methylprednisolone

Drug Name
  • Generic Name : methylprednisolone , methylprednisolone acetate ,methylprednisolone sodium succinate
  • Brand Name:
    • Oral: Medrol
    • IM injection: depMedalone, Depo-Medrol, Depopred–40
    • IV, IM injection: A-Methapred, Solu-Medrol
  • Classification: Corticosteroid, Glucocorticoid, Hormone
  • Pregnancy Category C 
Dosage & Route
  • Available forms : Tablets—4, 8, 16, 24, 32 mg; powder for injection—40, 125, 500 mg/mL, 1, 2 g/vial; suspension for injection—40, 80 mg/mL
ADULTS
  • Individualize dosage, depending on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. For maintenance, reduce initial dose in small increments at intervals until the lowest satisfactory clinical dose is reached. If long-term therapy is needed, consider alternate-day therapy with a short-acting corticosteroid. After long-term therapy, withdraw drug slowly to prevent adrenal insufficiency.

Oral

  • 4–48 mg/day. For alternate-day therapy, give twice the usual dose every other morning.

IV, IM

  • 10–40 mg IV administered over 1 min to several minutes. Give subsequent doses IV or IM.
  • WARNING: Rapid IV administration of large doses (more than 0.5–1 g in less than 10–120 min) has caused serious cardiac complications.

Methylprednisolone acetate

  • Rheumatoid arthritis, maintenance: 40–120 mg IM weekly.
  • Adrenogenital syndrome: 40 mg IM q 2 wk.
  • Dermatologic lesions: 40–120 mg IM weekly for 1–4 wk.
  • Asthma and allergic rhinitis: 80–120 mg IM.
  • Intralesional: 20–60 mg.
  • Intra-articular dose depends on site of injection: 4–10 mg (small); 10–40 mg (medium); 20–80 mg (large joints).
PEDIATRIC PATIENTS
  • Individualize dosage on the basis of severity and response rather than by formulae that correct doses for age or weight. Carefully observe growth and development in infants and children on prolonged therapy. Minimum dose of methylprednisolone is 0.5 mg/kg per 24 hr.
    • High-dose therapy: 30 mg/kg IV infused over 10–20 min; may repeat q 4–6 hr, but no longer than 72 hr.
Therapeutic actions
  • Methylprednisolone is a synthetic corticosteroid with mainly glucocorticoid activity and minimal mineralocorticoid properties. It decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.
Indications
  • Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders
  • Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
  • Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas
  • Trichinosis with neurologic or myocardial involvement
  • Prevention of nausea and vomiting associated with chemotherapy
  • Unlabeled use: Septic shock, respiratory distress syndrome, acute spinal cord injury
Adverse effects
  • Oedema, hypertension, arrhythmia; CNS, endocrine, metabolic and GI effects; hirsutism, acne, skin atrophy, bruising, hyperpigmentation; transient leukocytosis; arthralgia, muscle weakness, osteoporosis, fractures, cataracts, glaucoma; infections, hypersensitivity reactions, avascular necrosis, secondary malignancy, intractable hiccups.
Contraindications
  • Serious infections except septic shock or tuberculous meningitis; viral, fungal and tubercular skin lesions; admin of live virus vaccines. Preparations containing benzyl alcohol preservative are contraindicated in infants.
Nursing considerations
Assessment
  • History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; pregnancy; lactation
  • Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose
Interventions
  • Use caution with the 24-mg tablets marketed as Medrol; these contain tartrazine, which may cause allergic reactions, especially in people who are allergic to aspirin.
  • Give daily dose before 9 to mimic normal peak corticosteroid blood levels.
  • Increase dosage when patient is subject to stress.
  • WARNING: Taper doses when discontinuing high-dose or long-term therapy to allow adrenal recovery.
  • WARNING: Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
Teaching points
  • Do not to stop taking the oral drug without consulting your health care provider.
  • Avoid exposure to infections.
  • Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of disorder.