Methylprednisolone

A to Z Drug Facts

(METH-ill-pred-NIH-suh-lone)

Medrol,  Depo-Medrol, Medrol Veriderm

Methylpredinisolone Sodium Succinate

A-Methapred, Solu-Medrol

Methylprednisolone Acetate

Adlone, depMedalone 40, depMedalone 80, Depoject, Depo-Medrol, Depopred-40, D-Med 80, Duralone-40, Duralone-80, Medralone-40, Medralone-80, Medrol Acetate Topical, M-Prednisol-40, M-Prednisol-80, Rep-Pred 40, Rep-Pred 80

Class: Corticosteroid

 Action Depresses formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes and complement system. Modifies body's immune response.

 Indications Replacement therapy in primary or secondary adrenal cortex insufficiency; djunctive therapy for short-term administration in rheumatic disorders; exacerbation or maintenance therapy in collagen diseases; treatment of dermatologic diseases; ontrol of allergic states or allergic and inflammatory ophthalmic processes; anagement of respiratory diseases; treatment of hematologic disorders; palliative management of neo-plastic diseases; management of cerebral edema associated with primary or metastatic brain tumor, craniotomy or head injury; induction of diuresis in edematous states (from nephrotic syndrome); management of critical exacerbations of GI diseases; management of acute exacerbations of multiple sclerosis; treatment of tuberculous meningitis; management of trichinosis with neurologic or myocardial involvement. Intra-articular or soft tissue administration: Adjunctive therapy for short-term administration in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis and posttraumatic osteoarthritis. Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata and cystic tumors of aponeurosis or tendon. Topical administration: Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Unlabeled use(s): Reduction of mortality in severe alcoholic hepatitis; prevention of respiratory distress syndrome; treatment of septic shock; improvement of neurologic function in acute spinal cord injury.

 Contraindications Systemic fungal infections; idiopathic thrombocytopenic purpura (IM administration); administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin or axilla; use in premature infants (sodium succinate salt).

 Route/Dosage

METHYLPREDNISOLONE

ADULTS: PO 4–48 mg/day.

METHYLPREDNISOLONE SODIUM SUCCINATE

ADULTS: IV/IM 10–40 mg administered over 1 to several min. In severe condition, 30 mg/kg infused over 30 min; may repeat q 4–6 hr for 48–72 hr. INFANTS & CHILDREN: IV/IM Not less than 0.5 mg/kg/24 hr.

METHYLPREDNISOLONE ACETATE

ADULTS: IM 40–120 mg q wk for 1–4 wk. Intra-articular/intralesional 4–80 mg into joints or lesions. Topical Apply sparingly to affected areas 2–4 times daily.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Barbiturates: May decrease pharmacologic effect of methylprednisolone. Hydantoins, rifampin: May increase clearance and decrease efficacy of methylprednisolone. Ketoconazole: May decrease clearance of methylprednisolone. Macrolide antibiotics: Significantly decreases methylprednisolone clearance; may need to decrease dose. Salicylates: May reduce serum levels and efficacy of salicylates.

 Lab Test Interferences Drug may cause increased levels of urine glucose and serum cholesterol, decreased serum levels of potassium, T₃ and T₄, decreased uptake of thyroid I¹³¹, false-negative result in nitroblue-tetrazolium test for systemic bacterial infection and suppression of skin-test reactions.

 Adverse Reactions

CV: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; yocardial rupture; fatal arrest; circulatory collapse; CHF. CNS: Convulsions; pseudotumor cerebri (increased intracranial pressure with papilledema); vertigo; headache; neuritis; paresthesias; psychosis. DERM: Impaired wound healing; thin, fragile skin; petechiae and ecchymoses; rythema; lupus erythematosus-like lesions; subcutaneous fat atrophy; striae; irsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation. Topical application: burning; itching; irritation; erythema; dryness; folliculitis; ypertrichosis; pruritus; perioral dermatitis; allergic contact dermatitis; tinging, cracking and tightening of skin; secondary infections; skin atrophy; triae; miliaria; telangiectasia. EENT: Posterior subcapsular cataracts; increased intraocular pressure; glaucoma; xophthalmos. GI: Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; ncreased appetite and weight gain; peptic ulcer with perforation and hemorrhage; owel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMA: Leukocytosis. META: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; etabolic alkalosis; hypocalcemia. OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; fatigue; nsomnia. Intra-articular administration: Osteonecrosis; tendon rupture; infection; skin atrophy; postinjection flare; hypersensitivity; facial flushing. Topical application may produce adverse reactions seen with systemic use because of absorption.

