倍他米松

**倍他米松**
臨床資料
商品名（英語：Drug nomenclature）	Celestone、Eleuphrat及其他
AHFS/Drugs.com	Monograph
MedlinePlus	a682799
核准狀況	美 DailyMed: Betamethasone;
懷孕分級	澳: C ; ;
給藥途徑	口服給藥、外用藥物及肌肉注射
ATC碼	A07EA04 (WHO) C05AA05 D07AC01 D07BC01 D07CC01 D07XC01 H02AB01 R01AD06 R03BA04 S01BA06 S01BB04 S01CA05 S01CB04 S02BA07 S03BA03 S03CA06;
法律規範狀態
法律規範	澳：限醫生處方（S4）; 英：處方藥（℞-only） (POM); 美：處方藥（℞-only）; 處方藥（℞-only）;
藥物動力學數據
藥物代謝	肝臟CYP3A4
生物半衰期	36-54小時
排泄途徑	腎臟 (經由尿液排出人體)
識別資訊
	IUPAC命名法 (8S,9R,10S,11S,13S,14S,16S,17R)-9-Fluoro- 11,17-dihydroxy-17-(2-hydroxyacetyl)-10,13,16-trimethyl- 6,7,8,9,10,11,12,13,14,15,16,17-dodecahydro- 3H-cyclopenta[a]phenanthren-3-one; ;
CAS號	378-44-9
PubChem CID	9782;
IUPHAR/BPS	7061;
DrugBank	DB00443 ;
ChemSpider	9399 ;
UNII	9842X06Q6M;
KEGG	D00244 ;
ChEBI	CHEBI:3077 ;
ChEMBL	ChEMBL632 ;
CompTox Dashboard（英語：CompTox Chemicals Dashboard） (EPA)	DTXSID3022667 ;
ECHA InfoCard	100.006.206
化學資訊
化學式	C22H29FO5
摩爾質量	392.47 g·mol−1
3D模型（JSmol（英語：JSmol））	交互式圖像;
	SMILES O=C(CO)[C@]3(O)[C@]2(C[C@H](O)[C@]4(F)[C@@]/1(\C(=C/C(=O)\C=C\1)CC[C@H]4[C@@H]2C[C@@H]3C)C)C;
	InChI InChI=1S/C22H29FO5/c1-12-8-16-15-5-4-13-9-14(25)6-7-19(13,2)21(15,23)17(26)10-20(16,3)22(12,28)18(27)11-24/h6-7,9,12,15-17,24,26,28H,4-5,8,10-11H2,1-3H3/t12-,15-,16-,17-,19-,20-,21-,22-/m0/s1 ; Key:UREBDLICKHMUKA-DVTGEIKXSA-N ;

倍他米松（英語：Betamethasone）是一種類固醇藥物，^[3]用於治療多種疾病，包括類風濕性關節炎和全身性紅斑狼瘡等風濕性疾病、皮膚炎和乾癬等皮膚病、氣喘和血管性水腫等過敏性疾病、促進早產嬰兒肺部發育、克隆氏症、白血病等癌症，以及與氟氫可的松（英語：fludrocortisone）聯合使用以治療腎上腺功能不全（英語：adrenal insufficiency）等。^[3]給藥方式有口服、肌肉注射或在皮膚上塗抹（通常有霜劑、乳液或液體形式）。^[3]^[4]

使用此藥物後嚴重的副作用有感染風險增加、肌肉無力、嚴重過敏反應和思覺失調。^[3]長期使用可能會導致腎上腺功能不全。^[3]長期使用後突然停藥可能會有嚴重性後果。^[3]使用霜劑通常會導致毛髮增長和皮膚不適。^[4]倍他米松屬於糖皮質素類藥物。^[3]它是地塞米松的立體異構體，這兩種化合物僅在16位甲基的空間構型上有所不同（參見類固醇#命名法）。^[5]

醫療用途[編輯]

倍他米松是一種皮質類固醇，有丸劑、注射劑、軟膏、乳膏、乳液、凝膠或皮膚用噴霧劑，以及用於頭皮的泡沫劑。^[6]經注射給藥時，抗炎性作用約會在兩小時內開始，並持續7天。^[3]

