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"Diprospan" is a drug belonging to the group of glucocorticoids. It has anti-inflammatory, anti-allergic, immunosuppressive, anti-shock and desensitizing effects. The active component of the product is betamethasone.

How to use Diprospan

"Diprospan" is prescribed for diseases of the musculoskeletal system and soft tissues: osteoarthritis, bursitis, epicondylitis, rheumatoid arthritis, radiculitis, lumbago, fasciitis, foot diseases. It is also used for allergic diseases: rhinitis, bronchitis, hay fever, asthma, serum sickness, drug allergies, reactions to insect bites. The drug is used for dermatological diseases: neurodermatitis, coin-shaped eczema, atopic dermatitis, contact dermatitis, lichen planus, urticaria, severe photodermatitis, pemphigus, psoriasisherpetic dermatitis. The drug is also prescribed for systemic connective tissue diseases and adrenal insufficiency.

"Diprospan" is produced in the form of a solution or suspension for injection. The drug is administered intramuscularly, intradermally, intraarticularly. Perarticular injections (around the joint) are also performed. The solution cannot be administered intravenously. Intramuscularly "Diprospan" is prescribed 1-2 ml 1 r. in 2-4 weeks. Intra-articular and periarticular injections are given in the following doses: into the metacarpophalangeal, interphalangeal, sternoclavicular joint - 0.25-5 ml, into the elbow, wrist - 0.5-1 ml, knee, shoulder ankle - 1 ml, hip joint - 1 -2 ml. When using the drug intradermally, the dose of 1 ml should not be exceeded, which should be administered 1 r. per week.

Side effects, contraindications to the use of "Diprospan"

A single use of Diprospan or a short course of treatment does not cause significant side effects. In case of long-term use, the drug can cause an increase in the process of excretion of calcium and potassium from the body, hypernatremia, fluid retention in tissues, weight gain, chronic heart failure, increased blood pressure, metabolic disorders in muscle tissue, osteoporosis, fractures of long bones, muscle weakness , tendon ruptures, aseptic necrosis of the head of the femur and humerus, pancreatitis, flatulence, erosive and ulcerative lesions of the gastrointestinal tract, impaired wound healing, dizziness, headache, insomnia, depression, steroid diabetes mellitus, menstrual irregularities, glaucoma, cataracts, allergic reactions.

"Diprospan" is contraindicated in case of systemic mycoses, hypersensitivity to the drug. Do not inject the drug into infected surfaces or into the intervertebral space. When treating infectious arthritis and unstable joints, the drug should not be administered intra-articularly. Diprospan is used with caution for cirrhosis, gastrointestinal ulcers, osteoporosis, renal failure, chicken pox, hypertension, diabetes, thrombophlebitis.

How often can Diprospan be injected?

Diprospan– anti-inflammatory, anti-allergenic, hormonal, anti-shock, immunosuppressive drug and its component betamethasone .

The drug is administered intramuscularly or intraarticularly.

For psoriasis (severe form) Diprospan you need to inject once a month, but each time the remission is shorter.

For allergies - once every 3 years, but this is only in the instructions for use, although many, after one injection, are not bothered by allergies and do not take the drug.

The dose should be gradually reduced; the drug should not be stopped abruptly.

You should not get carried away with this drug, because it is a very strong hormonal drug and has many side effects.

Diprospan is used for seasonal allergies, 1 injection per year. From 2 to 5 years, this drug perfectly removes allergies, but then frequent injections with the same drug causes addiction in the body and no longer becomes as effective as in the first years.

Diprospan is a very aggressive hormonal drug and its frequent use can greatly disrupt hormonal levels, which will be very difficult to restore.

For psoriasis (in acute and severe cases), Diprospan is injected no more than once every 2-4 weeks and no more than 3-4 injections. Next, you need to choose another drug for treatment.

For severe joint pain, Diprospan injections are given directly into the joint - 1 injection every 3 - 4 weeks and no more than 3 injections in total.

Diprospan in a dosage of 1 ml in one ampoule, one ampoule or five ampoules in one package. The main active ingredient is betamethasone. is excreted in approximately 11 days. A drug with a good therapeutic effect, but many attribute the occurrence of side effects precisely because the drug is a hormonal agent; Diprospan is a hormone. Only a qualified healthcare professional injects Diprospan with syringes with a long needle, a five-piece syringe intramuscularly, and injects the drug into the joints.

If injections are given into the same joint, then one injection is prescribed. The action lasts for 2 months. If the injection sites are different, then the break is from one to two weeks.

more than a year ago

Diprospan is an excellent remedy for allergies. I would like to note right away that the drug is hormonal, so abusing it will not lead to anything good. It is prescribed only in very acute periods, when allergies simply interfere with normal life. To relieve symptoms on long time One ampoule is enough. Conveniently, the drug is sold individually. It is not recommended to inject more than once a year. Only if there are serious indications for more frequent use.

Diprospan for osteochondrosis

Before the era of non-steroidal anti-inflammatory drugs, glucocorticosteroids were most often used for the treatment of osteochondrosis and other pathologies of the musculoskeletal system. In modern medicine, these drugs have also not lost their importance, but they are used much less frequently and only for certain indications, since they have a lot of side effects and have an impressive list of contraindications. However, in severe inflammatory processes combined with severe pain, which often occurs with osteochondrosis and other diseases of the spine and joints, the prescription of glucocorticosteroids is justified. One of the most popular remedies in this series is Diprospan.

Diprospan packaging option

The drug is a transparent, colorless suspension with a yellowish tint, a slightly viscous consistency, which contains easily suspended whitish particles. There are no foreign impurities in the liquid. Shaking leads to the formation of a stable suspension of yellowish or white color. The drug is available in the form of an injection solution.

Composition and pharmacological action

The active component of Diprospan is betamethasone. It is contained in the drug in two forms:

betamethasone disodium phosphate, which ensures rapid achievement of the effect;
betamethasone dipropionate, which prolongs the therapeutic effect.

The drug exhibits high glucocorticoid and low corticoid activity. The effect of Diprospan in osteochondrosis is due to its influence on different types metabolism and a pronounced anti-inflammatory effect: its active components suppress the production of substances leading to the development of the inflammatory process. The drug also has an immunosuppressive and antiallergic effect.

Pharmacokinetics

Ampoule with suspension

Betamethasone sodium phosphate has good solubility. Subject to hydrolysis in a short time. Thanks to the rapid absorption of Diprospan, a high rate of achievement of the therapeutic effect is ensured, which is very important during an acute attack of osteochondrosis, accompanied by severe pain. Betamethasone sodium phosphate is almost completely eliminated from the body within 24 hours after use.

Betamethasone dipropionate has slightly different qualities: the process of its absorption from the depot occurs slowly. The substance is metabolized gradually, resulting in a long-lasting effect. It takes more than 10 days to remove this component.

Metabolism occurs in the liver, excretion occurs through the kidneys.

Indications for use

When prescribing Diprospan for the treatment of osteochondrosis, other pathological conditions and diseases in which glucocorticoid therapy makes it possible to achieve the desired result, an important point must be taken into account: for many diseases, such therapy can only be used as an addition to standard treatment.

Diprospan is taken for soft tissue damage

Diseases of the musculoskeletal system for which Diprospan is prescribed include:

spinal osteochondrosis in localized or widespread form;
joint damage of a rheumatoid nature;
lesions of soft tissues and ligaments;
arthrosis;
arthritis;
Bekhterev's disease.

In addition, Diprospan is used in the treatment of the following diseases:

allergic;
dermatological;
systemic pathologies of connective tissue;
hemoblastoses;
adrenal insufficiency;
some other diseases and conditions that require treatment with systemic glucocorticosteroid drugs.

Contraindications

For osteochondrosis and any other diseases, there are certain restrictions on the use of Diprospan. In particular, the drug is not prescribed for:

systemic mycoses;
infectious arthritis and joint instability (in case of intra-articular injection);
hypersensitivity to the components of the drug or other glucocorticosteroids.

The use of Diprospan is prohibited in childhood. The drug is not administered subcutaneously or intravenously.

It is prescribed with caution in the presence of the following diseases and conditions:

If Diprospan is used for osteochondrosis or articular pathologies, its further use is considered inappropriate if the two previous administrations were not effective enough or produced a short-term effect. Do not inject the drug into the intervertebral space or infected surfaces.

Pregnancy

During pregnancy, the use of Diprospan for osteochondrosis is not recommended. If the medication is prescribed during lactation, breastfeeding must be stopped.

