Adrenal suppression with intranasal betamethasone drops

Abstract

Intranasal betamethasone sodium phosphate drops (Betnesol) are frequently used to relieve nasal congestion due to polyposis. We report a case of significant hypothalamic-pituitary-adrenal suppression secondary to the long-term use of intranasal betamethasone drops. This case emphasizes that the topical application of potent corticosteroids may produce systemic effects.

Dose‐related efficacy and tolerability of fluticasone propionate nasal drops 400 μg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo‐controlled randomized study in adult patients

“…Topical corticosteroids are widely recognized as the fundamental medical treatment for nasal polyps [ 8–10] although the available systems for intranasal drug delivery are not ideally suited to the long‐term corticosteroid usage required to control polyposis. Accurate drug delivery and low systemic bioavailability are of particular importance in these chronic conditions, and the FPND unit dose formulation has been developed specifically to address the problem of safe and effective treatment of nasal polyps [ 22–27]. Previous studies have demonstrated significant reductions in polyp size using the aqueous nasal spray formulation (FPANS) at a dose of 200 μg b.i.d.…”

“…This apparent discrepancy between improved distribution yet lower systemic bioavailability of FPND is thought to arise as a result of the increased ciliary clearance that occurs in the posterior nasal cavity. Low systemic bioavailability is an important consideration in patients requiring long‐term topical treatment with corticosteroids and unit dose FPND has advantages over betamethasone sodium phosphate, the only alternative steroid nasal drops currently available, which has shown systemic side‐effects and can be over‐dosed [ 26, 27]. FPND is therefore indicated for the regular treatment of nasal polyps.…”

Effects of Inhaled or Nasal Glucocorticoids on Adrenal Function and Growth

“…This raises the question of the type of GCS administered, dosing and frequency of administration, as in one report "liberal and frequent application" was observed 40 . At high doses there is some evidence that significant adrenal suppression may occur.…”

Do topical ophthalmic corticosteroids suppress the hypothalmic-pituitary-adrenal axis in post-penetrating keratoplasty patients?

“…1 Despite this, recent reports suggest that the topical and inhaled use of corticosteroids can lead to suppression of the hypothalmic-pituitaryadrenal (HPA) axis [2][3][4][5] that is, exogenous, supraphysiological corticosteroid levels suppress both corticotrophin-releasing factor production in the hypothalamus and adrenocorticotrophic hormone production in the pituitary gland. This suppression, depending on its severity, may significantly reduce cortisol production by the adrenal glands (leading to adrenal atrophy), causing systemic effects that can lead to confusion, hyponatreamia, and life-threatening hypotension in the event of a trauma, surgery, or illness, known as an 'adrenal crisis'.…”