseases and pathological conditions requiring systemic GCS therapy (adrenogenital syndrome, regional ileitis,pathological changes in blood, if necessary, the use of GCS).

Forms of release

Suspension for injection (including for the introduction of the inside of the joint).

Solution for injections (injections in ampoules).

Instructions for use and how to use them

Intramuscular, intraarticular, periarticular, intra-abdominal, intradermal, interstitial and intraluminal injections. The small dimensions of the crystals of Betamethasone dipropionate allow the use of needles of small diameter (up to 26 calibers) for intradermal administration and administration directly to the lesion site.

The drug is administered with a disposable syringe using needles (0.5x25 mm and 0.8x50 mm) included in the kit.

DO NOT INSERT INSIDE! DO NOT INSERT!

Strict compliance with the rules of asepsis is mandatory when applying Diprospan. Shake the syringe before use.

The dosage regimen and the mode of administration are set individually, depending on the indications, the severity of the disease and the patient's response.

With systemic therapy, the initial dose of Diprospan is in most cases 1-2 ml. The introduction is repeated as necessary, depending on the patient's condition.

Intramuscular injection of SCS should be carried out deep in the muscle, while choosing large muscles and avoiding entering other tissues (to prevent tissue atrophy).

The drug is administered intramuscularly:

• in severe conditions requiring emergency measures; the initial dose is 2 ml;
• with various dermatological diseases; as a rule, it is sufficient to administer 1 ml of a suspension of Diprospan;
• with diseases of the respiratory system. The onset of the drug occurs within a few hours after an intravenous injection of the suspension. With bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis, a significant improvement is achieved after the introduction of 1-2 ml of Diprospan;
• with acute and chronic bursitis, the initial dose for the IM is 1-2 ml of the suspension. If necessary, several repeated injections are carried out.

If a satisfactory clinical response does not occur after a certain period of time, Diprospan should be withdrawn and another therapy prescribed.

With local administration, simultaneous application of a local anesthetic is necessary only in rare cases.If desired, 1% or 2% solutions of procaine hydrochloride or Lidocaine without methyl paraben, propylparaben, phenol and other similar substances are used. In this case, the mixing is carried out in a syringe, first by typing in the syringe from the vial the required dose of a suspension of Diprospan. Then the required amount of local anesthetic is taken from the ampoule into the same syringe and shaken for a short period of time.

In the case of acute bursitis (sub-deltoid, subscapular, elbow and prenadalovenous), the introduction of 1-2 ml of the suspension into the synovial bag alleviates the pain and restores the mobility of the joint for several hours. After relieving the exacerbation of chronic bursitis, smaller doses of the drug are used.

In acute tenosynovitis, tendinitis and peritendinitis, one injection of Diprospan improves the patient's condition; when chronic - the injection is repeated depending on the patient's reaction. It is necessary to avoid the introduction of the drug directly into the tendon.

Intra-articular administration of Diprospan in a dose of 0.5-2 ml relieves pain, limiting the mobility of joints in rheumatoid arthritis and osteoarthritis within 2-4 hours after administration.The duration of the therapeutic effect varies considerably and can be 4 or more weeks. The recommended dose of the drug when injected into large joints is 1 to 2 ml; in the middle - 0.5-1 ml; in small - 0.25-0.5 ml.

Recommended single doses of the drug (with the interval between administrations 1 week) for bursitis: with 0.25-0.5 ml of homozygliness (as a rule, 2 injections are effective), with spurs - 0.5 ml, with restriction of mobility of the big toe - 0.5 ml, with synovial cyst - 0.25-0.5 ml, with tenosynovitis - 0.5 ml, with acute gouty arthritis - 0.5-1.0 ml. For most injections, a tuberculin syringe with a 25 gauge needle is suitable. After reaching the therapeutic effect, the maintenance dose is selected by gradually reducing the dose of betamethasone administered at appropriate intervals. The reduction is continued until the minimum effective dose is reached.

If there is a threat of a stressful situation (not related to the disease), it may be necessary to increase the dose of Diprospan. The cancellation of the drug after prolonged therapy is carried out by a gradual dose reduction.

Monitoring of the patient's condition is carried out, at least,during the year after the end of long-term therapy or use in high doses.

Side effect

• fluid retention in tissues;
• chronic heart failure (in predisposed patients);
• increased blood pressure;
• muscle weakness;
• loss of muscle mass;
• osteoporosis;
• compression fracture of the spine;
• aseptic necrosis of the head of the femoral or humerus;
• pathological fractures of tubular bones;
• ruptures of tendons;
• erosive and ulcerative lesions of the gastrointestinal tract with possible subsequent perforation and bleeding;
• flatulence;
• impaired wound healing;
• atrophy and thinning of the skin;
• petechiae, ecchymosis;
• increased sweating;
• steroid acne;
• stria;
• propensity to develop pyoderma and candidiasis;
• convulsions;
• increased intracranial pressure with edema of the optic disc (more often at the end of therapy);
• dizziness;
• headache;
• euphoria;
• mood changes;
• depression (with severe psychotic reactions);
• increased irritability;
• insomnia;
• violation of the menstrual cycle;
• secondary adrenal insufficiency (especially during the period of stress in case of illness, trauma, surgical intervention);
• the Itenko-Cushing syndrome;
• decrease in carbohydrate tolerance;
• violation of intrauterine development;
• delay in growth and sexual development in children;
• increased intraocular pressure;
• glaucoma;
• weight gain;
• anaphylactic reactions;
• shock;
• angioedema;
• lowering blood pressure;
• flow of blood to the face after injection (or intra-articular injection).

Contraindications

• hypersensitivity to betamethasone or other components of the drug, or other SCS;
• systemic fungal infections;
• intravenous or subcutaneous administration;
• with intra-articular injection: unstable joint, infectious arthritis;
• introduction into infected cavities and into the intervertebral space;
• children's age up to 3 years (presence in the composition of benzyl alcohol);
• violations of coagulation (including treatment with anticoagulants).

Application in pregnancy and lactation

Due to the lack of controlled studies of the safety of the use of Diprospan during pregnancy, the use of the drug in pregnant women or in women of childbearing age requires a preliminary assessment of the intended benefit and potential risk to the mother and fetus.Newborns, whose mothers received therapeutic doses of GCS during pregnancy, should be under medical supervision (for early detection of signs of adrenal insufficiency).

If it is necessary to appoint Diprospan during lactation, the issue of stopping breastfeeding should be addressed, taking into account the importance of therapy for the mother (due to possible side effects in children).

special instructions

The dosage regimen and the mode of administration are set individually, depending on the indications, the severity of the disease and the patient's response.

The dose should be as small as possible, and the period of application as short as possible. The initial dose is selected until the necessary therapeutic effect is achieved. If after a sufficient period of time the therapeutic effect is not observed, the drug is canceled by gradually reducing the dose of Diprospan and selecting another appropriate method of treatment.

After reaching the therapeutic effect, the maintenance dose is selected by gradually reducing the dose of betamethasone administered at appropriate intervals. The reduction is continued until the minimum effective dose is reached.

If there is a threat of a stressful situation (not related to the disease), it may be necessary to increase the dose of Diprospan. The cancellation of the drug after prolonged therapy is carried out by a gradual dose reduction.

The patient's condition is monitored for at least a year after the end of long-term therapy or at high doses.

The introduction of the drug into soft tissues, into the lesion and inside the joint can, with pronounced local action, simultaneously lead to systemic action. Given the likelihood of developing anaphylactoid reactions with parenteral administration of GCS, the necessary precautions should be taken before administering the drug, especially if the patient has anamnestic indications of allergic reactions to medicines.

Diprospan contains two active substances - betamethasone derivatives, one of which - betamethasone sodium phosphate - quickly penetrates into the systemic bloodstream. When the appointment of Diprospan should take into account the possible systemic action of the rapidly dissolving fraction of the drug.

Against the background of the use of Diprospan, mental disorders are possible (especially in patients with emotional instability or susceptibility to psychosis).

When appointing Diprospan, patients with diabetes mellitus may need to correct hypoglycemic therapy.

Patients receiving glucocorticosteroids should not be vaccinated against smallpox. Other immunizations should not be performed in patients receiving SCS (especially at high doses), because of the possibility of developing neurological complications and low response immune response (absence of antibody formation). However, immunization is possible with replacement therapy (for example, with primary adrenal insufficiency).

