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Methylprednisolone acetate

Intramuscular
Intraarticular
Intralesional
Class
Steroid hormones
Subclass
Glucocorticoids
Generic name
methylPREDNISolone
Common formulations
Suspension for injection
Dosage and administration
Adults patients
Treatment
Acute rheumatic carditis
•
4-80 mg IM once
Loeffler's syndrome
•
40-120 mg IM once
Sarcoidosis in patients with symptomatic sarcoidosis
•
40-120 mg IM once
Adjunctive treatment
Acute bursitis • Acute episode
•
4-30 mg IM once
Axial spondyloarthritis • Acute flare
•
40-120 mg IM weekly
Indications for use
Labeled indications
Adults
•
Treatment of Loeffler's syndrome
•
Treatment of Stevens-Johnson syndrome
•
Treatment of acute rheumatic carditis
•
Treatment of adrenal insufficiency (secondary)
•
Treatment of allergic conjunctivitis
•
Treatment of allergic corneal marginal ulcer
•
Treatment of allergic rhinitis (seasonal or perennial)
•
Treatment of allergy in patients with drug hypersensitivity reaction
•
Treatment of aspiration pneumonitis
•
Treatment of asthma (bronchial asthma)
•
Treatment of atopic dermatitis
•
Treatment of autoimmune hemolytic anemia (acquired)
•
Treatment of berylliosis
•
Treatment of chorioretinitis
•
Treatment of congenital adrenal hyperplasia
•
Treatment of congenital hypoplastic anemia
•
Treatment of contact dermatitis
•
Treatment of dermatomyositis and polymyositis
•
Treatment of erythroblastopenia
•
Treatment of exfoliative dermatitis
•
Treatment of herpes zoster ophthalmicus
•
Treatment of hypercalcemia of malignancy
•
Treatment of idiopathic thrombocytopenic purpura
•
Treatment of iridocyclitis
•
Treatment of iritis (acute)
•
Treatment of iritis (chronic)
•
Treatment of keratitis
•
Treatment of mycosis fungoides
•
Treatment of neoplastic diseases in patients with leukemia
•
Treatment of neoplastic diseases in patients with lymphoma
•
Treatment of nephrotic syndrome (idiopathic)
•
Treatment of nephrotic syndrome in patients with SLE
•
Treatment of nonsuppurative thyroiditis
•
Treatment of optic neuritis
•
Treatment of posterior uveitis (diffuse posterior uveitis)
•
Treatment of regional enteritis
•
Treatment of sarcoidosis in patients with symptomatic sarcoidosis
•
Treatment of secondary thrombocytopenia
•
Treatment of serum sickness
•
Treatment of sympathetic ophthalmia
•
Treatment of SLE
•
Treatment of trichinosis (myocardial involvement, neurologic involvement)
•
Treatment of ulcerative colitis
•
Adjunctive treatment for acute bursitis (acute episode)
•
Adjunctive treatment for acute tenosynovitis (acute nonspecific tenosynovitis)
•
Adjunctive treatment for axial spondyloarthritis (acute flare)
•
Adjunctive treatment for dermatitis herpetiformis
•
Adjunctive treatment for gouty arthritis (acute)
•
Adjunctive treatment for LET (acute episode)
•
Adjunctive treatment for medial epicondylitis (acute episode)
•
Adjunctive treatment for post-traumatic osteoarthritis
•
Adjunctive treatment for psoriatic arthritis
•
Adjunctive treatment for rheumatoid arthritis
•
Adjunctive treatment for subacute bursitis
•
Adjunctive treatment for synovitis of osteoarthritis (acute exacerbation)
•
Adjunctive treatment for tuberculous meningitis
Safety risks
Contraindications
Hypersensitivity to methylprednisolone acetate or any of its components
Idiopathic thrombocytopenic purpura
Systemic fungal infections
Warnings and precautions
Congestive HF, cardiomegaly
•
Use caution in patients with concomitant use of amphotericin B.
Exacerbation of Cushing's syndrome
•
Use caution in patients with pre-existing Cushing's disease.
Exacerbation of hypothalamic-pituitary-adrenal axis suppression
•
Use caution in patients with hypothalamic-pituitary-adrenal (HPA) axis suppression.
Exacerbation of Mycobacterium tuberculosis infection
•
Use caution in patients with tuberculosis.
Exacerbation of threadworm infestation
•
Use caution in patients with known or suspected Strongyloides (threadworm) infestation.
Fluid retention, increased BP
•
Use caution in patients taking high doses, especially those with hypertension, congestive HF, or renal insufficiency.
Increased blood glucose
•
Use caution in patients with diabetes mellitus.
Increased intraocular pressure, cataract, optic atrophy, glaucoma, visual field defect
•
Use caution in prolonged use of corticosteroids.
Kaposi's sarcoma, fungal infections
•
Use extreme caution in patients receiving corticosteroid therapy, most often for chronic conditions.
LV free wall rupture
•
Use extreme caution in patients with recent myocardial infarction.
Mask symptoms of systemic infection
•
Maintain a high level of suspicion, as methylprednisolone may decrease the resistance and inability to localize infection.
Quadriplegia, cortical visual impairment, spinal muscular atrophy, stroke
•
Use extreme caution in patients undergoing epidural injection of corticosteroids.
Reactivation of amebiasis
•
Use caution in patients with latent amebiasis.
Reactivation of HBV infection
•
Use caution in patients who are hepatitis B carriers or who appear to have resolved hepatitis B infection.
Recurrent infections, immunosuppression
•
Use caution in patients taking the drug for prolonged period or high doses, with risk factors for developing infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection.
VZV infection, measles
•
Use caution in all patients especially non-immune patients taking corticosteroids, including methylprednisolone.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use with caution.
Renal replacement therapy
Any modality
•
Use with caution.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Monitor neonates for signs of hypoadrenalism. US FDA pregnancy category: C.
•
There are no adequate or well-controlled studies on the use of methylprednisolone in pregnant women.
•
Complications, including cleft palate, stillbirth, and premature abortion, have been reported when corticosteroids were administered during pregnancy in animals.
•
If these drugs must be used during pregnancy, the potential risks should be discussed with the patient.
•
The ACOG (ACOG) include methylprednisolone as a last-line treatment option for nausea and vomiting of pregnancy in patients who have failed other therapies and suggest a limited duration of use for this purpose in responding patients.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
Unlikely to cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
Acute respiratory distress syndrome, achilles tendon rupture, acne, acute pancreatitis, adrenocortical insufficiency, anaphylaxis, aseptic necrosis of bone, atelectasis, bradycardia, cardiac arrhythmias, cataract, cerebrovascular accident, congestive heart failure, corneal pathology, Cushing's syndrome, ↓ blood lymphocyte count, ↓ blood monocytes, ↓ serum potassium, diabetes mellitus, drug-induced liver injury, ecchymosis, fluid retention, gastrointestinal perforation, glaucoma, growth restriction, hypertension, ↑ ICP, ↑ WBC count, ↑ blood glucose, ↑ blood glucose, ↑ liver enzymes, ↑ serum sodium, meningitis, myopathy, osteoporosis, papilledema, paraplegia, peptic ulcer disease, peritonitis, pleural effusion, Pneumocystis pneumonia, pneumothorax, psychosis, pulmonary tuberculosis, depression, hallucinations, insomnia, mania, muscle weakness, seizure, vision loss, respiratory failure, spinal cord ischemia, tetraparesis
Interactions
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