Use for osteochondrosis

When treating osteochondrosis, the choice of drug is often determined by the preferences of the doctor and his clinical experience. Often, when new tools appear, experts show conservatism. However, in the case of Diprospan, everything turned out quite successfully: the drug won the recognition of doctors in a short time. Their reviews are overwhelmingly positive and indicate the high effectiveness of the drug, which provides a powerful and long-lasting anti-inflammatory effect in a short time. In addition, the use of Diprospan reduces the likelihood of complications. These qualities of the drug are due to its unique microcrystalline structure.

The administration of Diprospan leads to blocking of the inflammatory process that occurs during osteochondrosis at the cellular biochemical level. The drug has an inhibitory effect on substances that provoke an inflammatory reaction.

It should be noted that in the treatment of osteochondrosis and other diseases of a degenerative-dystrophic nature, Diprospan cannot be considered a panacea. It only helps eliminate pain and inflammation.

Since long-term use of Diprospan can lead to the destruction of cartilage tissue, for osteochondrosis it is advisable to combine a corticosteroid with chondroprotectors. They protect cartilage from the aggressive effects of Diprospan and accelerate their regeneration.

Administration of the drug

The injection solution is administered intramuscularly, intradermally, peri- or intra-articularly (into the periarticular area or joint).

Intra-articular administration of the drug

For intramuscular injections, 1-2 ml of the drug is prescribed.
Periarticular administration: 0.2 ml per 1 sq. cm of the skin of the joint.
Intra-articular administration: maximum 2 ml per 1 injection once a week.

Before administration, the drug is slightly warmed up (to body temperature). Intramuscular administration of Diprospan is carried out in the outer upper quadrant of the buttock.

If a blockade with Diprospan is performed for osteochondrosis, it is diluted with lidocaine or novocaine - the choice depends on the individual tolerance of the particular patient. If pain occurs, preliminary local anesthesia is recommended.

Diprospan is a long-acting drug: the active components will remain in the body for about 10 days. Therefore, its use should be limited: the drug can be prescribed a maximum of once every 14-30 days.

Side effects

According to expert reviews, in some cases, the use of Diprospan for osteochondrosis can provoke the development of undesirable reactions. The main ones:

Setting up an injection of diprospan

Metabolic disorders: increased potassium secretion, increased amount of excreted calcium, hypernatremia, negative nitrogen balance, retention of excess fluid in the body, lipomatosis with possible neurological complications, weight gain.
Cardiovascular system: increased blood pressure, development of chronic heart failure.
Musculoskeletal system: steroid myopathy, muscle weakness, loss of muscle mass, increased severity of myasthenic symptoms in myasthenia gravis, osteoporosis, pathological fractures of long bones, joint instability, tendon ruptures, necrosis of the head of the humerus or femur, compression fracture of the spine.
Digestive system: hiccups, flatulence, pancreatitis, damage to the gastrointestinal tract of an erosive-ulcerative nature. Perforation and bleeding are possible.
Dermatological reactions: thinning and atrophy of the skin, impaired wound healing, ecchymoses, petechiae, dermatitis, stretch marks, acne, a tendency to develop candidiasis and pyoderma, worsening reaction to skin tests, increased sweating.
Central and peripheral nervous system: increased intracranial pressure (may be accompanied by papilledema), convulsions, dizziness, headaches, frequent mood changes, insomnia, irritability, tendency to depression, psychotic reactions, euphoria.
Endocrine system: secondary adrenal insufficiency, menstrual irregularities, development of steroid diabetes mellitus, Itsenko-Cushing syndrome, increased need for insulin, decreased carbohydrate tolerance, in children - delayed growth and puberty.
Vision: increased intraocular pressure, exophthalmos, glaucoma, cataracts, rarely - loss of vision.
Allergic reactions: anaphylactic shock, angioedema, arterial hypotension.
Local reactions: skin and subcutaneous atrophy, hyperpigmentation, hypopigmentation, aseptic abscesses.
Other reactions: flushing of the face after injection.

Content

To treat arthritis, muscle heaviness, and joint pain, doctors use Diprospan - the instructions for its use contain information that the medicine can be used in various fields of medicine. It eliminates inflammation of the tendons and is used in ophthalmology and for the treatment of skin diseases. The drug solution is intended for parenteral administration.

Diprospan injections

According to the generally accepted classification, the drug Diprospan belongs to glucocorticoid medications for parenteral administration. This is a unique drug containing substances of prolonged and rapid action. Injections with Diprospan suspension help to cope with pathologies faster, but in addition and in parallel provide a long-term therapeutic effect.

Compound

Diprospan is available only in the form of a solution; there are no other types of medicine. Its composition and description:

Pharmacological action

The medication is a glucocorticosteroid that inhibits the release of interleukins and interferons gamma from macrophages and lymphocytes. Due to this, the medicine has antiallergic, antishock, and anti-inflammatory effects. Diprospan has a desensitizing, antitoxic, and immunosuppressive effect. The mechanism of action is the release of beta-lipotropin by the pituitary gland without reducing the level of beta-endorphin.

The drug increases the excitability of the central nervous system, reduces the number of lymphocytes and eosinophils, increases the number of red blood cells, stimulating the production of erythropoietins. In the body, the active substances of the composition interact with receptors, forming a complex that can penetrate the cell nucleus and stimulate RNA synthesis. This acid is responsible for the production of the lipocortin protein, which inhibits the phospholipase enzyme and suppresses the synthesis of arachidonic acid (a precursor of inflammatory processes).

The active components of the composition take part in protein, carbohydrate, water-electrolyte and lipid metabolism. Betamethasone disodium phosphate dissolves easily, is quickly absorbed into tissues, and gives an immediate effect. Betamethasone dipropionate is absorbed more slowly. The combination of components helps to achieve a general or local effect quickly, but for a long time. The solution is administered intravenously, intramuscularly, intraarticularly, periarticularly, intradermally.

Indications for use

Doctors often prescribe Diprospan - the instructions for use of the drug include information about the following indications:

burn, cardiogenic, surgical, traumatic, toxic, blood transfusion, anaphylactic shock;
acute and severe forms of drug allergies, anaphylactoid reactions;
swelling of the brain due to a tumor or surgery, radiation therapy, head injury;
severe form of bronchial asthma, status asthmaticus;
systemic lupus erythematosus, rheumatoid arthritis;
acute adrenal insufficiency;
liver coma;
poisoning with cauterizing liquids.

For joints

Diprospan injection suspension, according to the instructions, is widely used in the treatment of joints:

inflammatory diseases of the musculoskeletal system (synovitis, tenosynovitis, bursitis);
pain syndromes due to arthrosis of the knee joint;
rheumatoid arthritis;
gout, pain due to psoriasis;
spinal osteochondrosis;
hygroma;
glenohumeral periarthritis;
pain in the spine, thoracic region, neck, after injuries;
spinal hernia.

Diprospan in ophthalmology

After eye surgery, Diprospan is used to relieve inflammation and pain. According to the instructions, it can also be used for the treatment of Graves' ophthalmopathy and chalazion. The latter disease is a benign formation on the eyelids, resulting from chronic proliferative inflammation of the meibomian gland. When used in ophthalmology, the drug is administered subconjunctivally.

For skin diseases

The medicine can also be used in the treatment of skin diseases, including allergic manifestations on the skin. Indications for use of the drug include:

contact dermatitis;
arthropathic psoriasis;
keloid scars;
lichen planus;
common pemphigus;
alopecia areata (baldness);
diffuse neurodermatitis and eczema.

How to inject Diprospan

Diprospan blockade is used for severe pain in the knee joint and for glenohumeral periarthritis. Other diseases require an individual approach. The method of application of the solution, dosage and course depend on the severity of the disease. This can be a slow intravenous jet or drip at a dose of 4-8 mg at a time, if necessary up to 20 mg, and a maintenance dose of 2-4 mg.

The solution is injected deeply intramuscularly. Children 1-5 years old are prescribed 2 mg, 6-12 years old - 4 mg. To prevent hyaline-membranous disease of newborns, the solution is administered intramuscularly in an amount of 8 mg over 48-72 hours, injections are continued every day. Doses are administered intra-articularly and periarticularly:

very large pelvic joints – 4-8 mg;
large knee, ankle, shoulder joints – 4 mg;
middle joints (elbows, wrists) – 2-4 mg;
small interphalangeal, sternoclavicular, metacarpophalangeal - 1-2 mg.