 Precautions

Pregnancy: Pregnancy category undetermined (systemic use); Category C (topical use). Lactation: Excreted in breast milk. Children: May be more susceptible to adverse effects from topical use. Benzyl alcohol/gasping syndrome may occur with use of methylprednisolone sodium succinate. Elderly patients: May require lower doses. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions, including anaphylaxis, may occur rarely. Immunosuppression: Because drug causes immunosuppressed state, do not administer live virus vaccines during treatment. Infections: May mask signs of infection. May decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug systemically with caution in ocular herpes simplex because of risk of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Repository injections: Do not inject subcutaneously. Avoid injection into deltoid muscle and repeated intramuscular injection into same site. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during and after stressful situations. Tartrazine sensitivity: May contain tartrazine, which may cause allergic-type reactions in susceptible individuals.

 Administration/Storage

• When initiating or discontinuing drug therapy, taper dose.
• With oral administration, give with food. Tablets can be crushed and given with fluid.
• Administer once-daily dose or alternate-day dosing in morning before 9 AM.
• Administer multiple doses at evenly spaced intervals throughout day. When large doses are given, administer antacids between meals to help to prevent peptic ulcers. For long-term use, alternate-day regimen may be used.
• With intra-articular injection, inject into synovial space. Do not inject unstable joints.
• When treating conditions such as tendonitis or tenosynovitis, inject into tendon sheath rather than into substance of tendon.
• When treating conditions such as epicondylitis, outline area of greatest tenderness and infiltrate drug into area.
• When treating ganglia of tendon sheaths, inject drug directly into cyst.
• When treating dermatologic conditions, avoid injection of sufficient material to cause blanching, which may cause small slough.
• Do not inject into deltoid muscle. IM injection should be administered deeply into gluteal muscle.
• If giving as injection, rotate sites.
• Although methylprednisolone sodium succinate can be given both IM and IV, methylprednisolone acetate can only be administered IM; it cannot be administered IV.
• With topical application, once ointment is applied, plastic wrap can be used over area to increase absorption. To avoid skin irritation, do not leave plastic wrap in place > 12 hr. Wash hands before and after application.
• Do not use topically on face, groin or axilla.
• Use solution within 48 hr of mixing.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note renal and liver function; state of mental health; emologic, cardiac, vision and skin problems; and history of frequent fungal infections.
• Assess baseline renal function (ie, creatinine, electrolytes, frequency, 24-hr urine output).
• Check for history of hepatitis B.
• Assess for signs of adrenal insufficiency: low blood glucose, nausea, anorexia, weakness, dizziness, weight loss and diarrhea.
• Obtain baseline vital signs, weight and lab test results ie, electrolytes, CBC, T₃, T₄, cholesterol, urine glucose).
• Observe growth and development of infants and children on prolonged therapy.
• Monitor renal function, especially in patients with renal impairment.
• If skin irritation occurs, withhold medication and notify physician.
• If signs of infection, renal or liver dysfunction, bleeding, circulatory problems, edema, weight gain or respiratory changes occur, notify physician.
• If difficulties with GI tract or vision changes occur, notify physician.
• If patient is having difficulty with weight control, obtain dietary counseling.
• If patient is diabetic, monitor closely for possible increased requirements for insulin or sulfonylurea.

 Patient/Family Education

• Instruct patient to take medication at same time each day and with food if taking orally.
• With cream or ointment application, instruct patient to soak area of skin before gently applying light film of medication, to increase absorption. Caution patient to wash hands before and after application.
• Encourage patient to eat low-sodium, low-fat foods.
• Advise patient to practice frequent, thorough handwashing to help to prevent infections.
• Advise patient on chronic steroid therapy to wear or carry identification eg, Medi-Alert) indicating condition and medication regimen.
• Inform patient of potential for mood swings.
• Warn patient regarding increasing appetite and consequent weight gain. Instruct patient to weigh self daily.
• Inform patient of moonface, which often occurs with this medication.
• Advise patient of acne and skin flushing, which are often associated with this medication. Instruct patient in proper skin care practices to help to prevent irritation and/or acne.
• Instruct patient to report these symptoms to physician: swelling in feet and ankles, signs of infection (fever, over-growth in mouth, vaginal yeast, wound not healing or with drainage), diarrhea, nausea, vomiting, weight loss, discolored or painful urine, vision changes, menstrual irregularity and fatigue.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts