Betamethasone 500 microgram Soluble Tablets

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

In this leaflet, Betamethasone 500 microgram Soluble Tablets will be called Betamethasone Soluble Tablets.

1. What Betamethasone Soluble Tablets are and what they are used for
2. What you need to know before you take Betamethasone Soluble Tablets
3. How to take Betamethasone Soluble Tablets
4. Possible side effects
5. How to store Betamethasone Soluble Tablets
6. Contents of the pack and other information

• if you are allergic to betamethasone or any of the other ingredients of this medicine (listed in section 6)
• if you have an infection and have not yet started taking medicine (e.g. antibiotics) to treat it.

Talk to your doctor, pharmacist or nurse before taking Betamethasone Soluble Tablets

• if you have ever had severe depression or manic depression (bipolar disorder). This includes having had depression before while taking steroid medicines like Betamethasone Soluble Tablets;
• if any of your close family has had these illnesses;
• if you have or have ever had tuberculosis (TB);
• if you have epilepsy (fits), severe mental illness, heart disease, hypertension (high blood pressure), stomach or duodenal ulcers;
• if you have osteoporosis (thinning of the bones). Post menopausal women are particularly at risk of this;
• if you or any of your family have ever had glaucoma (raised eye pressure);
• if you have recently had a heart attack;
• if you have recently been in contact with someone who has chickenpox, shingles or measles or recently had chickenpox, shingles or measles yourself. This product may make chickenpox, shingles or measles much worse;
• if you or any of your family are diabetic;
• if you have an underactive thyroid gland;
• if you have myasthenia gravis (a disease which causes muscle weakness);
• if you have ever suffered from muscle wasting due to corticosteroids;
• if you have liver, kidney or heart disease;
• if you have just been or are about to be immunised;
• if you have an infection;
• if you are pregnant or breast-feeding (see “Pregnancy and breast-feeding” section below).
• if you experience blurred vision or other visual disturbances;
• if you have pheochromocytoma (a tumour of the adrenal gland).

Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

• Some medicines may increase the effects of Betamethasone Soluble Tablets and your doctor may wish to monitor you carefully if you are taking these medicines (including some medicines for HIV: ritonavir, cobicistat);
• Insulin or oral antidiabetic drugs;
• Medicines for high blood pressure;
• Water tablets (diuretics);
• Medicines for thinning the blood e.g. warfarin;
• Non-steroidal anti-inflammatory drugs e.g. ibuprofen;
• Salicylates e.g. aspirin;
• Medicines for myasthenia gravis called anticholinesterases;
• Medicines for the heart called cardiac glycosides;
• Acetazolamide (used to treat glaucoma);
• Rifampicin and rifabutin (antibiotics for tuberculosis) and ephedrine;
• Carbamazepine, phenytoin, primidone, phenobarbitone and aminoglutethimide for epilepsy;
• Carbenoxolone (an ulcer healing drug), theophylline (used to treat asthma and other breathing difficulties) and amphotericin B (anti-fungal);
• Oral contraceptive (the pill);
• Mifepristone (anti-progesterone);
• Somatropin (growth hormone);
• Vecuronium and other muscle relaxants;
• Fluoroquinolones (used for some infections);
• Quetiapine (improves symptoms of some mental illnesses);
• Tretinoin (used for skin problems such as bad acne);
• Any other medicine, including medicines obtained without a prescription.

Betamethasone Soluble Tablets may also affect the results of gallbladder X-ray procedures.

Mental health problems can happen while taking steroids like Betamethasone Soluble Tablets (see also section 4).

• These illnesses can be serious;
• Usually they start within a few days or weeks of starting the medicine;
• They are more likely to happen at high doses;
• Most of these problems go away if the dose is lowered or the medicine is stopped. However, if problems do happen they might need treatment.

Talk to a doctor if you (or someone who is taking this medicine), show any signs of mental problems. This is particularly important if you are depressed or might be thinking about suicide. In a few cases, mental problems have happened when doses are being lowered or stopped.

You should avoid contact with anyone who has either chickenpox, shingles or measles as it could be extremely serious if you caught it from them.

Tell your doctor immediately if you suspect you may have come into contact with a person who has chickenpox, shingles or measles. However, do not stop taking your tablets, unless your doctor tells you to.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

Taking steroids often or for a long time during pregnancy can slow the baby’s growth in the womb or may temporarily affect the baby’s heart and body movements.

Sometimes the baby may get digestive juices going up into the tube that carries food from the mouth to the stomach. The baby may also make less of its own steroid after birth, but this rarely causes any problems. If you become pregnant whilst taking this medicine, please tell your doctor but DO NOT stop taking the tablets unless told to do so (see section 3).

Breast-feeding

If you are breast-feeding, the steroid may enter the baby and lower their hormone levels, if you are taking high doses for a long time.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’. For a dose ranging between two to ten tablets (1000 to 5000 micrograms per dose), this medicine contains between 41.8 mg and 209 mg sodium (main component of cooking/table salt) in each dose. This is equivalent to 1.74% to 8.70% of the UK recommended maximum daily dietary intake of 2.4g sodium for an adult.

This medicine contains 6mg of sodium benzoate in each tablet. Sodium benzoate may increase jaundice (yellowing of the skin and eyes) in newborn babies (up to 4 weeks old).

Your doctor will choose the dose that is right for you. Your dose will be shown clearly on the label that your pharmacist puts on your medicine. If it does not or you are not sure, ask your doctor or pharmacist.

