Posology : מינונים

4.2    Posology and method of administration
DOSING REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE SPECIFIC DISEASE, THE SEVERITY OF THE CONDITION AND THE RESPONSE OF THE PATIENT.

The initial dose should be maintained or adjusted until a satisfactory response is observed. If a satisfactory clinical response does not occur after a reasonable period of time, treatment with Diprospan Suspension should be discontinued and other appropriate therapy initiated.

Systemic Administration:

For systemic therapy, treatment is initiated with 1 to 2 ml in most conditions and repeated as necessary.
Administration is by deep intramuscular (IM) injection in the gluteal region. Dosage and frequency of administration will depend on the severity of the patient’s condition and the therapeutic response.

In a severe illness, such as lupus erythematosus or status asthmaticus which has been resolved by appropriate life-saving procedures, 2 ml might be required initially.

A wide variety of dermatologic conditions respond to IM injections of corticosteroids. An IM injection of 1 ml, repeated according to the response of the condition, has been found to be effective.

In respiratory tract disorders, onset of relief of symptoms has occurred within a few hours after IM injection of Diprospan Suspension. Effective control of symptoms with 1 to 2 ml is obtained in bronchial asthma, hay fever, allergic bronchitis and allergic rhinitis.

In the treatment of acute or chronic bursitis, excellent results are obtained with 1 to 2 ml IM injection of Diprospan Suspension, repeated as necessary.

Local Administration:

Concomitant use of local anesthetic is rarely necessary. If coadministration of a local anesthetic is desired, Diprospan Suspension may be mixed (in the syringe) with 1% or 2% procaine hydrochloride or lidocaine, using formulations which do not contain parabens. Similar local anesthetics may also be used.
Anesthetics containing methylparaben, propylparaben, phenol, etc. should be avoided. The required dose of Diprospan Suspension is first withdrawn into the syringe. The local anesthetic is then drawn in, and the syringe is shaken briefly.

In acute subdeltoid, subacromial, olecranon, and prepatellar bursitis, an intrabursal injection of 1 to 2 ml of Diprospan Suspension may relieve pain and restore full range of movement within a few hours.
Chronic bursitis may be treated with reduced dosage once acute symptoms are controlled. In acute tenosynovitis, tendinitis, and peritendinitis, one injection of Diprospan Suspension should alleviate the condition. In chronic forms of these conditions, it may be necessary to repeat the injections as the patient’s condition requires.

Following 0.5 to 2 ml intra-articular administration of Diprospan Suspension, relief of pain, soreness, and stiffness associated with rheumatoid arthritis and osteoarthritis may be experienced within two to four hours. Duration of relief, which varies widely in both diseases, is four or more weeks in the majority of cases. An intra-articular injection of Diprospan Suspension is well tolerated in the joint and peri-articular tissues. Recommended doses for intra-articular injection are: large joints (knee, hip, shoulder), 1 – 2 ml; medium joints (elbow, wrist, ankle), 0.5 – 1 ml; small joints (foot, hand, chest), 0.25 – 0.5 ml.

Dermatologic conditions may respond to intralesional administration of Diprospan Suspension. An intradermal dosage of 0.2 ml/cm2 of Diprospan Suspension evenly injected with a tuberculin syringe and a 26-gauge needle is recommended. The total amount of Diprospan Suspension injected at all sites each week should not exceed 1 ml.

Diprospan Suspension may be used effectively in disorders of the foot that are responsive to corticosteroids.

Bursitis under heloma durum (corn) may be controlled with two successive injections of 0.25 ml each. In some conditions such as hallux rigidus, digiti quinti varus (fifth toe varus) and acute gouty arthritis, onset of relief may be rapid. A tuberculin syringe with a 25-gauge needle is suitable for most injections.
Recommended doses at intervals of approximately one week: bursitis under heloma (corn) durum or molle, 0.25 – 0.5 ml; bursitis under calcaneal spur, 0.5 ml; bursitis over hallux rigidus, 0.5 ml; bursitis over digiti quinti varus (fifth toe varus), 0.5 ml; synovial cyst, 0.25 – 0.5 ml; Morton’s neuralgia (metatarsalgia), 0.25 – 0.5 ml; tenosynovitis, 0.5 ml; periostitis of cuboid, 0.5 ml; acute gouty arthritis, 0.5 – 1 ml. After a favorable response is obtained, the proper maintenance dosage should be determined by decreasing the initial dose in small decrements at appropriate time intervals until the lowest dose which will maintain an adequate clinical response is determined.

Exposure of the patient to stressful situations unrelated to the existing disease may necessitate an increased dose of Diprospan Suspension. If the drug is to be discontinued after long-term therapy, the dose should be decreased gradually.

Shake before use.