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Potent Topical Corticosteroid (Nasal Drops) Pregnancy: Safety for use in pregnancy and lactation has not been established. There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormal foetal development including cleft palate and intrauterine growth retardation. There may therefore be a very small risk of such defects in the human foetus.

Betamethasone Sodium Phosphate Nasal Drops

Brand names: Betnesol Drops (0.1%)

Betamethasone sodium phosphate nasal drops deliver a potent corticosteroid directly to the nasal mucosa, typically for severe nasal polyps, persistent rhinitis or marked nasal obstruction not controlled by standard sprays.

Adult dose

Dose: Inflammatory non-infected conditions of the nose: two or three drops of betamethasone sodium phosphate 0.1% w/v drops to be instilled into each nostril twice daily as required
Route: Nasal - topical nasal use, drops instilled into each nostril (this card does not cover the ocular or otic routes of the same product)
Frequency: Twice daily as required
Pinned product: Betamethasone 0.1% w/v Drops (eMC product 3395); SPC section 2: "Betamethasone Sodium Phosphate 0.1% w/v" (benzalkonium chloride 0.02% w/v). SPC 4.1 verbatim: "For the topical treatment of inflammatory non-infected conditions of the eye, ear or nose." - nasal use is licensed; the same product is also licensed ocular and otic and those routes are not covered by this card. SPC 4.2 verbatim: "Administration for topical nasal use. Adults, Elderly and Children: Two or three drops to be instilled into each nostril twice daily as required." Duration (SPC 4.2): "The frequency of dosing depends on the clinical response. If there is no clinical response within 7 days of treatment, the drops should be discontinued. Treatment should be the lowest effective dose for the shortest possible time. After more prolonged treatment (over 6 to 8 weeks), the drops should be withdrawn slowly to avoid relapse." SPC 4.4: "Nasal administration of corticosteroids is not advised if an untreated nasal infection is present, or if the patient has pulmonary tuberculosis or following nasal surgery (until healing has occurred)." The SPC prints no maximum dose.

Paediatric dose

Route: Nasal - topical nasal use, drops instilled into each nostril
Frequency: Twice daily as required
SPC 4.2 verbatim: "Administration for topical nasal use. Adults, Elderly and Children: Two or three drops to be instilled into each nostril twice daily as required." No lower age limit or age bands are printed in the section retrieved; no per-kg figure - do not derive one. SPC 4.4: "Prolonged use may lead to the risk of adrenal suppression in infants." SPC 4.8: "Growth retardation has been reported in children receiving nasal corticosteroids at licensed doses. It is recommended that the height of children receiving prolonged treatment with nasal corticosteroids is regularly monitored."

Dose adjustments

Renal

Not stated in the SPC sections retrieved (SPC 4.2 gives no renal dose adjustment).

Hepatic

Not stated in the SPC sections retrieved (SPC 4.2 gives no hepatic dose adjustment).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to any of the preparation's components
  • Bacterial, viral, fungal, tuberculous or purulent conditions of the eye
  • Glaucoma, or herpetic keratitis (e.g. dendritic ulcer) considered a possibility
  • Otitis externa should not be treated when the eardrum is perforated, due to the risk of ototoxicity
  • SPC 4.4 warning (nasal use): nasal corticosteroids not advised if an untreated nasal infection is present, if the patient has pulmonary tuberculosis, or following nasal surgery (until healing has occurred)

Side effects

  • Following nasal administration, most common: nasal irritation and dryness
  • Also reported after nasal use: sneezing, headache, light headedness, urticaria, nausea, epistaxis, rebound congestion, bronchial asthma, perforation or ulceration of the nasal septum, anosmia, parosmia and disturbance to sense of taste
  • Hypersensitivity reactions, usually delayed type: irritation, burning, stinging, itching and dermatitis
  • Systemic effects of nasal corticosteroids, particularly at high doses for prolonged periods: Cushing's syndrome, Cushingoid features, adrenal suppression, growth retardation in children and adolescents, cataract, glaucoma, and psychological or behavioural effects (psychomotor hyperactivity, sleep disorders, anxiety, depression, aggression - particularly in children)
  • Blurred vision (visual disturbance reported with systemic and topical corticosteroid use)

Interactions

  • CYP3A inhibitors, including cobicistat-containing products: expected to increase the risk of systemic corticosteroid side-effects - avoid unless the benefit outweighs the risk; if used together, monitor for systemic corticosteroid side-effects
  • Benzalkonium chloride preservative: should not be used in patients wearing soft contact lenses (ocular use)

Monitoring

  • Clinical response: if no response within 7 days of treatment, discontinue the drops
  • After more prolonged treatment (over 6 to 8 weeks), withdraw slowly to avoid relapse
  • Height of children receiving prolonged treatment with nasal corticosteroids should be regularly monitored; if growth is slowed, review therapy with the aim of reducing the dose, and consider referral to a paediatric specialist
  • Blurred vision or other visual disturbance: consider referral to an ophthalmologist for evaluation of possible causes (cataract, glaucoma, central serous chorioretinopathy)

Clinical monograph

How it works

Betamethasone is a potent glucocorticoid that suppresses local mucosal inflammation and oedema, reducing polyp size and improving nasal airflow.

Prescribing in practice

  • Because betamethasone is more systemically absorbed than modern intranasal steroids, prolonged or high-dose use risks systemic corticosteroid effects and adrenal suppression, so courses should be limited and supervised.
  • Correct head positioning when instilling the drops is essential to reach the polyp-bearing area and improve effectiveness.
  • Avoid in untreated nasal or sinus infection, and use cautiously where there is recent nasal surgery or trauma.

Monitoring

For longer or repeated courses watch for features of systemic steroid exposure and review nasal response and the need for ENT referral or surgery.

Counselling the patient

  • Use the recommended head-down position so the drops reach the right area.
  • Do not exceed the prescribed duration without review.
  • Report visual disturbance, mood change or other steroid-related effects.

Evidence & guidelines

Intranasal corticosteroids are first-line medical therapy for nasal polyps, with betamethasone drops reserved for short, supervised courses in resistant disease.

Reference: NICE CKS Nasal Polyps; BAO-HNS Guideline for Rhinosinusitis (2016); EPOS 2020; SPC Betnesol Drops; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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