乳膏可用於緩解皮膚不適（例如皮膚炎引起的瘙癢和剝落）。它用作局部乾癬的治療，與二丙酸倍他米松（英語：betamethasone dipropionate）（倍他米松衍生物）或是水楊酸的作用相似，或與卡泊三醇/倍他米松二丙酸（英語：Calcipotriol/betamethasone dipropionate）組成複方劑使用。（參見卡泊三醇/二丙酸倍他米松#Regulation}}）倍他米松磷酸鈉（英語：Betamethasone phosphate）可作口服劑和注射劑，其適應症與其他類固醇相同。很多以倍他米松為基礎的藥物都含有戊酸酯類固醇。(如Betamethasone valerate（英語：倍他米松二丙酸酯）與倍他米松二丙酸（英語：betamethasone dipropionate）)

在一項隨機對照試驗中，倍他米松被證明可將與共濟失調微血管擴張症候群 (A-T) 相關的一些共濟失調症狀減輕28-31%。^[7]

倍他米松也用於刺激胎兒肺臟成熟，以預防新生兒呼吸窘迫症候群 (IRDS) ，並降低早產兒顱內出血的發生率和死亡率。^[8]

含有0.05%倍他米松的乳膏似乎可有效治療男孩的包莖問題，^[9]而通常因此能避免包皮環切術。^[10]^[11]^[12]此藥物已成為英國國民保健署體系中一些醫生的首選，用以避免包皮環切的治療方式。^[13]^[14]

副作用[編輯]

欣快感^[15]
抑鬱症^[15]
腎上腺功能不全^[15]
高血壓^[15]
皮下微血管群變明顯，出現瘀點^[15]
多毛症^[15]
瘀斑^[15]

在大面積皮膚、破損或裸露皮膚、皮膚皺褶或密封敷料之下長時間使用如倍他米松的皮質類固醇藥物，在極少數情況下可能會導致吸收過多，所產生的副作用例如有局部皮膚變薄，及導致腎上腺減少產生天然激素。

倍他米松也可在早產兒分娩前使用，以幫助其肺部發育。

當注射到人體硬膜外腔（英語：epidural space）或脊柱時，可能會導致嚴重的副作用，如視力喪失、中風和癱瘓。^[16]

藥理學[編輯]

形式[編輯]

倍他米松有多種化合物形式：二丙酸倍他米松（品牌有Diprosone、Diprolene、Celestamine、Procort（於巴基斯坦）等）、倍他米松磷酸鈉（於意大利，品牌名稱有Bentelan）和倍他米松二丙酸酯（品牌名稱有Audavate、Betnovate 、Celestone、Fucibet（夫西地酸/倍他米松二丙酸酯（英語：Fusidic acid/betamethasone valerate）複方藥））等。在美國和加拿大，倍他米松與克催瑪汝混合，以Lotrisone和Lotriderm的品牌銷售。它還與水楊酸組合用於治療乾癬（品牌名稱為Diprosalic）。在一些國家，它也與克催瑪汝和慶大黴素（兩者皆為（抗細菌藥）混合販售。

倍他米松磷酸鈉與醋酸倍他米松（英語：betamethasone acetate）的混合物在美國以Celestone Soluspan的品牌名稱出售。^[17]

社會與文化[編輯]

倍他米松的專利於1958年在美國提出申請，於1961年獲得，也於1961年取得美國的核准用於醫療用途。^[3]^[18]此藥物的霜劑和軟膏已列入世界衛生組織基本藥物標準清單之中。^[19]由於專利已過期，市面有其通用名藥物販售。^[3]此藥物於2021年在美國最常用處方藥中排名第251，開立的處方箋數量超過100萬張。^[20]^[21]

參見[編輯]

倍他米松/右氯苯那敏（英語：Betamethasone/dexchlorpheniramine）

參考文獻[編輯]