Intradermal or intrawound administration for the treatment of inflammatory skin diseases has a dose of 0.2 ml/cm2, but not more than 4 mg/week. As a local infiltration, 1-2 mg is administered for bursitis (up to 8 mg in the acute form), for tendonitis - 2 mg, for periarticular inflammation - 2-4 mg, the injection is repeated every 1-2 weeks. 2 mg of solution is injected subconjunctivally.

Most diseases with injections do not require the parallel use of local anesthetics; if necessary, the local anesthetic drug Lidocaine is allowed. First, Diprospan is drawn into the syringe, then the anesthetic Lidocaine. For periarticular blockades, the drug is injected directly at the tendon. Symptoms of heel spurs are eliminated after a single local injection of 0.5 ml; for alopecia areata, 1 ml is injected into the muscle once a week in a course of 3-5 injections. After swelling is detected during rhinoplasty, Diprospan injections are given into the nose.

How long does it take for it to start working?

According to the instructions, the medication begins to act 10 minutes after administration. This ability of the drug helps to provide first aid for anaphylactic shock. The action lasts up to 72 hours, after the injection is repeated. The average effect time of a medication lasts a day, sometimes less. The time depends on the characteristics of the patient’s body.

How often can Diprospan be injected?

The medication is administered into the same joint once every 2-3 months, but not more often. Doctors recommend using the drug in different joints at intervals of 1-2 weeks. After completion of glucocorticosteroid therapy, the dose is reduced gradually. Abrupt withdrawal of medication should not be allowed, as this can lead to unpleasant consequences.

Special instructions

When studying the instructions for use of the medication, it is useful to pay attention to the special instructions paragraph, which contains information:

Do not inject the drug into unstable joints;
blood monitoring is carried out before and after steroid therapy;
you cannot combine Diprospan injections with the use of anesthetics in one ampoule; the mixture is prepared in a syringe;
does not affect hormonal levels;
therapy of active tuberculosis, intercurrent infections and sepsis requires combination with antibiotic therapy;
children who are in contact with patients with measles and chickenpox receive specific immunoglobulins during the treatment period.

Diprospan during pregnancy

The instructions for use of Diprospan contain information that the drug can be used during pregnancy and breastfeeding, but after a careful balance of benefits and risks and if the expected effect for the mother exceeds the negative reactions for the fetus. To prevent certain diseases in newborns, intramuscular injections are administered 2-3 days before birth.

In childhood

Diprospan intramuscularly or intravenously for children can be used only for absolute indications and after a thorough examination by a doctor. According to the instructions, during therapy the child must be constantly monitored by a doctor, because during the period of growth, glucocorticosteroids can negatively affect the function of the pituitary gland and adrenal cortex, which leads to a slowdown in development.

Drug interactions

The combination of Diprospan with other drugs may not always be safe. How drugs affect each other is indicated in the instructions for use:

reduces the effectiveness of insulin, oral hypoglycemic drugs, indirect anticoagulants, weakens the effect of diuretics, vaccines with viruses;
Rifampin, barbiturates, Phenytoin weaken the effect of GCS, hormonal contraceptives increase it;
ethanol and non-steroidal anti-inflammatory drugs lead to erosions, bleeding and ulcers of the gastrointestinal tract;
estrogens and oral contraceptives increase the risk of developing hirsutism and acne;
diuretics lead to hypokalemia, digitalis cardiac glycosides lead to arrhythmia, Ritodrine can cause pulmonary edema in pregnant women.

Alcohol compatibility

According to the instructions, ethanol in combination with glucocorticosteroids can cause erosive and ulcerative lesions of the gastrointestinal tract and bleeding. In parallel, glucocorticoids increase tolerance to ethyl alcohol and reduce its toxic effect without changing the concentration in the blood. This effect makes it possible to use Diprospan to treat ethyl alcohol poisoning.

Side effects of Diprospan

When using Diprospan injections, various side effects appear, the frequency and severity of which depend on the dose and adherence to the circadian rhythm:

“steroid” diabetes mellitus;
suppression of adrenal function, Itsenko-Cushing syndrome;
increased blood pressure, stretch marks, myasthenia gravis;
nausea, pancreatitis, vomiting, esophagitis, gastrointestinal perforation;
flatulence, hiccups, decreased or increased appetite;
arrhythmia, bradycardia, cardiac arrest, heart failure, foci of thrombosis;
increased intracranial pressure, insomnia, convulsions;
increased potassium excretion, weakness;
osteoporosis, pathological bone fractures;
nephritis;
allergic reactions, exacerbation of infections;
burning, tissue numbness, pain at the injection site, glaucoma;
flushing of the face, nosebleeds.

Overdose

Symptoms of overdose include nausea, sleep disturbance, euphoria, agitation or depression. When using high doses, manifestations of systemic osteoporosis, fluid retention in the body, and increased blood pressure are possible. Treatment is gradual withdrawal of the drug, supporting the body by correcting the electrolyte balance, taking antacids, phenothiazines, and lithium preparations. According to the instructions, when Cushing's syndrome develops, aminoglutethimide is taken.

Contraindications

A contraindication for parenteral administration of the solution is hypersensitivity to the components of the composition. For intra-articular injections, the prohibitions on use are:

arthroplasty, pathological joint bleeding;
intra-articular infections, fractures;
history of periarticular infections;
periarticular osteoporosis, osteoarthritis without synovitis, bone destruction;
deformation, pathological joint mobility, ankylosis, narrowing of the joint space, aseptic necrosis of the forming epiphyses.

Terms of sale and storage

The drug is available by prescription and is stored in a dry place at a temperature of 2-25 degrees for three years.

Analogues

A direct analogue of the drug is the injection suspension Flosteron with the same active ingredients and effect. Indirect substitutes for the drug can be drugs with a similar therapeutic effect, but with different substances in the composition:

Diprospan price

You can buy Diprospan through online platforms or pharmacies at prices that depend on the level of trade margins and the number of ampoules in the package. Approximate cost for one ampoule of the drug in Moscow and St. Petersburg pharmacies will be:

Video

Lifestyle of many modern people inactive.

Sedentary work, long periods of time at the computer, lack of adequate physical activity, poor nutrition and other factors undermine the immune system and make the body susceptible to allergies, tuberculosis, hepatitis, skin and musculoskeletal diseases, as well as systemic and autoimmune pathologies.

Timely use of Diprospan allows a person to prevent the development of diseases due to the glucocorticoid activity of betamethasone.

Diprospan: composition and pharmacological properties

The medicine Diprospan is a suspension for injection. The release form is ampoule; there is also a packaging option in disposable syringes.

The active component of the drug is betamethasone. The ability of a substance to inhibit the release of interferon and interleukins (1,2) from lymphocytes and macrophages gives multiple effects:

Each ampoule of Diprospan contains 5 mg of active ingredient. Of the additional components, the medicine contains hydrochloric acid, benzyl alcohol, chloride, edetate and sodium phosphate, nipagin, sodium salt, Trilon B and other compounds.

The drug belongs to the group of steroid glucocorticosteroids. These are hormones produced by the human body in the adrenal cortex. The natural production of hormones is regulated by the central nervous system, and the pituitary gland controls this process.

Diprospan exhibits glucocorticosteroid properties by enhanced production of lipocortin and inhibition of the production of leukotrienes and prostaglandins. An excess of the latter provokes various pathological processes in the body.

As an anti-inflammatory agent, Diprospan stabilizes cell membranes, delays the flow of pro-inflammatory particles to the problem area, strengthens blood vessels and improves blood microcirculation.

The antiallergic property is expressed by the regulation of the production of allergy mediators and other cellular structures. This entails positive changes in the body's immune response.

The anti-shock effect is observed in an increase in blood pressure and dilation of blood vessels. This occurs due to the fact that the concentration of catecholamines in the systemic circulation increases.

The metabolic effect of Diprospan is manifested by acceleration of protein synthesis, stimulation of liver function, improvement of electrolyte metabolism and increase in blood glucose concentration.

Indications and contraindications

Diprospan injections have the following indications for use:

Allergic conditions - rhinitis, urticaria, atopic dermatitis, bronchial asthma, serum sickness, reactions to medications and insect and reptile bites, status asthmaticus.
Dermatological diseases - lichen planus, diffuse neurodermatitis, eczema, contact dermatitis, arthropathic psoriasis, keloid scars, pemphigus, insulin lipodystrophy, alopecia areata.
Systemic pathologies – dermatomyositis, periarteritis nodosa, scleroderma, systemic lupus erythematosus.
Kidney diseases - nephrotic syndrome and glomerulonephritis.
Blood diseases – lymphoma, leukemia, transfusions.
Gastrointestinal pathologies - gluten enteropathy, nonspecific ulcerative colitis, Crohn's disease.
Adrenal dysfunction – adrenogenital syndrome, adrenal insufficiency (primary and secondary).
Rheumatic diseases - heel spur, bursitis, lumbago, torticollis, exostosis, rheumatoid arthritis, thumb stiffness, tendinitis, ankylosing spondylitis, epicondylitis, etc.

