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Corticosteroids - topical (skin), nose, and eyes - Management
Basis for recommendation
Most of the recommendations on minimizing adverse effects are based on published expert opinion [Scadding et al, 2008], the British National Formulary [BNF 59, 2010], and a drug reference database [Sweetman, 2009].
- Nasal drops — betamethasone drops have a higher systemic bioavailability, and therefore a greater potential for adverse effects, than other intranasal corticosteroids [Scadding et al, 2008]. The risk of systemic effects is more likely with drops than sprays, as these are more likely to be administered incorrectly [BNF 59, 2010]. Fluticasone nasal drops are considered to have an extremely low systemic bioavailability [ABPI Medicines Compendium, 2009b].
- The Commission on Human Medicines (formerly the Committee on Safety of Medicines) recommends that the height of children receiving high doses of intranasal steroids over extended periods be frequently monitored, and treatment reviewed if any effect on growth is observed [CSM, 1998].
- Techniques for the use of nasal drops and sprays is from a manufacturer's Patient Information Leaflets [ABPI Medicines Compendium, 2008b; ABPI Medicines Compendium, 2010b].
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