^ Betamethasone Use During Pregnancy. Drugs.com. 2019-12-30 [2020-03-29].
^ Betamethasone 500 microgram Soluble Tablets - Summary of Product Characteristics (SmPC). (emc). 2018-04-05 [2020-03-29].
^ ^3.00 ^3.01 ^3.02 ^3.03 ^3.04 ^3.05 ^3.06 ^3.07 ^3.08 ^3.09 Betamethasone. The American Society of Health-System Pharmacists. [2015-12-02]. （原始內容存檔於2015-12-08）.
^ ^4.0 ^4.1 Betamethasone topical. The American Society of Health-System Pharmacists. [2015-12-02]. （原始內容存檔於2015-12-08）.
^ Antignac JP, Le Bizec B, Monteau F, Andre F. Differentiation of betamethasone and dexamethasone using liquid chromatography/positive electrospray tandem mass spectrometry and multivariate statistical analysis. Journal of Mass Spectrometry. January 2002, 37 (1): 69–75. Bibcode:2002JMSp...37...69A. PMID 11813313. doi:10.1002/jms.260.
^ Betamethasone Topical. MedlinePlus. 2020-03-19 [2020-03-29].
^ Zannolli R, Buoni S, Betti G, Salvucci S, Plebani A, Soresina A, et al. A randomized trial of oral betamethasone to reduce ataxia symptoms in ataxia telangiectasia. Movement Disorders. September 2012, 27 (10): 1312–1316. PMID 22927201. S2CID 23696748. doi:10.1002/mds.25126.
^ Antenatal Corticosteroid Therapy for Fetal Maturation. ACOC Clinical. August 2017 [2024-03-31].
^ Moreno G, Corbalán J, Peñaloza B, Pantoja T. Topical corticosteroids for treating phimosis in boys. The Cochrane Database of Systematic Reviews. September 2014, 9 (9): CD008973. PMC 10765470 . PMID 25180668. doi:10.1002/14651858.CD008973.pub2.
^ Van Howe RS. Cost-effective treatment of phimosis. Pediatrics. October 1998, 102 (4): E43. PMID 9755280. doi:10.1542/peds.102.4.e43 . （原始內容存檔於2009-08-19）. A review of estimated costs and complications of 3 phimosis treatments.
^ Esposito C, Centonze A, Alicchio F, Savanelli A, Settimi A. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World Journal of Urology (Springer Science and Business Media LLC). April 2008, 26 (2): 187–190. PMID 18157674. S2CID 8922151. doi:10.1007/s00345-007-0231-2.
^ Zampieri N, Corroppolo M, Zuin V, Bianchi S, Camoglio FS. Phimosis and topical steroids: new clinical findings. Pediatric Surgery International. April 2007, 23 (4): 331–335. PMID 17308904. S2CID 22849471. doi:10.1007/s00383-007-1878-x.
^ Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU International. February 2001, 87 (3): 239–244. PMID 11167650. S2CID 2161551. doi:10.1046/j.1464-410x.2001.02033.x .
^ Chu CC, Chen KC, Diau GY. Topical steroid treatment of phimosis in boys. The Journal of Urology. September 1999, 162 (3 Pt 1): 861–863. PMID 10458396. doi:10.1097/00005392-199909010-00078.
^ ^15.0 ^15.1 ^15.2 ^15.3 ^15.4 ^15.5 ^15.6 betamethasone (PDF). F.A. Davis. 2017 [2017-03-07]. （原始內容存檔 (PDF)於2017-09-08）.
^ FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. FDA. 2014-04-23 [2016-08-15]. （原始內容存檔於2016-08-11）.
^ Celestone Soluspan- betamethasone acetate and betamethasone sodium phosphate injection, suspension. DailyMed. 2019-11-18 [2020-03-29].
^ Fischer J, Ganellin CR. Analogue-based Drug Discovery. John Wiley & Sons. 2006: 485. ISBN 9783527607495.
^ World Health Organization. World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. hdl:10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^ The Top 300 of 2021. ClinCalc. [2024-01-14]. （原始內容存檔於2024-01-15）.
^ Betamethasone - Drug Usage Statistics. ClinCalc. [2024-01-14].

Template:Nasal preparations

模板:皮膚病用抗生素和化療藥

[Drugs.com_pregnancy-1] Betamethasone Use During Pregnancy. Drugs.com. 2019-12-30 [2020-03-29].

[2] Betamethasone 500 microgram Soluble Tablets - Summary of Product Characteristics (SmPC). (emc). 2018-04-05 [2020-03-29].

[AHFS2015-3] 3.00 ^3.01 ^3.02 ^3.03 ^3.04 ^3.05 ^3.06 ^3.07 ^3.08 ^3.09 Betamethasone. The American Society of Health-System Pharmacists. [2015-12-02]. （原始內容存檔於2015-12-08）.

[AHFS2015Top-4] 4.0 ^4.1 Betamethasone topical. The American Society of Health-System Pharmacists. [2015-12-02]. （原始內容存檔於2015-12-08）.

[5] Antignac JP, Le Bizec B, Monteau F, Andre F. Differentiation of betamethasone and dexamethasone using liquid chromatography/positive electrospray tandem mass spectrometry and multivariate statistical analysis. Journal of Mass Spectrometry. January 2002, 37 (1): 69–75. Bibcode:2002JMSp...37...69A. PMID 11813313. doi:10.1002/jms.260.

[6] Betamethasone Topical. MedlinePlus. 2020-03-19 [2020-03-29].

[A_Randomized_Trial_of_Oral_Betamethazone_to_Reduce_Ataxia_Symptoms_in_Ataxia_Telangiectasia-7] Zannolli R, Buoni S, Betti G, Salvucci S, Plebani A, Soresina A, et al. A randomized trial of oral betamethasone to reduce ataxia symptoms in ataxia telangiectasia. Movement Disorders. September 2012, 27 (10): 1312–1316. PMID 22927201. S2CID 23696748. doi:10.1002/mds.25126.

[ACOC_Clinical-8] Antenatal Corticosteroid Therapy for Fetal Maturation. ACOC Clinical. August 2017 [2024-03-31].

[9] Moreno G, Corbalán J, Peñaloza B, Pantoja T. Topical corticosteroids for treating phimosis in boys. The Cochrane Database of Systematic Reviews. September 2014, 9 (9): CD008973. PMC 10765470 . PMID 25180668. doi:10.1002/14651858.CD008973.pub2.

[vanHowe1998-10] Van Howe RS. Cost-effective treatment of phimosis. Pediatrics. October 1998, 102 (4): E43. PMID 9755280. doi:10.1542/peds.102.4.e43 . （原始內容存檔於2009-08-19）. A review of estimated costs and complications of 3 phimosis treatments.

[World_Journal_of_Urology-11] Esposito C, Centonze A, Alicchio F, Savanelli A, Settimi A. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World Journal of Urology (Springer Science and Business Media LLC). April 2008, 26 (2): 187–190. PMID 18157674. S2CID 8922151. doi:10.1007/s00345-007-0231-2.

[Pediatric_Surgery_International-12] Zampieri N, Corroppolo M, Zuin V, Bianchi S, Camoglio FS. Phimosis and topical steroids: new clinical findings. Pediatric Surgery International. April 2007, 23 (4): 331–335. PMID 17308904. S2CID 22849471. doi:10.1007/s00383-007-1878-x.

[Berdue2001-13] Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU International. February 2001, 87 (3): 239–244. PMID 11167650. S2CID 2161551. doi:10.1046/j.1464-410x.2001.02033.x .

[Chu1999-14] Chu CC, Chen KC, Diau GY. Topical steroid treatment of phimosis in boys. The Journal of Urology. September 1999, 162 (3 Pt 1): 861–863. PMID 10458396. doi:10.1097/00005392-199909010-00078.

[Davis-15] 15.0 ^15.1 ^15.2 ^15.3 ^15.4 ^15.5 ^15.6 betamethasone (PDF). F.A. Davis. 2017 [2017-03-07]. （原始內容存檔 (PDF)於2017-09-08）.

[16] FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. FDA. 2014-04-23 [2016-08-15]. （原始內容存檔於2016-08-11）.

[17] Celestone Soluspan- betamethasone acetate and betamethasone sodium phosphate injection, suspension. DailyMed. 2019-11-18 [2020-03-29].

[Fis2006-18] Fischer J, Ganellin CR. Analogue-based Drug Discovery. John Wiley & Sons. 2006: 485. ISBN 9783527607495.

[WHO21st-19] World Health Organization. World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. hdl:10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.

[20] The Top 300 of 2021. ClinCalc. [2024-01-14]. （原始內容存檔於2024-01-15）.

[21] Betamethasone - Drug Usage Statistics. ClinCalc. [2024-01-14].

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