It is forbidden to inject Diprospan if you have an individual intolerance to the components.

Relative contraindications to the use of hormonal agents are:

Osteoporosis.
Diabetes mellitus.
Glaucoma.
Tuberculosis.
Arterial hypertension.
Cushing's syndrome.
Mental disorders.
Stomach ulcer.
Systemic fungal infections.
Viral and purulent infections.
Thromboembolic syndrome.
Thrombocytopenic purpura (with intramuscular injection).

Periarticular administration of Diprospan (to bioactive points of the joints) is contraindicated in patients with infective endocarditis and arthritis, aseptic necrosis, periarticular cellulitis with ulcerations, osteomyelitis and diabetes mellitus. It is also prohibited to inject into psoriasis lesions.

How to give injections with Diprospan

The drug is not administered intravenously or subcutaneously. The instructions for use compiled on Diprospan require intramuscular and periarticular administration. If injections are needed to treat the eyes, they are injected into the skin of the lower eyelid.

The dose is always selected individually, taking into account the clinical characteristics of a particular disease. The purpose of use is to create a drug depot during hormonal therapy with short-term medications.

How often can Diprospan be injected?

The product is administered into the same joint once every 2 to 3 months. Injections are given in different joints at intervals of 1 to 2 weeks. As therapy is completed, the dose is gradually reduced so that the body does not feel a sudden withdrawal of the drug.

Instructions

Let's consider the features of using Diprospan for various diseases.

Psoriasis

You can use Diprospan for psoriasis if the disease is very severe or it is diagnosed in an arthritic form.

Alopecia areata

Injections are given intramuscularly once a week. The dosage is 1 ml. The general course of treatment consists of 3 to 5 injections.

Eczema

If there are symptoms of diffuse eczema, Diprospan is injected to control the acute inflammatory process and support the body during severe disease.

In ophthalmology

For endocrine ophthalmopathy and in the postoperative period for pathologies of the visual system, Diprospan is administered parabulbarly, i.e. by placing an injection in the lower eyelid area.

After rhinoplasty

An injection of Diprospan into the nose is given when severe swelling of the tissues is observed after surgery.

Rheumatoid arthritis

Doctors practice intra-articular administration of Diprospan in addition to systemic hormonal therapy. For arthrosis of the joint and rheumatoid arthritis, the medicine minimizes pain and increases joint mobility. Relief occurs 2 to 4 hours after the injection.

Diprospan blockade to reduce pain is indicated for carpal tunnel syndrome, osteochondrosis, headaches, phantom and facial pain. Medicine is injected into the joint for bursitis and tendinitis, avoiding damage to the problem area.

Possible side effects

The occurrence of side effects during the use of Diprospan was rarely recorded. Negative reactions arose due to drug abuse, which caused the pituitary gland to suffer.

What anomalies may a person using Diprospan encounter:

Acne.
Myopathy.
Decreased sexual desire.
Ulcerogenic effect.
Increased blood pressure.
Delayed growth of bone, cartilage and muscle tissue.
Mental disorders and nervous disorders (convulsive seizures, euphoria, irritability, depression, insomnia, causeless anxiety).
Anaphylactic shock and allergic reactions.
Ophthalmological pathologies (corneal perforation, cataracts, glaucoma).
Formation of pigmented areas at injection sites, aseptic abscesses, atrophy at the level of the dermis and subcutaneous fat.

If for any reason treatment with Diprospan is not suitable for the patient, the doctor looks for effective analogues. An alternative option is Flosteron, an absolute analogue of Diprospan. Among the synonyms, a specialist can recommend Metypred, Kenalog, Dexazon, Depos, Polcortolon, Betaspan Depot.

The interaction of Diprospan with other medications leads to increased side effects of the drug in question and a decrease in the beneficial properties of drugs from other groups. In combination with Isoniazid, Diprospan can provoke mental disorders.

How much does Diprospan cost?

The average price in Russia for 1 ampoule of Diprospan suspension is 250 rubles. In Ukraine, patients can buy 5 ampoules with a volume of 1 ml each at a price of 1100 – 1600 hryvnia per pack.

In Russian online pharmacies, the cost of the drug varies from 195 to 840 rubles. For residents of Kazakhstan, purchasing Diprospan costs 7 thousand tenge.

Reviews

Patients leave mostly positive reviews for Diprospan injections. In messages on forums, the drug is described as a powerful anti-inflammatory and desensitizing agent that can quickly relieve unpleasant symptoms of diseases. The medicine is good for arthrosis and eczema, but in some people it caused shortness of breath and weight gain.

Doctors in reviews of Diprospan write about the inadmissibility of abusing effective injections. Despite the benefits of injections, their overdose has a toxic effect on the body. Therefore, injections must be given strictly according to the scheme developed by the doctor.

It should also be taken into account that if administered incorrectly intra-articularly, Diprospan can cause quite serious complications:

In general, doctors and patients are satisfied with the results of using Diprospan. But the effectiveness of injections is always related to the type of disease, its severity, concomitant pathologies and the use of appropriate medications.

kozhnyi.ru

Diprospan

Due to the lack of controlled studies of the safety of the drug Diprospan® during pregnancy, if it is necessary to prescribe the drug to pregnant women or women of childbearing age, a preliminary assessment of the expected benefit of therapy for the mother and the potential risk to the fetus is required.

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 prescribe Diprospan® during lactation, the issue of stopping breastfeeding should be decided, taking into account the importance of therapy for the mother (due to possible side effects in children).

Use for liver dysfunction

Use with caution in severe chronic liver failure, liver cirrhosis.

Use for renal impairment

Use with caution in severe chronic renal failure.

Use in children

Special instructions

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

The drug should be used in the minimum effective dose, the period of use should be as short as possible.

The initial dose is adjusted until the desired therapeutic effect is achieved. If after a sufficient period of time the therapeutic effect is not observed, the drug is discontinued by gradually reducing the dose of the drug. Diprospan® and select another appropriate treatment method.

After achieving a therapeutic effect, the maintenance dose is selected by gradually reducing the dose of betamethasone, which is 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 use in high doses.

Administration of the drug into soft tissues, into the lesion and inside the joint can, with a pronounced local effect, simultaneously lead to a systemic effect.

Considering the likelihood of developing anaphylactoid reactions with parenteral administration of GCS, the necessary precautions should be taken before administering the drug, especially if there is a history of allergic reactions to drugs.

Diprospan® contains two active substances - betamethasone compounds, one of which, betamethasone sodium phosphate, is a rapidly soluble fraction and therefore quickly penetrates the systemic circulation. The possible systemic effect of the drug should be taken into account.

During the use of the drug Diprospan®, mental disorders are possible, especially in patients with emotional instability or a tendency to psychosis.

When prescribing Diprospan to patients with diabetes mellitus, adjustment of hypoglycemic therapy may be required.

Patients receiving Diprospan® in doses that suppress the immune system should be warned about the need to avoid contact with patients with chickenpox and measles (especially important when prescribing the drug to children).

When using the drug Diprospan®, it should be taken into account that GCS can mask the signs of an infectious disease, as well as reduce the body's resistance to infections.

Prescription of Diprospan for active tuberculosis is possible only in cases of fulminant or disseminated tuberculosis in combination with adequate anti-tuberculosis therapy. When prescribing Diprospan to patients with latent tuberculosis or with a positive reaction to tuberculin, the issue of preventive anti-tuberculosis therapy should be decided. When using rifampin prophylactically, an increase in the hepatic clearance of betamethasone should be taken into account (dose adjustment may be required).

If there is fluid in the joint cavity, a septic process should be excluded.

A noticeable increase in pain, swelling, increased temperature of the surrounding tissues and further limitation of joint mobility indicate infectious arthritis. Once the diagnosis is confirmed, antibacterial therapy must be prescribed.

Repeated injections into a joint for osteoarthritis may increase the risk of joint destruction. The introduction of GCS into the tendon tissue gradually leads to tendon rupture.

After successful therapy with intra-articular injections of the drug Diprospan®, the patient should avoid overloading the joint.