You may have been given a steroid card which also tells you how many tablets to take each day (see section 6).

Method of administration:

Your tablets can be swallowed whole, but they are best taken as a drink after allowing them to dissolve in a glass of water.

Do not exceed the stated dose.

Do not suddenly stop taking the tablets even if you feel better unless your doctor tells you to - you could become ill.

The dose used will depend upon the disease, its severity and how quickly you get better. The following doses are a guide only:

Adults

Short term treatment:

• 2000 - 3000 micrograms (4-6 tablets) daily for the first few days, then;
• Your doctor may reduce the daily dose by 250 - 500 micrograms (1/2 or 1 tablet) every two to five days, depending upon the response.

Rheumatoid arthritis:

• 500 - 2000 micrograms (1-4 tablets) daily;
• For long-term treatment the dose may be lower.

Most other conditions:

• 1500 - 5000 micrograms (3-10 tablets) daily for one to three weeks;
• Your doctor may then gradually reduce this to a lower dose;
• Larger doses may be needed for mixed connective tissue diseases and ulcerative colitis.

If you need to take half a tablet you should break one in half. Use the break line on one side of the tablet to help you snap it.

Use in children and adolescents

• A proportion of the adult dose may be used. Your doctor will advise how much.

If you have any queries about the amount of medicine you have been prescribed, ask your doctor.

While you are taking this medicine, your doctor may ask you to have check-ups. These are to make sure that your medicine is working properly and that the dose you are taking is right for you.

Do not take more Betamethasone Soluble Tablets than you should. If you accidentally take too much, immediately contact the nearest hospital casualty department or your doctor.

Do not take a double dose to make up for a forgotten dose. Take your next dose at the usual time.

Do not stop taking Betamethasone Soluble Tablets without first talking to your doctor.

It is very important that you do not suddenly stop taking Betamethasone Soluble Tablets, even if you feel better from your original illness or are suffering from a side effect, unless your doctor tells you to.

If you stop taking your medicine too suddenly, you may suffer from some of the following: Fever, joint and muscle pain, itching eyes, nose or skin, mood changes, loss of weight, low hormone levels and low blood pressure, symptoms of which may include dizziness, headaches or fainting. In extreme cases, this can be fatal. Your doctor will tell you how to stop taking Betamethasone Soluble Tablets.

Steroids including betamethasone can cause serious mental health problems. These are common in both adults and children. They can affect about 5 in every 100 people taking medicines like betamethasone.

• Feeling depressed, including thinking about suicide;
• Feeling high (mania) or moods that go up and down;
• Feeling anxious, having problems sleeping, difficulty in thinking or being confused and losing your memory;
• Feeling, seeing or hearing things which do not exist. Having strange and frightening thoughts, changing how you act or having feelings of being alone.

If you notice any of these problems talk to a doctor straight away.

Most people find that using this medicine for a short time causes no problems. If you need to take the tablets for more than two weeks your doctor will prescribe as low as possible, dose.

Not known (Frequency cannot be estimated from the available data)

High doses taken for a long time or repeated short courses, can lead to side effects such as:

• low levels of hormones which can cause irregular menstrual periods in women, suppression of growth in adolescents and children, changes in blood sugar, salt or protein levels, extra hair growth and/or weight gain, increased sweating or increases in appetite;
• increased levels of cholesterol in your blood;
• increased susceptibility to infection, including worsening of tuberculosis (TB) if this is already present;
• wasting of muscles, thinning of the bones (osteoporosis) or fractures, breaking of tendons and breakdown of the bone due to lack of blood supply;
• water retention (which may cause a bloated feeling) or higher blood pressure (symptoms may include headaches) or changes in blood chemistry due to loss of potassium;
• if you have recently had a heart attack, betamethasone can sometimes cause a serious complication of the heart, whereby the tissues can become affected by tears or breaks;
• mood changes, depression, sleep problems or worsening of epilepsy or schizophrenia if you already have either of these problems;
• children may experience swelling and fluid build-up near the eyes and brain (this may result in a throbbing headache which may be worse upon waking up, coughing or sudden movement and patchy vision with blind spots and possible lack of colour vision);
• increased pressure in the eye (glaucoma), cataract, worsening of viral or fungal diseases, thinning of the cornea or sclera (the outer membrane of the eye) or other eye problems (which may cause headaches or blurred vision);
• heartburn or indigestion, hiccups, nausea, bloating of the abdomen, stomach ulcers which may bleed, oesophageal ulcer, thrush in the mouth or throat or pancreas disorders;
• bruising, poor wound healing, abscesses, acne, rashes, thinning of the skin, prominent veins, changes in skin colour or blistering of the skin, mouth, eyes and genital;
• blood clots or allergic reactions (which can include rashes, breathing difficulties or shock), blood disorders or heart failure;
• Blurred vision

Additional care should be taken if this medicine is given to elderly patients, as side effects may be more serious.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is betamethasone, as betamethasone sodium phosphate.

Each tablet contains 500 micrograms (0.5mg) betamethasone as betamethasone sodium phosphate

• The other ingredients are sodium hydrogen carbonate (E500), sodium acid citrate, saccharin sodium, povidone, erythrosine (E127) and sodium benzoate (E211).

Betamethasone Soluble Tablets are round, pink soluble tablets, scored on one side and with ‘Betnesol Evans’ engraved on the other. Betamethasone Soluble Tablets are supplied in blister packs of 100 tablets.