Methylprednisolone
Indications
Methylprednisolone is used for:
Anti-inflammatory or immunosuppressive, Allergic conditions
Adult Dose
Oral
Anti-inflammatory or immunosuppressive
Adult: Initially, 2-60 mg daily in 1-4 divided doses, depending on the disease being treated.
Allergic conditions
Adult:
24 mg on day 1 (8 mg before breakfast, 4 mg after lunch, 4 mg after supper, and 8 mg at bedtime) or 24 mg as a single or in 2-3 divided doses upon initiation (regardless of time of day);
20 mg on day 2 (4 mg before breakfast, 4 mg after lunch, 4 mg after supper, and 8 mg at bedtime);
16 mg on day 3 (4 mg before breakfast, 4 mg after lunch, 4 mg after supper, and 4 mg at bedtime);
12 mg on day 4 (4 mg before breakfast, 4 mg after lunch, and 4 mg at bedtime);
8 mg on day 5 (4 mg before breakfast and 4 mg at bedtime);
4 mg on day 6, given before breakfast.
May be tapered over 12 days (to decrease chance of dermatitis flareup)
Child Dose
Oral
Anti-inflammatory or immunosuppressive
Child: 0.5-1.7 mg/kg daily or 5-25 mg/m2 daily in divided doses 6-12 hrly.
Usual dosing range, 0.117-1.66 mg/kg/day PO divided q6-8hr
Renal Dose
Administration
Should be taken with food.
Contra Indications
Systemic fungal infections and known hypersensitivity to components.
Precautions
Patient w/ heart failure, HTN, DM, GI disease (e.g. diverticulitis, intestinal anastomoses, peptic ulcer, ulcerative colitis), multiple sclerosis, myasthenia gravis, acute MI, cataracts, glaucoma, osteoporosis, history of seizure disorder, thyroid disease. Avoid abrupt withdrawal. Renal and hepatic impairment (including cirrhosis). Childn. Pregnancy and lactation. Monitoring Parameters Monitor BP, blood glucose, electrolytes, growth in childn.
Lactation: Drug enters milk; use with caution
Pregnancy-Lactation
Pregnancy category: C
Lactation: Drug enters milk; use with caution
Interactions
Loss of corticosteroid-induced adrenal suppression w/ aminoglutethimide. Risk of hypokalaemia w/ K-depleting agents (e.g. amphotericin B, diuretics). Decreased clearance w/ macrolide antibiotics. May decrease serum levels of isoniazid. Increased clearance w/ cholestyramine. Risk of convulsions w/ ciclosporin. Increased risk of arrhythmias w/ digitalis glycosides. Decreased metabolism w/ oestrogens, including OCs. Enhanced metabolism w/ CYP3A4 inducers (e.g. rifampicin, barbiturates). Increased plasma concentrations w/ CYP3A4 inhibitors (e.g. ketoconazole, erythromycin). Risk of GI effects w/ aspirin or other NSAIDs. May increase the anticoagulant effect of warfarin. May reduce the therapeutic effect of antidiabetics.
Potentially Fatal: May diminish response to live or live, attenuated vaccines.
Adverse Effects
Side effects of Methylprednisolone :
Adrenal suppression, anaphylactoid reactions, immunosuppression, acute myopathy, Kaposi's sarcoma, psychiatric disturbances (e.g. depression, euphoria, insomnia, mood swings, personality changes), increased susceptibility and severity of infections, impaired healing, HTN, Na and fluid retention, CV collapse (high dose), peptic ulcer, cataract subcapsular, skin atrophy, acne, muscular weakness, growth retardation, decreased blood K; dermal/subdermal skin depression at inj site. Topical: Itching, burning erythema, vesiculation; rarely, folliculitis, hypertrichosis, perioral dermatitis, skin discolouration, allergic skin reactions.
Mechanism of Action
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.