Long-term use of corticosteroids can lead to posterior subcapsular cataracts (especially in children), glaucoma with possible damage to the optic nerve, and may contribute to the development of secondary eye infections (fungal or viral).

It is necessary to periodically conduct an ophthalmological examination, especially in patients receiving Diprospan® for more than 6 months.

With an increase in blood pressure, fluid and sodium chloride retention in tissues and an increase in potassium excretion from the body (less likely than with the use of other corticosteroids), patients are recommended to follow a diet with limited salt and are additionally prescribed potassium-containing drugs. All corticosteroids enhance calcium excretion.

With the simultaneous use of Diprospan and cardiac glycosides or drugs that affect the electrolyte composition of plasma, monitoring of the water-electrolyte balance is required.

Acetylsalicylic acid is prescribed with caution in combination with the drug Diprospan® for hypoprothrombinemia.

The development of secondary adrenal insufficiency due to too rapid withdrawal of GCS is possible within several months after the end of therapy. If a stressful situation occurs or is threatened during this period, therapy with Diprospan® should be resumed and a mineralocorticoid drug should be prescribed at the same time (due to a possible disruption of mineralocorticoid secretion). Gradual withdrawal of GCS can reduce the risk of developing secondary adrenal insufficiency.

With the use of GCS, changes in sperm motility and number are possible.

During long-term therapy with GCS, it is advisable to consider the possibility of switching from parenteral to oral GCS, taking into account the assessment of the benefit/risk ratio.

Patients receiving GCS should not be vaccinated against smallpox or undergo other immunizations, especially during treatment with GCS in high doses, due to the possibility of developing neurological complications and a low immune response (lack of antibody formation). Immunization is possible during replacement therapy (for example, with primary adrenal insufficiency).

Use in pediatrics

Children undergoing Diprospan® therapy (especially long-term therapy) should be under close medical supervision for possible growth retardation and the development of secondary adrenal insufficiency.

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Diprospan for osteochondrosis

Diprospan packaging option

Description

Composition and pharmacological action

The active component of Diprospan is betamethasone. It is contained in the drug in two forms:

betamethasone disodium phosphate, which ensures rapid achievement of the effect;
betamethasone dipropionate, which prolongs the therapeutic effect.

The drug exhibits high glucocorticoid and low corticoid activity. The effect of Diprospan in osteochondrosis is due to its influence on various types of metabolism and a pronounced anti-inflammatory effect: its active components suppress the production of substances leading to the development of the inflammatory process. The drug also has an immunosuppressive and antiallergic effect.

Pharmacokinetics

Ampoule with suspension

Metabolism occurs in the liver, excretion occurs through the kidneys.

Indications for use

Diprospan is taken for soft tissue damage

Diseases of the musculoskeletal system for which Diprospan is prescribed include:

spinal osteochondrosis in localized or widespread form;
joint damage of a rheumatoid nature;
lesions of soft tissues and ligaments;
arthrosis;
arthritis;
Bekhterev's disease.

In addition, Diprospan is used in the treatment of the following diseases:

allergic;
dermatological;
systemic pathologies of connective tissue;
hemoblastoses;
adrenal insufficiency;
some other diseases and conditions that require treatment with systemic glucocorticosteroid drugs.

Contraindications

For osteochondrosis and any other diseases, there are certain restrictions on the use of Diprospan. In particular, the drug is not prescribed for:

systemic mycoses;
infectious arthritis and joint instability (in case of intra-articular injection);
hypersensitivity to the components of the drug or other glucocorticosteroids.

The use of Diprospan is prohibited in childhood. The drug is not administered subcutaneously or intravenously.

It is prescribed with caution in the presence of the following diseases and conditions:

Pregnancy

During pregnancy, the use of Diprospan for osteochondrosis is not recommended. If the medication is prescribed during lactation, breastfeeding must be stopped.

Use for osteochondrosis

Administration of the drug

The injection solution is administered intramuscularly, intradermally, peri- or intra-articularly (into the periarticular area or joint).

Intra-articular administration of the drug

For intramuscular injections, 1-2 ml of the drug is prescribed.
Periarticular administration: 0.2 ml per 1 sq. cm of the skin of the joint.
Intra-articular administration: maximum 2 ml per 1 injection once a week.

Before administration, the drug is slightly warmed up (to body temperature). Intramuscular administration of Diprospan is carried out in the outer upper quadrant of the buttock.

Diprospan is a long-acting drug: the active components will remain in the body for about 10 days. Therefore, its use should be limited: the drug can be prescribed a maximum of once every 14-30 days.

Side effects

According to expert reviews, in some cases, the use of Diprospan for osteochondrosis can provoke the development of undesirable reactions. The main ones:

Setting up an injection of diprospan

Metabolic disorders: increased potassium secretion, increased amount of excreted calcium, hypernatremia, negative nitrogen balance, retention of excess fluid in the body, lipomatosis with possible neurological complications, weight gain.
Cardiovascular system: increased blood pressure, development of chronic heart failure.
Musculoskeletal system: steroid myopathy, muscle weakness, loss of muscle mass, increased severity of myasthenic symptoms in myasthenia gravis, osteoporosis, pathological fractures of long bones, joint instability, tendon ruptures, necrosis of the head of the humerus or femur, compression fracture of the spine.
Digestive system: hiccups, flatulence, pancreatitis, damage to the gastrointestinal tract of an erosive-ulcerative nature. Perforation and bleeding are possible.
Dermatological reactions: thinning and atrophy of the skin, impaired wound healing, ecchymoses, petechiae, dermatitis, stretch marks, acne, a tendency to develop candidiasis and pyoderma, worsening reaction to skin tests, increased sweating.
Central and peripheral nervous system: increased intracranial pressure (may be accompanied by papilledema), convulsions, dizziness, headaches, frequent mood changes, insomnia, irritability, tendency to depression, psychotic reactions, euphoria.
Endocrine system: secondary adrenal insufficiency, menstrual irregularities, development of steroid diabetes mellitus, Itsenko-Cushing syndrome, increased need for insulin, decreased carbohydrate tolerance, in children - delayed growth and puberty.
Vision: increased intraocular pressure, exophthalmos, glaucoma, cataracts, rarely - loss of vision.
Allergic reactions: anaphylactic shock, angioedema, arterial hypotension.
Local reactions: skin and subcutaneous atrophy, hyperpigmentation, hypopigmentation, aseptic abscesses.
Other reactions: flushing of the face after injection.

Description

A transparent, colorless, slightly viscous liquid containing white or almost white particles that easily suspend, free from foreign impurities.

Compound

Active ingredient: betamethasone;

1 ml of suspension contains 6.43 mg of betamethasone dipropionate (equivalent to 5 mg of betamethasone) and 2.63 mg of betamethasone sodium phosphate (equivalent to 2 mg of betamethasone);

excipients: disodium hydrogen phosphate dihydrate, sodium chloride, disodium edetate, polysorbate 80, benzyl alcohol, methyl parahydroxybenzoate (E 218), propyl parahydroxybenzoate (E 216), sodium carboxymethylcellulose, macrogol, hydrochloric acid, water for injection.

Pharmacotherapeutic group

Corticosteroids for systemic use.

ATX code: N02AB01.

Pharmacological properties

Pharmacodynamics

Betamethasone is a synthetic glucocorticoid (9 alpha-fluoro-16 beta-methylprednisolone). Betamethasone has strong anti-inflammatory, antiallergic and immunosuppressive effects.

Betamethasone does not have a clinically significant mineralocorticoid effect. Glucocorticoids penetrate the cell membrane and form complexes with specific receptors in the cytoplasm. These complexes subsequently penetrate into the cell nucleus, are fixed on DNA (chromatin) and stimulate the transcription of messenger RNA, as well as the synthesis of proteins of various enzymes. The latter will ultimately be responsible for the effects observed with systemic use of glucocorticoids. In addition to influencing the inflammatory and immune processes, glucocorticoids also affect the metabolism of carbohydrates, proteins and lipids. In addition, glucocorticoids affect the cardiovascular system, skeletal muscles and the central nervous system.

Effect on inflammatory and immune processes

The anti-inflammatory, immunosuppressive and antiallergic properties of glucocorticoids are important when used in therapeutic practice. The main results of these properties are: a decrease in the number of immunoactive cells at the site of the inflammatory process, a decrease in vasodilation, stabilization of lysosomal membranes, suppression of phagocytosis, and a decrease in the production of prostaglandins and related substances.

The anti-inflammatory activity of the drug is approximately 25 times higher than that of hydrocortisone and 8-10 times higher than that of prednisolone (in weight ratio).

