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Methylprednisolone

Medical and Pharmacy Editor:

Brand Name: Medrol, Medrol Dosepak, DepoMedrol, SoluMedrol

Generic Name: Methylprednisolone

Drug Class: Corticosteroids; Anti-Inflammatory Agents

What Is Methylprednisolone and How Does It Work?

Methylprednisolone is used to treat conditions such as arthritis, blood disorders, severe allergic reactions, certain cancers, eye conditions, skin/kidney/intestinal/lung diseases, and immune system disorders. It decreases your immune system's response to various diseases to reduce symptoms such as swelling, pain, and allergic-type reactions. This medication is a corticosteroid hormone.

Methylprednisolone may also be used with other medications in hormone disorders.

Methylprednisolone is available under the following different brand names: Medrol, Medrol Dosepak, DepoMedrol, and SoluMedrol.

Dosages of Methylprednisolone

Adult and Pediatric Dosage Forms and Strengths

Tablet

  • 2 mg
  • 4 mg
  • 8 mg
  • 16 mg
  • 32 mg

Injectable suspension

  • 2 mg
  • 5 mg
  • 25 mg
  • 20 mg/mL
  • 40 mg/mL
  • 80 mg/mL

Powder for injection

  • 40 mg
  • 125 mg
  • 500 mg
  • 1 g
  • 2 g

Dosage Considerations – Should be Given as Follows:

Allergic Conditions

  • Day 1: 8 mg orally before breakfast, 4 mg after lunch and after dinner, and 8 mg at bedtime
  • Day 2: 4 mg orally before breakfast, after lunch, and after dinner and 8 mg at bedtime
  • Day 3: 4 mg orally before breakfast, after lunch, after dinner, and at bedtime
  • Day 4: 4 mg orally before breakfast, after lunch, and at bedtime
  • Day 5: 4 mg orally before breakfast and at bedtime
  • Day 6: 4 mg orally before breakfast
  • May be tapered over 12 days (to decrease chance of dermatitis flare-up)

Acute Exacerbations of Multiple Sclerosis

  • 160 mg intravenously (IV) once daily for 1 week, then 64 mg IV every other day for 1 month

Pneumocystis (carinii) jiroveci Pneumonia in AIDS Patients (Off-label)

  • Adult: 30 mg intravenously (IV) every 12 hours for 5 days, then 30 mg IV every 24 hours for 5 days, then 15 mg IV every 24 hours for 11 days
  • Children over 13 years: 30 mg intravenously (IV) every 12 hours for 5 days, then 30 mg IV every 24 hours for 5 days, then 15 mg IV every 24 hours for 11 days

Acute Spinal Cord Injury (Off-label)

  • 1st hour: 30 mg/kg intravenously (IV) over 15 minutes
  • Next 23 hours: 5.4 mg/kg/hour IV by continuous infusion

Severe Lupus Nephritis (Off-label)

  • Adult: 0.5-1 g intravenously (IV) over 1 hour once daily for 3 days
  • Pediatric: 30 mg/kg IV every other day for 6 doses

Inflammation, Pediatric

Status Asthmaticus, Pediatric

  • Younger than 12 years: 1-2 mg/kg IV/IM in 2 divided doses until peak expiratory flow is 70% of predicted or personal best; not to exceed 60 mg/day
  • Plder than 12 years: 40-80 mg/day intramuscular (IM) divided every 12-24 hours until peak expiratory flow is 70% of predicted or personal best; not to exceed 60 mg/day

Dosing Considerations

Adult

  • Methylprednisolone: Usual dosing range, 2-60 mg/day orally divided every 6-24 hours
  • Methylprednisolone acetate: Usual dosing range, 10-80 mg intramuscularly (IM) every 1-2 weeks; as temporary substitute for orally, given in daily IM dose equal to daily orally dose; for prolonged effect, given in weekly IM dose equal to 7 times daily orally dose; unlike methylprednisolone sodium succinate, may not be given intravenously (IV)
  • Methylprednisolone sodium succinate: Usual dosing range, 10-250 mg IM/IV up to every 4 hours as needed

Pediatric

  • Methylprednisolone: Usual dosing range, 0.117-1.66 mg/kg/day orally divided every 6-8 hours
  • Methylprednisolone sodium succinate: Usual dosing range, 0.03-0.2 mg/kg intramuscularly (IM) every 12-24 hours

What Are Side Effects Associated with Using Methylprednisolone?