Patients receiving Diprospan in doses suppressing immunity should be warned about the need to avoid contact with patients with chicken pox and measles (especially important when prescribing the drug to children).

When using Diprospan, it should be borne in mind that SCS can mask the signs of an infectious disease, as well as reduce the body's resistance to infections. The appointment of Diprospan with active tuberculosis is possible only in cases of fulminant or disseminated tuberculosis in combination with adequate antituberculous therapy.When appointing Diprospan, patients with latent tuberculosis or with a positive reaction to tuberculin should decide on the issue of preventive antituberculous therapy. In the preventive use of rifampin, acceleration of hepatic clearance of betamethasone should be considered (dose adjustment may be required).

In the presence of fluid in the joint cavity, the septic process should be excluded. A marked increase in soreness, swelling, an increase in the temperature of surrounding tissues, and a further limitation of joint mobility are indicative of infectious arthritis. When confirming the diagnosis, antibacterial therapy should be prescribed.

Repeated injections into the joint with osteoarthritis may increase the risk of joint destruction. The introduction of SCS into the tendon tissue gradually leads to rupture of the tendon. After successful intra-articular therapy, the patient should avoid overloading the joint.

Prolonged use of GCS can lead to posterior subcapsular cataract (especially in children), glaucoma with possible damage to the optic nerve and may contribute to the development of secondary eye infection (fungal or viral).It is necessary to conduct an ophthalmological examination periodically, especially in patients receiving Diprospan for more than 6 months.

With increasing blood pressure, fluid retention and sodium chloride in tissues and increasing the excretion of potassium from the body (less likely than using other GCS), patients are recommended a diet with restriction of table salt and additionally prescribed potassium-containing drugs. All GCSs increase the excretion of calcium.

With the simultaneous use of Diprospans and cardiac glycosides or preparations that affect the electrolyte composition of the plasma, control of the water-electrolyte balance is required.

Caution is prescribed Acetylsalicylic acid in combination with diprospan in hypoprothrombinemia.

The development of secondary adrenocortical insufficiency due to too rapid cancellation of SCS is possible within a few months after the end of therapy. In case of occurrence or threat of occurrence of a stressful situation during this period, therapy with Diprospan should be resumed and at the same time a mineralocorticoid drug should be prescribed (due to a possible violation of the secretion of mineralocorticoids). The gradual elimination of GCS can reduce the risk of developing secondary adrenal insufficiency.

Against the background of the use of GCS, a change in the mobility and the number of spermatozoa is possible. With prolonged therapy with GCS, it is advisable to consider the possibility of switching from parenteral to oral GCS, taking into account the evaluation of the "benefit / risk" ratio.

Pediatric Use

Children who are being treated with Diprospan (especially long-term therapy) should be carefully monitored for possible lag in the growth and development of secondary adrenal insufficiency.

Drug Interactions

With the simultaneous administration of phenobarbital, rifampin, phenytoin or ephedrine, it is possible to accelerate the metabolism of the drug with a decrease in its therapeutic activity.

With the simultaneous use of GCS and estrogens, dosage adjustment may be required (because of the risk of overdose).

With the combined use of diprospan and potassium-releasing diuretics, the likelihood of developing hypokalemia increases.

Simultaneous use of GCS and cardiac glycosides increases the risk of arrhythmia or digitalis intoxication (due to hypokalemia). Diprospan may increase the excretion of potassium caused by amphotericin B.With the combined use of Diprospan and indirect anticoagulants, changes in blood coagulation that require dose adjustment are possible.

When combined use of GCS with non-steroidal anti-inflammatory drugs or with ethanol and ethanol-containing drugs, an increase in the incidence or intensity of erosive-ulcerative gastrointestinal lesions is possible.

When combined, GCS can reduce the concentration of salicylates in the blood plasma.

Simultaneous administration of GCS and somatotropin can lead to a slower absorption of the latter (avoiding the administration of beta-metazone doses exceeding 0.3-0.45 mg / m2 body surface per day).

Analogues of the drug Diprospan

Structural analogs for the active substance:

• Acriderm;
• Beloderm;
• Betazon;
• Betamethasone;
• Betamethasone valerate;
• Betamethasone dipropionate;
• Betliben;
• Betnoveit;
• Kuterid;
• Flosteron;
• Celestoderm-B;
• Celeston.

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