Effect on carbohydrate and protein metabolism

Glucocorticoids stimulate protein catabolism. In the liver, through the process of gluconeogenesis, the released amino acids are converted into glucose and glycogen. Glucose absorption in peripheral tissues is reduced, leading to hyperglycemia and glycosuria, especially in patients predisposed to diabetes.

Effect on lipid metabolism

Glucocorticoids have a lipolytic effect. Lipolysis is most pronounced at the level of the extremities. In addition, glucocorticoids affect lipogenesis, which is most pronounced in the torso, neck and head. Together, these effects lead to a redistribution of lipid deposits.

The maximum pharmacological activity of glucocorticoids occurs later than the maximum serum concentration of the drug, indicating that most of the drug's effects are based not on direct drug action, but on changes in enzyme activity.

Pharmacokinetics

Betamethasone sodium phosphate and betamethasone dipropionate are absorbed at the injection site, providing a rapid onset of therapeutic action, as well as other local and general pharmacological effects.

Betamethasone sodium phosphate quickly dissolves in water and is metabolized in the body to betamethasone (a biologically active glucocorticoid). 2.63 mg of betamethasone sodium phosphate is equivalent to 2 mg of betamethasone.

The use of betamethasone dipropionate allows you to achieve a long-term effect of the drug. This substance is practically insoluble, representing a depot, so absorption is slower, and symptom relief lasts longer.

Betamethasone is metabolized in the liver. Binding occurs mainly with albumin. In patients with liver disease, the metabolism of betamethasone is longer or

delayed.

Indications for use

Corticosteroid therapy is auxiliary and does not replace conventional treatment.

Intramuscular administration

Diprospan is indicated for the treatment of various rheumatological, dermatological, allergic diseases, collagen and other diseases, which usually respond to treatment with corticosteroids.

Intra-articular and periarticular injection, as well as injection directly into soft tissues

As an auxiliary short-term therapy (in acute form or exacerbation of the disease) for osteoarthritis, rheumatoid arthritis.

Intradermal administration

For dermatological diseases.

Local injection into the tissues of the foot

As an auxiliary short-term therapy (in acute form or exacerbation of an existing disease) for bursitis against the background of a hard callus, spurs, stiffness of the big toe or deformation of the fifth toe, with a synovial cyst, Morton's metatarsal neuralgia, tenosynovitis, periostitis of the cuboid bone.

Typical situations

Allergic conditions

Bronchial asthma, status asthmaticus, seasonal or perennial allergic rhinitis, severe allergic bronchitis, contact dermatitis, atopic dermatitis, hay fever, angioedema, serum sickness, hypersensitivity reactions to drugs or insect bites.

Rheumatic diseases

Osteoarthritis, rheumatoid arthritis, bursitis, lumbago, sciatica, coccydynia, acute gouty arthritis, torticollis, ganglion cyst, ankylosing spondylitis, sciatica, exostosis, fasciitis.

Dermatological diseases

Atopic dermatitis (coin-shaped eczema), neurodermatitis (limited neurodermatitis), contact dermatitis, severe solar dermatitis, urticaria, hypertrophic lichen planus, diabetic necrobiosis lipoidica, alopecia areata, discoid lupus erythematosus, psoriasis, keloid scars, pemphigus vera, dermatitis herpetiformis, cystic blackheads

Collagen diseases

During exacerbation or as a maintenance treatment of certain types of disseminated systemic lupus erythematosus, periarteritis nodosa, scleroderma and dermatomyositis.

Oncological diseases

As a palliative treatment for leukemia and lymphoma in adults, as well as acute leukemia in children.

Other states

Adrenogenital syndrome, hemorrhagic rectocolitis, Crohn's disease, sprue, pathological changes in the blood that require glucocorticoid therapy, nephritis, nephrotic syndrome.

In the presence of primary or secondary adrenal insufficiency, treatment with Diprospan can be carried out, however, if necessary, mineralocorticoids must be used simultaneously.

Directions for use and dosage

The solution should be shaken before use.

THE DOSE IS SELECTED INDIVIDUALLY DEPENDING ON THE PATIENT'S NEEDS, TYPE OF DISEASE, ITS SEVERITY AND REACTION OF THE PATIENT'S BODY.

The dose should be minimal and the period of administration should be as short as possible.

The initial dose must be adjusted until a satisfactory clinical effect is achieved. If, after a sufficient period of time, a satisfactory clinical effect cannot be achieved, treatment should be discontinued, gradually reducing the dose of Diprospan, and other appropriate treatment should be carried out.

If the effect is satisfactory, it is necessary to determine the optimal dose, gradually reducing the initial dose (at acceptable intervals) until the minimum dose is reached that provides an adequate clinical effect.

Diprospan cannot be administered intravenously or subcutaneously.

Systemic application

For systemic therapy, the initial dose of the drug in most cases is 1-2 ml. The administration is repeated if necessary. The drug is injected deep intramuscularly into the buttock. The dose and frequency of use of the drug depend on the severity of the patient’s condition and the therapeutic effect. For serious diseases when urgent treatment is necessary, for example, with systemic lupus erythematosus or status asthmaticus, the initial dose of the drug may be 2 ml.

For various dermatological diseases, a good response is usually achieved after intramuscular administration of 1 ml of Diprospan; administration of the drug can be repeated depending on the therapeutic effect.

For diseases of the respiratory system, symptom relief is achieved a few hours after an intramuscular injection of the drug Diprospan®. For bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis, effective control of symptoms is achieved after administration of 1-2 ml of the drug.

In acute or chronic bursitis, effective results are achieved after one intramuscular injection of 1-2 ml of Diprospan; If necessary, you can repeat the administration of the drug.

Local application

The simultaneous use of a local anesthetic drug is necessary only in isolated cases (the injection is almost painless). If simultaneous administration of an anesthetic drug is desired, then Diprospan can be mixed (in a syringe, not in a vial) with a 1% or 2% solution of lidocaine hydrochloride, procaine hydrochloride or similar local anesthetics using paraben-free dosage forms. The use of anesthetics containing methylparaben, propylparaben, phenol and other similar substances is not permitted. First, the required dose of Diprospan should be drawn into a syringe from the bottle; then the required amount of local anesthetic is drawn into the same syringe and shaken for a short period of time.

For acute bursitis (subdeltoid, subacromial and prepatellar), injection of 1-2 ml of Diprospan directly into the synovial bursa can relieve pain and completely restore mobility within several hours.

For chronic bursitis. If a good effect is obtained after emergency treatment, the dose of the drug can be reduced.

For tendinitis, tenosynovitis and peritendinitis. In the acute stage of the disease, one injection of the drug may be enough to improve the patient’s condition; in the chronic stage, repeated administration of the drug may be required, depending on the patient’s condition.

For rheumatoid arthritis and osteoarthritis. Intra-articular administration of the drug in a dose of 0.5-2 ml, as a rule, reduces pain, tenderness and stiffness of the joints within 2-4 hours after administration. The duration of the therapeutic effect of the drug varies significantly in these two diseases and can be 4 or more weeks. Intra-articular administration of the drug Diprospan is well tolerated both in the joints and periarticular tissues.

When administered into large joints (for example, knee, hip): 1-2 ml; when administered into the middle joints (for example, elbow): 0.5-1 ml; when administered into small joints (for example, joints of the hand): 0.25-0.5 ml.

For skin diseases. For dermatological diseases, administering the drug Diprospan directly to the lesion is effective. The positive effect on some lesion sites where the drug is not directly applied may be due to a small systemic effect of the drug.

The dose is 0.2 ml/cm2. The drug is administered intradermally (not subcutaneously) using a tuberculin syringe with a needle with a diameter of 26 G. The total amount of the drug injected into all affected areas should not exceed 1 ml.

For foot diseases sensitive to glucocorticoid therapy. For bursitis against the background of a callus, the use of two consecutive injections of the drug, 0.25 ml each, can be effective. Other conditions, such as hallux rigidus, fifth toe varus, and acute gouty arthritis, may improve very quickly. A tuberculin syringe with a 25G, 1.9cm long needle is suitable for most foot injections. Recommended doses (with intervals between administrations of about 1 week) are:

For bursitis:

Against the background of a hard callus 0.25-0.5 ml with a spur 0.5 ml with stiffness of the big toe 0.5 ml with varus deformity of the fifth toe 0.5 ml

For synovial cyst 0.25-0.5 ml

For Morton's metatarsal neuralgia 0.25-0.5 ml

For tenosynovitis 0.5 ml

For periostitis of the cuboid bone 0.5 ml

For acute gouty arthritis 0.5-1 ml

Side effect

Adverse reactions observed with the use of the drug Diprospan, as well as reactions with the use of other corticosteroids, are determined by the dose and duration of use of the drug.

