Methyl­ prednisolone

FDA label

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Renal Undefined

Hepatic Undefined

Dexamethasone and betamethasone are NOT suitable for alternate-day therapy (prolonged adrenal suppression); methylprednisolone is short-acting (adrenal suppression 1¼–1½ days) and is.

Instructions

• Individualize dose to the disease and patient response; maintain or adjust the initial dose until satisfactory response, then reduce in small decrements at appropriate intervals to the lowest effective maintenance dose.
• After long-term therapy, withdraw gradually rather than abruptly.
• Discontinue and transfer to other therapy if there is no satisfactory response after a reasonable period.
• Increase the dose temporarily during stress (trauma, surgery, illness) or disease exacerbation.
• ADT: give every other morning — exogenous corticosteroid suppresses adrenocortical activity least when given at the time of maximal endogenous activity (AM).
• Keep the initial suppressive-dose period as brief as possible (usually 4–10 days in allergic and collagen disease) when ADT is intended.
• 4 mg methylprednisolone ≡ 5 mg prednisolone.

Contraindications

• Systemic fungal infections

Cautions

• HPA-axis suppression: recovery time after pharmacologic dosing is variable and the patient is vulnerable to stress throughout — cover surgery, trauma, illness.
• Do not stop abruptly after long-term therapy — corticoid withdrawal syndrome.
• Cushingoid state, growth suppression in children, osteoporosis, latent diabetes, electrolyte imbalance with prolonged pharmacologic dosing.
• May suppress reactions to skin tests.
• Symptom flare can occur in the latter part of the off-steroid day on ADT; counsel patients.

Adverse reactions

• Fluid/electrolyte: sodium and fluid retention, potassium loss, hypokalemic alkalosis, hypertension, CHF in susceptible patients
• Musculoskeletal: muscle weakness/wasting, steroid myopathy, osteoporosis, vertebral compression fracture, aseptic necrosis of femoral/humeral heads, tendon rupture (esp. Achilles)
• GI: peptic ulcer with perforation/hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis, transaminase/alk phos elevation (small, reversible)
• Endocrine: Cushingoid state, growth suppression in children, secondary adrenocortical/pituitary unresponsiveness, menstrual irregularity, decreased carbohydrate tolerance, latent diabetes unmasked, increased insulin/oral hypoglycemic requirement
• Ophthalmic: posterior subcapsular cataract, increased intraocular pressure, glaucoma, exophthalmos
• Neurologic: increased intracranial pressure with papilledema (pseudotumor cerebri), convulsions, vertigo, headache
• Dermatologic: impaired wound healing, thin fragile skin, petechiae/ecchymoses, facial erythema, increased sweating
• Urticaria and other allergic, anaphylactic, or hypersensitivity reactions

Pregnancy Undefined

Lactation Undefined