METI-DERM
Clinical safety rating: caution
Comprehensive clinical and safety monograph for METI-DERM (METI-DERM).
METI-DERM contains methylprednisolone aceponate, a corticosteroid that binds to glucocorticoid receptors, modulating gene expression to inhibit pro-inflammatory cytokines, phospholipase A2, and prostaglandin synthesis, thereby reducing inflammation, pruritus, and vasodilation.
| Metabolism | Methylprednisolone aceponate is hydrolyzed by esterases in the skin and systemically to methylprednisolone, which undergoes hepatic metabolism via CYP3A4 to inactive metabolites. |
| Excretion | Renal: ~60% as unchanged drug and metabolites; biliary/fecal: ~35% as metabolites and unchanged drug; minor respiratory elimination. |
| Half-life | Terminal elimination half-life: 6–8 hours in healthy adults; prolonged to 12–15 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Approximately 88% bound primarily to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Vd: 0.8–1.2 L/kg; indicates moderate tissue distribution with accumulation in inflamed tissues. |
| Bioavailability | Topical: ~2–5% systemic bioavailability; oral: ~70–80% with first-pass metabolism. |
| Onset of Action | Topical: within 1–2 hours for anti-inflammatory effect; peak plasma concentrations at 4–6 hours after topical application. |
| Duration of Action | Topical: anti-inflammatory effects persist for 12–24 hours; systemic effects may last up to 24 hours after single dose. |
| Molecular Weight | 504.6 Da (betamethasone dipropionate) |
Apply a thin film topically to affected area once or twice daily.
| Dosage form | CREAM |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | For children 2 years and older, apply a thin film topically to affected area once or twice daily. Safety and efficacy in children under 2 years have not been established. |
| Geriatric use | Use with caution due to potential for skin atrophy and increased systemic absorption; apply the smallest amount for the shortest duration necessary. |
| 1st trimester | Contains betamethasone dipropionate (class C corticosteroid): Animal studies show teratogenicity; human risk unclear. Avoid if possible. |
| 2nd trimester | Limited data; use only if benefit outweighs risk. Topical absorption minimal but caution advised. |
| 3rd trimester | Prolonged use may cause fetal adrenal suppression or low birth weight. Avoid large areas, prolonged use, or occlusive dressings. |
Clinical note
Comprehensive clinical and safety monograph for METI-DERM (METI-DERM).
| Placental transfer | Betamethasone crosses the placenta; systemic absorption after topical use is low (<5%), but significant if used on large areas/damaged skin. Fetal exposure can cause adrenal suppression. |
| Breastfeeding | Betamethasone is excreted into breast milk in small amounts, but systemic absorption after topical application is negligible. However, avoid application to the breast or nipple area to prevent infant ingestion. Use lowest potency for shortest duration. |
■ FDA Black Box Warning
None (not an FDA boxed warning drug)
| Serious Effects |
Hypersensitivity to betamethasone or any componentFungal, viral (e.g., herpes simplex, varicella), or bacterial skin infectionsRosaceaPerioral dermatitis
| Precautions | Topical corticosteroids may cause reversible HPA axis suppression, Cushing's syndrome, hyperglycemia, and glucosuria upon systemic absorption, especially with use on large surface areas, occlusive dressings, or in pediatric patients., Local adverse reactions include skin atrophy, striae, telangiectasias, burning, itching, and allergic contact dermatitis., Avoid use in the presence of untreated bacterial, fungal, or viral cutaneous infections., Pediatric patients may be more susceptible to systemic toxicity due to higher skin surface-to-body weight ratios., Not for ophthalmic or oral use. Discontinue if irritation develops. |
| Food/Dietary | No known food interactions. No dietary restrictions required. |
Loading safety data…
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Insufficient human data; animal studies not performed; use only if benefit outweighs risk; potential fetal harm cannot be excluded. |
| Fetal Monitoring | Monitor fetal growth ultrasound if used during second/third trimester; assess for signs of maternal adrenal suppression. |
| Fertility Effects | No known impairment of fertility in animal studies; human data lacking. |
| Clinical Pearls | METI-DERM (clobetasol propionate 0.05% cream/ointment) is a super-high-potency topical corticosteroid. Avoid using on face, groin, axillae, or intertriginous areas. Limit use to 2 consecutive weeks; do not exceed 50 g/week. Monitor for HPA axis suppression with prolonged use. Taper dose when discontinuing to avoid rebound. |
| Patient Advice | Apply thin layer to affected areas only, usually once or twice daily as directed. · Do not use on face, underarms, groin, or areas with broken skin. · Wash hands after application (unless hands are being treated). · Do not cover treated area with bandages or plastic wrap unless instructed by doctor. · Avoid using for more than 2 continuous weeks; report if no improvement after 2 weeks. · Avoid contact with eyes. If contact occurs, rinse with plenty of water. · Do not use for diaper rash or in children under 12 years. · Inform your healthcare provider about any other skin products you are using. |