Water-electrolyte imbalance: sodium retention, potassium loss, hypokalemic alkalosis, fluid retention, congestive heart failure in predisposed patients, arterial hypertension.

Musculoskeletal disorders: muscle weakness, loss of muscle mass, worsening myasthenia gravis symptoms, osteoporosis, sometimes with severe bone pain and spontaneous fractures (vertebral compression fractures), avascular necrosis of bone (femoral or humeral head), tendon rupture, steroid myopathy, pathological fractures, joint instability .

Skin disorders: skin atrophy, slow wound healing, fragility and thinning of the skin, petechiae, ecchymosis, allergic dermatitis, angioedema, facial erythema, increased sweating, urticaria.

Gastrointestinal disorders: stomach ulcer with possible perforation and bleeding, pancreatitis, flatulence, intestinal perforation, ulcerative esophagitis, nausea, vomiting.

Nervous system disorders: convulsions, dizziness, headache, cephalgia, increased intracranial pressure (pseudotumor of the brain).

Mental disorders: euphoria, mood changes, personality changes and severe depression, increased irritability, insomnia, psychotic reactions, especially in patients with a history of psychiatric disorders, depression.

Visual disorders: increased intraocular pressure, glaucoma, posterior subcapsular cataract, exophthalmos, blurred vision.

Endocrine system disorders: clinical symptoms of Cushing's syndrome, menstrual irregularities, increased need for insulin or oral hypoglycemic agents in patients with diabetes, delayed fetal development or child growth, impaired carbohydrate tolerance, manifestations of latent diabetes mellitus, secondary failure of the pituitary gland and adrenal cortex, which is especially unfavorable in in case of stress (injury, surgery or illness). Metabolic disorders: negative nitrogen balance due to protein breakdown, lipomatosis, weight gain.

Immune system disorders. Corticosteroids can help suppress skin tests, mask the symptoms of infection and activate latent infection, as well as reduce resistance to infectious pathogens, in particular to mycobacteria (in tuberculosis), Candida albicans and viruses.

Other reactions: anaphylactic or allergic reactions, hypotensive or shock reactions.

General disorders and disorders at the injection site: rare cases of blindness associated with injection of the drug into the face or head, hyperpigmentation or hypopigmentation, subcutaneous and cutaneous atrophy, aseptic abscess, post-injection exacerbation (after intra-articular administration), Charcot arthropathy.

After repeated intra-articular administration of the drug, joint damage may occur. There is a risk of infection.

Contraindications

Hypersensitivity to any of the active or excipients or to corticosteroids (see Composition section).

Systemic fungal infections.

In patients with idiopathic thrombocytopenic purpura, intramuscular administration of the drug Diprospan is prohibited.

Overdose

Symptoms. An acute overdose of glucocorticosteroids, including betamethasone, does not threaten the patient’s life.

In the case of using the highest doses, it is very unlikely that an overdose of glucocorticosteroids will lead to undesirable consequences (provided that there are no such conditional contraindications as diabetes mellitus, glaucoma, active gastric ulcer or, if cardiac glycosides are not used simultaneously, coumarin anticoagulants or diuretics that remove potassium).

Treatment. Complications caused by the metabolic effects of corticosteroids or the effects of the underlying or concomitant disease, as well as complications resulting from interactions with other drugs, should be treated appropriately. It is necessary to ensure adequate fluid intake and monitor the composition of electrolytes in the blood serum and urine, paying special attention to the balance of sodium and potassium in the body. If an imbalance of these ions is detected, appropriate therapy must be carried out.

Precautions

The drug Diprospan cannot be administered intravenously or subcutaneously.

Serious neurological reactions (sometimes fatal) have been reported with epidural corticosteroid injections. Specific reactions have also been reported and include (but are not limited to): spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke. These serious neurological events have been reported both with and without the use of fluoroscopic examination. The safety and effectiveness of epidural corticosteroids have not been established and such use of corticosteroids is prohibited.

Anaphylactoid/anaphylactic reactions with the possibility of shock have been rarely observed in patients treated with parenteral corticosteroids. Appropriate precautions should be taken in patients with a history of allergic reactions to corticosteroids.

The drug must be administered under aseptic conditions.

Diprospan contains two betamethasone esters, one of which (betamethasone sodium phosphate) is rapidly absorbed at the site of drug administration. Therefore, the physician should be aware that this soluble substance may have systemic effects.

When discontinuing or sharply reducing the dose of the drug after long-term use (in the case of very high doses - after a short period of use), as well as after an increase in the need for corticosteroids (as a result of stress: infection, trauma, surgery), adrenal insufficiency may develop. Therefore, the dose must be reduced gradually. In stressful situations, it is sometimes necessary to restart the use of corticosteroids or increase their dose.

Dose reduction should take place under the close supervision of a physician. In addition, it is sometimes necessary to monitor the patient's condition for a period of up to 1 year after the end of long-term treatment or after using high doses of the drug.

Symptoms of adrenal insufficiency: malaise, muscle weakness, mental disorders, lethargy, muscle and bone pain, peeling skin, shortness of breath, anorexia, nausea, vomiting, fever, hypoglycemia, hypotension, dehydration, death as a result of abrupt cessation of treatment. Treatment of adrenal insufficiency includes the use of glucocorticoids, mineralocorticoids, water, sodium chloride and glucose.

Rapid administration of a high dose intravenous corticosteroid may cause cardiovascular collapse; for this reason, the injection should be performed over 10 minutes.

During long-term therapy with corticosteroids, it is necessary to consider switching from parenteral to oral use of the drug, weighing all the benefits and possible risks.

When performing an intra-articular injection, it is important to know the following.

This method of using the drug can have a local and general effect. An analysis of intra-articular fluid is necessary to exclude a septic process in the joint. Do not administer the drug if there is an intra-articular infection. Increased pain, swelling, decreased joint mobility, fever, or malaise may be signs of septic arthritis. If an infectious process is diagnosed, it is necessary to carry out appropriate antibacterial therapy. Corticosteroids should not be injected into an unstable joint, into infected areas, or into intervertebral spaces. Repeated injections into a joint for osteoarthritis may increase the risk of joint destruction. Direct injection of corticosteroids directly into the tendon should be avoided as there is a risk of subsequent tendon rupture.

Corticosteroids must be administered deeply intramuscularly to avoid local tissue atrophy.

The introduction of corticosteroids into soft tissues or directly into the lesion, as well as intra-articular administration, can have a general and local effect.

Special risk groups

Taking into account the properties of glucocorticoids (conversion of proteins into glucose), betamethasone can only be used in patients with diabetes for a short period of time and only under constant medical supervision.

In patients with hypothyroidism or cirrhosis, an increased effect of glucocorticoids is observed.

The use of the drug Diprospan should be avoided for eye herpes, given the risk of perforation of the cornea.

When using drugs based on corticosteroids, psychotic disorders are possible. Susceptibility to emotional or psychotic instability may worsen during treatment with corticosteroid-based medications.

Use the drug with caution when: nonspecific ulcerative colitis, threat of perforation, abscess or other purulent infections; diverticulitis; intestinal anastomosis; peptic ulcer of the stomach and duodenum; renal failure; arterial hypertension; osteoporosis; myasthenia gravis; glaucoma; acute psychosis; viral and bacterial infections; developmental delay; tuberculosis; Cushing's syndrome; diabetes; heart failure; epilepsy that is difficult to treat; tendency to thromboembolism or thrombophlebitis; pregnancy.

Given the fact that complications during corticosteroid therapy depend on the dose and duration of treatment, the benefit/risk ratio for each individual patient should be taken into account, individually selecting the dose and duration of treatment.

Corticosteroids may mask some signs of an infection or make it harder to detect. Due to a decrease in resistance, new infections may arise during the use of the drug.

Long-term use of the drug can lead to the development of posterior subcapsular cataracts (especially in children) or glaucoma with possible damage to the optic nerve, as well as contribute to the development of secondary eye infections (fungal or viral).

Ophthalmological examinations should be carried out regularly, especially during long-term treatment (more than 6 weeks).

