Celestamine

Special precautions

If celestamine contains Betamathasone :

As it contains Betamethasone as an active ingredient, adjustments of dosages in both adults and children may be required with remission or exacerbation of the clinical condition. Also, we should consider each patient’s individual response to therapy and exposure of the patient to psychological or physical stress such as injury, surgery or serious infection.

Betamethasone is a Corticosteroid, so we should monitor the patient for at least up to one year following the discontinuation of long-term or high-dose corticosteroid therapy.

Since complications of glucocorticoid therapy are dependent on duration and dosage of treatment, doctor should make the decision of risk or benefit for with each patient and their associated comorbidities.

Since high dose or long-term corticosteroid therapy is associated with many side effects like osteoporosis (fragile bones), hypertension (high blood pressure), diabetes etc. the lowest possible dose of corticosteroid should be used to control the condition under treatment. A gradual reduction of dosage is recommended.

When the drugs are used in patients who have other comorbidities like hypothyroidism and cirrhosis, adverse effects of corticosteroids are increased.

Patients who take corticosteroids should be cautious if it’s used in patients with ocular herpes simplex because of possible risk of corneal perforation.

Psychological derangements also reported with corticosteroid therapy and those who already have emotional instability or psychotic tendencies may be aggravated by corticosteroid drugs like betamethasone/celestamine preparations.

These drugs should be used with caution conditions such as diverticulitis, fresh intestinal anastomoses, nonspecific ulcerative colitis, if there is a possible impending perforation, other pyogenic infection, abscess, or active or latent peptic ulcer disease, myasthenia gravis, osteoporosis, hypertension and renal insufficiency.

Since Corticosteroids are immunosuppressive agents, they may mask some signs of ongoing infection, and new infections may also appear during use. When corticosteroids are used, decreased resistance and inability to localize infection may occur.

Prolonged use of corticosteroid may lead to glaucoma with possible damage to the optic nerves, posterior subcapsular cataracts (mainly in children) and may increase the chance of secondary ocular infections due to fungi or viruses.

Elevation of blood pressure, retention of salt and water, and increased excretion of potassium which lead to hypokalemic complications may also occur with average and large doses of corticosteroids.

However, these side effects are less likely to occur when synthetic derivatives of corticosteroids are used except when used in large doses.

Supplementation of potassium and restriction of Dietary salt may be considered for these patients. All corticosteroids will increase excretion of calcium. So, it’s advised to take calcium supplements or calcium rich foods to prevent complications that can occur with long term calcium deficiency.

Since corticosteroids have immunosuppressive actions, patients should never be vaccinated for small pox. Other immunization procedures also should never be undertaken in patients who receive treatments with corticosteroids like betamethasone, celestamine etc., especially high doses, because of lack of antibody response and possible risk of neurological complications.

Patients who are on treatment with immunosuppressant doses of corticosteroids should be warned and they should avoid exposure to chicken pox or measles. If exposed, they should immediately obtain medical advice as it might end up in serious complications.  This is particularly important in children, elderly patients and patients who are already on immunosuppressive state like diabetes mellitus.

Treatment with Corticosteroid is in active tuberculosis should be restricted to those patients with disseminated or fulminating tuberculosis in which the corticosteroid is used in conjunction with an appropriate antituberculous regimen.

If corticosteroids are used in patients with latent tuberculosis, close monitoring is necessary since reactivation of the disease may occur due to suppression of immune system. Patients should receive chemoprophylaxis during prolonged corticosteroid therapy.

Growth and development of children who receive corticosteroid therapy for a prolonged period should be assessed carefully, since administration of corticosteroid can disturb the growth rates and inhibit the production of endogenous corticosteroids in these patients.

Celestamine should not be used in newborn and premature infants.

Corticosteroid therapy may alter the motility and number of spermatozoa.

If Celestamine contains Dexchlorpheniramine Maleate :

Celestamine products containing Betamethasone/Dexchlorphenamine Maleate should be used with caution in patients with pyloroduodenal obstruction, peptic ulcer disease, narrow angle glaucoma, prostatic hypertrophy or bladder neck obstruction, cardiovascular disease including hypertension, in those with increased intraocular pressure or hyperthyroidism.

Patients should be warned about involving in activities requiring mental alertness, such as driving vehicles or operating machines etc.

Dexchlorpheniramine is a first-generation histamine receptor antagonist which crosses the blood brain barrier and causes dizziness, sedation, and hypotension in patients over 60 years of age.