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Methylprednisolone sodium succinate

Intravenous
Intramuscular
Class
Steroid hormones
Subclass
Glucocorticoids
Generic name
methylPREDNISolone
Brand names
Solu-Medrol®
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment
Acute rheumatic carditis
•
Start at: 10-15 mg IV q24h
•
Maintenance: 4-6 mg/kg IV q24h
Asthma • Bronchial asthma
•
40-80 mg IV q6-12h
Autoimmune hemolytic anemia • Acquired
•
0.5-1 mg/kg IV q24h
Chorioretinitis
•
Start at: 250-1,000 mg IV q24h
•
Maintenance: 40-120 mg IV q24h
Dermatomyositis and polymyositis
•
Start at: 1,000 mg IV q24h for 3-5 consecutive days
•
Maintenance: 40-60 mg IV q24h
Erythroblastopenia
•
20-40 mg IV q24h
Exfoliative dermatitis
•
40-120 mg IV q24h
Idiopathic thrombocytopenic purpura
•
0.5 mg/kg IV q24h
Loeffler's syndrome
•
Start at: 40-60 mg IV q24h
•
Maintenance: 20-40 mg IV q24-48h
Optic neuritis
•
1,000 mg IV q24h for 3 to 5 days
Regional enteritis
•
Start at: 40-60 mg IV q6-12h
•
Maintenance: 20 mg IV q24h
Sarcoidosis in patients with symptomatic sarcoidosis
•
20-80 mg IV q24h
Secondary thrombocytopenia
•
Start at: 10-40 mg IV q24h
•
Maintenance: 4-8 mg IV q24h
SLE
•
Start at: 10-15 mg/kg IV q24h
•
Maintenance: 40-60 mg IV q24h
Stevens-Johnson syndrome
•
1-2 mg/kg IV daily, in 1-4 divided doses
Ulcerative colitis
•
Start at: 40-125 mg IV q24h
•
Maintenance: 20-40 mg IV q24h
Uveitis
•
Start at: 10-40 mg IV q24h
•
Maintenance: 4-16 mg IV q24h
Adjunctive treatment
Axial spondyloarthritis • Acute flare
•
100-500 mg IV q24h for 1 to 5 days
Dermatitis herpetiformis
•
Start at: 40-60 mg IV q24h
•
Maintenance: 4-16 mg IV q24h
Indications for use
Labeled indications
Adults
•
Treatment of Loeffler's syndrome
•
Treatment of Stevens-Johnson syndrome
•
Treatment of acute rheumatic carditis
•
Treatment of allergic conjunctivitis
•
Treatment of allergic corneal marginal ulcer
•
Treatment of allergic rhinitis (seasonal or perennial)
•
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 mycosis fungoides
•
Treatment of nonsuppurative thyroiditis
•
Treatment of optic neuritis
•
Treatment of regional enteritis
•
Treatment of sarcoidosis in patients with symptomatic sarcoidosis
•
Treatment of secondary thrombocytopenia
•
Treatment of serum sickness
•
Treatment of SLE
•
Treatment of trichinosis (myocardial involvement, neurologic involvement)
•
Treatment of tuberculous meningitis
•
Treatment of ulcerative colitis
•
Treatment of uveitis
•
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 medial epicondylitis (acute episode)
•
Adjunctive treatment for post-traumatic osteoarthritis
•
Adjunctive treatment for psoriatic arthritis
•
Adjunctive treatment for subacute bursitis
•
Adjunctive treatment for synovitis of osteoarthritis (acute exacerbation)
Safety risks
Boxed warnings
Exacerbation of Mycobacterium tuberculosis infection
•
Use extreme caution in patients with tuberculosis.
Contraindications
Hypersensitivity to benzyl alcohol, especially in neonates and low birth weight infants
Hypersensitivity to cow's milk or its components or other dairy products
Hypersensitivity to methylprednisolone acetate or any of its components
Systemic fungal infection
Warnings and precautions
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 muscle weakness
•
Use caution in patients with myasthenia gravis.
Fluid retention, increased BP
•
Use caution in patients taking high doses, especially those with hypertension, congestive HF, or renal insufficiency.
Gastrointestinal perforation, gastric ulcer
•
Use caution in patients with active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis.
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 caution in patients receiving corticosteroid therapy, most often for chronic conditions.
LV rupture
•
Use caution in patients with recent myocardial infarction.
Osteoporosis
•
Use caution in patients with a history of bones disorders.
Psychosis
•
Use caution in patients with pre-existing emotional instability.
Quadriplegia, cortical visual impairment, spinal muscular atrophy, stroke
•
Use caution in patients undergoing epidural injection of corticosteroids.
Recurrent infections, immunosuppression
•
Use extreme 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.
Scleroderma renal crisis
•
Use caution in patients with pre-existing systemic sclerosis.
Seizures
•
Use caution in patients with a history of seizure disorder.
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: A
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Infatns should be monitored for adrenal insufficiency. 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
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