Subcutaneous betamethasone: an alternative to out-of-stock dexamethasone

Dexamethasone is the most widely used corticosteroid in palliative care due to its potent anti-inflammatory action. When oral administration is not feasible, dexamethasone is often administered subcutaneously. During a recent shortage of injectable dexamethasone, we were required to consider alternatives. However, evidence and clinical experience regarding the use of alternative subcutaneous corticosteroids in the palliative population remain limited. Our objective was to evaluate the clinical effectiveness and tolerability of subcutaneously administered betamethasone in the palliative demographic as an alternative to out-of-stock dexamethasone injection. Eight patients received subcutaneous betamethasone for various indications, including intracranial hypertension, liver capsule pain, superior vena cava obstruction, malignant spinal cord compression and subacute bowel obstruction. All patients tolerated the treatment at different doses (range 1-16 mg) for various periods (range 6-27 days) without developing injection-site reactions or severe adverse effects. Improvement in symptom scores and relevant clinical assessments were observed. Subcutaneously administered betamethasone was well tolerated and effective in managing various indications in palliative patients, demonstrating its potential as a viable alternative to dexamethasone during stock shortages. Further prospective studies are required to establish its utility and tolerability in this demographic.