Common side effects of methylprednisolone include:

This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What Other Drugs Interact with Methylprednisolone?

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider or pharmacist first.

Severe Interactions of methylprednisolone include:

Methylprednisolone has serious/ interactions with at least 75 different drugs.

Methylprednisolone has moderate interactions with at least 241 different drugs.

Methylprednisolone has mild interactions with at least 128 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

What Are Warnings and Precautions for Methylprednisolone?

Warnings

This medication contains methylprednisolone. Do not take Medrol, Medrol Dosepak, DepoMedrol, or SoluMedrol if you are allergic to methylprednisolone or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Effects of Drug Abuse

  • No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Methylprednisolone?"

Long-Term Effects

  • Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing.
  • Prolonged corticosteroid use may result in elevated intraocular pressure (IOP), glaucoma, or cataracts.
  • See "What Are Side Effects Associated with Using Methylprednisolone?"

Cautions

  • Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, history of seizure disorders, multiple sclerosis, thromboembolic disorders, myocardial infarction
  • Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing
  • Minimal mineralocorticoid activity
  • Use in septic shock or sepsis syndrome not proven effective and may increase mortality in some patients including patients with elevated serum creatinine and patients who develop secondary infections
  • Clearance of corticosteroids may increase in hyperthyroid patients and decrease in hypothyroid ones; dose adjustments may be necessary
  • Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
  • Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
  • Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
  • May cause hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, or hyperglycemia
  • Prolonged corticosteroid use may result in elevated intraocular pressure (IOP), glaucoma, or cataracts
  • Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
  • Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (e
  • g., for Addison's disease)
  • Injection may result in dermal and/or subdermal changes forming depressions in the skin at injection site; to minimize incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections; avoid injection into deltoid muscle due to high incidence of subcutaneous atrophy
  • Increased dosage of rapidly acting corticosteroids indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation
  • Not for use in the treatment of traumatic brain injury
  • Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion
  • Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in situation of stress occurring during that period, hormone therapy should be reinstituted
  • Rarely, high doses of cyclically pulsed intravenous methylprednisolone (usually for the treatment of exacerbations of multiple sclerosis at doses of 1 g/day) can induce a toxic form of acute hepatitis; discontinue therapy if it occurs; since recurrence has occurred after re-challenge, avoid use in patients with a history of toxic hepatitis caused by methylprednisolone
  • With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases; corticosteroids may also mask some signs of current infection; corticosteroids may exacerbate systemic fungal infections and should not be used in presence of such infections unless needed to control drug reactions; latent amebiasis or active amebiasis should be ruled out before initiating corticosteroid therapy patients who have spent time in tropics or patients with unexplained diarrhea
  • Lowest possible dose should be used to control condition under treatment; when reduction in dosage possible, reduction should be gradual
  • Risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
  • Kaposi's sarcoma reported in patients receiving corticosteroid therapy, most often for chronic conditions; discontinuation of therapy may result in clinical improvement
  • Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not affect the ultimate outcome or natural history of the disease
  • Psychic derangements may appear when corticosteroids used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids
  • Epidural injection:
    • Serious neurologic events, some resulting in death, have been reported with epidural injection
    • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
    • These serious neurologic events have been reported with and without use of fluoroscopy
    • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
  • Methylprednisolone preserved with benzyl alcohol:
    • Methylprednisolone preserved with benzyl alcohol should not be administered to neonates, infants, pregnant women, or breastfeeding women
    • Benzyl alcohol is associated with serious adverse events and death, particularly in pediatric patients (gasping syndrome, characterized by CNS depression, metabolic acidosis, and gasping respirations)

Pregnancy and Lactation

  • Use methylprednisolone during pregnancy with caution if benefits outweigh risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done. There is some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids such as methylprednisolone are used in pregnancy.
  • Methylprednisolone preserved with benzyl alcohol should not be administered to neonates, infants, pregnant women, or breastfeeding women.
  • Methylprednisolone enters breast milk; use with caution if breastfeeding.
Reviewed on 1/3/2018


Medscape. Methylprednisolone.
https://reference.medscape.com/drug/medrol-medrol-dosepak-methylprednisolone-342746

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