The use of moderate and high doses of corticosteroids can lead to increased blood pressure, fluid and sodium retention, and increased potassium excretion. Such effects are less likely to occur with synthetic derivatives, unless used in high doses. The issue of using a diet with limited table salt and additional intake of drugs containing potassium may be considered. All corticosteroids enhance calcium excretion.

The following treatments are contraindicated in patients receiving corticosteroid therapy:

However, in patients using corticosteroids as replacement therapy, immunization is possible (for example, with Addison's disease).

Patients, especially children, receiving immunosuppressive doses of corticosteroids should avoid any contact with people with chickenpox or measles.

In active tuberculosis, corticosteroid therapy should be limited to cases of fulminant or disseminated tuberculosis. In this case, corticosteroids are used in combination with appropriate anti-tuberculosis therapy.

If corticosteroid therapy is prescribed to patients with latent tuberculosis or a positive reaction to tuberculin, constant monitoring of the condition is necessary, since reactivation of the disease is possible. During long-term corticosteroid therapy, patients should receive chemoprophylaxis.

If rifampicin is used in a chemoprophylaxis program, it must be remembered that this drug enhances the metabolic hepatic clearance of corticosteroids; Dose adjustment of corticosteroids may be necessary.

Because corticosteroids can affect the development of neonates and children and may inhibit endogenous corticosteroid production, children's growth and development should be closely monitored during long-term corticosteroid use. In some cases, corticosteroids can affect sperm motility and count.

Diprospan contains benzyl alcohol, which can cause toxic and anaphylactoid reactions in newborns and children under 3 years of age. The drug should not be used in premature or full-term newborns.

Diprospan contains methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216), which can cause allergic reactions (sometimes of a delayed type), and in exceptional cases, difficulty breathing.

When using systemic and local corticosteroids (including intranasal, inhaled and intraocular routes of administration), visual disturbances may occur. If the patient experiences symptoms such as blurred vision or other visual disturbances, the patient should be referred for consultation with an ophthalmologist to determine possible causes of the visual disturbance, which may include cataracts, glaucoma, or other rare diseases (eg, central serous chorioretinopathy), o which have been reported after the use of systemic and local corticosteroids.

Use during pregnancy and lactation

Due to the lack of studies on the safety of the use of glucocorticoids in pregnant and breastfeeding women, glucocorticosteroids should not be prescribed to women during pregnancy, lactation, or women of childbearing age, unless necessary and only after a careful assessment of the ratio of the expected positive effect and possible risks for the mother , fetus or child.

If corticosteroid therapy is indicated in the antenatal period, the expected clinical effect should be compared with possible side effects (in particular growth retardation and increased risk of infection).

In some cases, it is necessary to continue corticosteroid therapy during pregnancy or even increase the dose (for example, in the case of corticosteroid replacement therapy).

Intramuscular administration of betamethasone leads to a significant reduction in the incidence of fetal dyspnea if the drug is taken more than 24 hours before birth (before the 32nd week of pregnancy).

Published research suggests that the appropriateness of prophylactic corticosteroid therapy after 32 weeks of pregnancy is controversial. Therefore, the physician should evaluate the benefits and possible risks for the mother and fetus when using corticosteroid therapy after the 32nd week of pregnancy.

Corticosteroid therapy is not indicated for the treatment of hyaline membrane disease after birth.

For prophylactic treatment of hyaline membrane disease in preterm infants, the use of corticosteroids should be avoided in pregnant women with preeclampsia or eclampsia or signs of placental damage.

Children born to mothers who received significant doses of corticosteroids during pregnancy should be under medical supervision to identify early signs of adrenal insufficiency.

If women received betamethasone before birth, the newborns experienced a temporary delay in the production of fetal growth hormones, and also, possibly, pituitary hormones that regulate the production of corticosteroids by both the final and fetal portions of the fetal adrenal glands. However, suppression of fetal hydrocortisone does not affect the pituitary and adrenal responses to stress after birth.

Corticosteroids penetrate well through the placental barrier and into mother's milk.

Because corticosteroids cross the placenta, neonates and infants born to mothers treated with corticosteroids during most or part of pregnancy should be especially closely monitored for possible congenital cataracts, although such cases are very rare.

Since Diprospan may cause side effects in breastfed infants, consideration should be given to discontinuation of breastfeeding or the advisability of using the drug, depending on the importance of this therapy for the mother.

Women treated with corticosteroids during pregnancy should be monitored during and after labor and delivery for adrenal insufficiency caused by the stress of labor.

Impact on the ability to drive vehicles and machinery

Particular caution should be exercised when taking large doses of the drug, which may contribute to the development of central nervous system effects (euphoria, insomnia). Visual impairment is also possible with prolonged use of the drug.

Interactions with other drugs

Drug interactions

Corticosteroids (including betamethasone) are metabolized by CYP3A4.

Concomitant use with phenobarbital, rifampicin, phenytoin or ephedrine may increase the metabolism of corticosteroids and, as a result, reduce the therapeutic effect.

Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, products containing cobicistat) may result in increased corticosteroid exposure and thereby potentially increase the risk of systemic corticosteroid side effects. The benefits of concomitant use and the potential risks of systemic corticosteroid side effects should be considered, and patients should be monitored for any such adverse reactions.

The following treatments are contraindicated in patients receiving corticosteroid therapy:

Vaccination against smallpox, other methods of immunization (especially in high doses) due to the risk of neurological complications and a weak immune response (insufficient release of antibodies).

However, patients using corticosteroids as replacement therapy may be given immunization (eg, Addison's disease).

Concomitant use with diuretics, such as thiazides, may increase the risk of glucose intolerance.

Patients receiving concomitant treatment with corticosteroids and estrogens should be monitored as the effects of corticosteroids may be enhanced.

Concomitant use of corticosteroids and cardiac glycosides may increase the risk of arrhythmia or digitalis toxicity due to hypokalemia.

Often, patients receiving cardiac glycosides simultaneously use diuretics that help remove potassium from the body. In these cases, the patient must be prescribed potassium-containing drugs. Corticosteroids may enhance potassium excretion caused by amphotericin B. Closely monitor serum electrolyte levels, particularly serum potassium levels, in all patients receiving one of these drug combinations.

The simultaneous use of corticosteroids and coumarin anticoagulants may enhance or weaken the effects of anticoagulants, which requires dose adjustment. For patients receiving concomitant treatment with anticoagulants and glucocorticosteroids, it is necessary to be aware of the possible development of corticosteroid-induced ulcerations of the gastrointestinal tract, as well as the risk of internal bleeding.

Corticosteroids may reduce plasma concentrations of salicylates. If the dose of corticosteroids is reduced or therapy is discontinued, evaluation for possible salicylic acid toxicity should be performed. The combination of glucocorticosteroids and salicylates can increase the frequency and severity of ulcerative processes in the gastrointestinal tract.

When used simultaneously with non-steroidal anti-inflammatory drugs or ethanol, the risk of developing gastrointestinal ulcers or exacerbation of an existing ulcer may increase.

For patients With diabetes mellitus, in some cases it may be necessary to adapt the dose of oral antidiabetic drugs or insulin, taking into account the hyperglycemic effect of glucocorticosteroids.

Concomitant use with somatotropin may lead to a decrease in the response to this hormone. During treatment with somatotropin, betamethasone should be avoided in doses exceeding 300-450 mcg (0.3-0.45 mg) per 1 m2 of body surface per day.

Interactions during laboratory tests

Corticosteroids may interfere with the Nitro blue tetrazolium reduction test and cause false negative results.

If the patient is receiving treatment with corticosteroids, this must be taken into account when interpreting the results of biological tests (skin test, thyroid hormone levels, etc.).

Incompatibility

Rarely, concomitant use of local anesthetics may be necessary. If simultaneous administration of an anesthetic is desired, Diprospan can be mixed (in a syringe, not in a vial) with 1% or 2% solutions of lidocaine or procaine hydrochloride, or other anesthetics that do not contain parabens. The use of anesthetics containing methylparaben, propylparaben, phenol and other similar substances is not permitted.

5 ampoules along with instructions for use are placed in a cardboard box.

Manufacturer information

Schering-Plau Labeau N.V., Belgium.

Schering-Plough Labo N.V., Belgium.

Industrypark 30, Heist op den Berg, 2220, Belgium.

Industriepark 30, Heist-op-den-Berg, 2220, Belgium.

Registration Certificate Holder

Schering-Plough Central East AG, Weistrasse 20 CH-6000, Lucerne 6, Switzerland.

Schering-Plough Central East AG, Weystrasse 20 CH-6000, Lucerne 6, Switzerland.

S-CCDS-MKI460-SUi-082017a