methylprednisolone
Medrol**, Medrone§
methylprednisolone acetate
depMedalone 40, depMedalone 80, Depoject-40, Depoject-80, Depo-Medrol, Depo-Medrone§, Depopred-40, Depopred-80, Depo-Predate 40, Depo-Predate 80, Duralone-40, Duralone-80, Medralone-40, Medralone-80, Rep-Pred 40, Rep-Pred 80
methylprednisolone sodium succinate
A-methaPred, Solu-Medrol
Pregnancy Risk Category C
How supplied
methylprednisolone
Tablets: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg
methylprednisolone acetate
Injection (suspension): 20 mg/ml, 40 mg/ml, 80 mg/ml
methylprednisolone sodium succinate
Injection: 40-mg vial, 125-mg vial, 500-mg vial, 1,000-mg vial, 2,000-mg vial
Action
Not clearly defined. Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism.
Indications & dosage
Severe inflammation or immunosuppression--
Adults: 4 to 48 mg as single dose or in divided doses; 10 to 80 mg acetate I.M. daily, or 10 to 250 mg succinate I.M., 10 to 40 mg (base) repeated as needed or I.V. up to q 4 hours; or 4 to 40 mg acetate into smaller joints or 20 to 80 mg acetate into larger joints. Intralesional administration is usually 20 to 60 mg acetate. Intralesional and intra-articular injections may be repeated q 1 to 5 weeks.
Children: 0.03 to 0.2 mg/kg succinate or 1 to 6.25 mg/m2 I.M. once daily or b.i.d.
Shock--
Adults: 100 to 250 mg succinate I.V. at 2- to 6-hour intervals; or 30 mg/kg I.V. initially, repeated q 4 to 6 hours, p.r.n. Continue therapy for 2 to 3 days or until patient is stable.
Adverse reactions
CNS: euphoria, insomnia, psychotic behavior, pseudotumor cerebri, vertigo, headache, paresthesia, seizures.
CV: heart failure, hypertension, edema, arrhythmias, thrombophlebitis, thromboembolism, fatal arrest, circulatory collapse after rapid administration of large I.V. doses.
EENT: cataracts, glaucoma.
GI: peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting.
GU: menstrual irregularities.
Metabolic: hypokalemia, hyperglycemia, and carbohydrate intolerance; increased serum cholesterol levels; decreased serum calcium levels; increased urine calcium levels.
Musculoskeletal: growth suppression in children, muscle weakness, osteoporosis.
Skin: hirsutism, delayed wound healing, acne, various skin eruptions.
Other: cushingoid state (moonface, buffalo hump, central obesity), susceptibility to infections, acute adrenal insufficiency after increased stress or abrupt withdrawal after long-term therapy.
After abrupt withdrawal: rebound inflammation, fatigue, weakness, arthralgia, fever, dizziness, lethargy, depression, fainting, orthostatic hypotension, dyspnea, anorexia, hypoglycemia. After prolonged use, sudden withdrawal may be fatal.
Interactions
Drug-drug. Aspirin, indomethacin, other NSAIDs: increased risk of GI distress and bleeding. Give together cautiously.
Barbiturates, phenytoin, rifampin: decreased corticosteroid effect. Increase corticosteroid dosage, as ordered.
Oral anticoagulants: altered dosage requirements. Monitor PT and INR closely.
Potassium-depleting drugs such as thiazide diuretics: enhanced potassium-wasting effects of methylprednisolone. Monitor serum potassium levels.
Salicylates: decreased serum salicylate levels. Monitor for lack of salicylate effectiveness.
Skin-test antigens: decreased response. Defer skin testing until after therapy.
Toxoids, vaccines: decreased antibody response and increased risk of neurologic complications. Avoid concomitant use.
Effects on diagnostic tests
Methylprednisolone suppresses reactions to skin tests, causes false-negative results in the nitroblue tetrazolium test for systemic bacterial infections, and decreases 131I uptake and protein-bound iodine levels in thyroid function tests.
Contraindications
Contraindicated in patients with hypersensitivity to drug or its ingredients and in those with systemic fungal infections; also contraindicated in premature infants (acetate and succinate).
Nursing considerations
- Use cautiously in patients with GI ulceration or renal disease, hypertension, osteoporosis, diabetes mellitus, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thromboembolic disorders, seizures, myasthenia gravis, heart failure, tuberculosis, ocular herpes simplex, emotional instability, and psychotic tendencies.
- Determine if patient is sensitive to other corticosteroids.
- Drug may be used for alternate-day therapy.
- Most adverse reactions to corticosteroids are dose- or duration-dependent.
- For better results and less toxicity, give a once-daily dose in the morning.
- Give oral dose with food when possible. Critically ill patients may need concomitant antacid or H2-receptor antagonist therapy.
- Different salt formulations aren't interchangeable.
- Alert:
Don't give Solu-Medrol intrathecally because severe adverse reactions have been reported.
- Give I.M. injection deeply into gluteal muscle. Avoid S.C. injection because atrophy and sterile abscesses may occur.
- Dermal atrophy may occur with large doses of acetate salt. Use multiple small injections rather than a single large dose and rotate injection sites.
- Don't use acetate when immediate onset of action is needed.
- Discard reconstituted solution after 48 hours.
- Always adjust to lowest effective dose, as ordered.
- Monitor patient's weight, blood pressure, serum electrolyte levels, and sleep patterns. Euphoria may initially interfere with sleep, but patients generally adjust to therapy after 1 to 3 weeks.
- Drug may mask or exacerbate infections, including latent amebiasis.
- Watch for depression or psychotic episodes, especially in high-dose therapy.
- Diabetic patient may need increased insulin; monitor blood glucose levels.
- Watch for an enhanced response to drug in patients with hypothyroidism or cirrhosis.
- Watch for allergic reaction to tartrazine in patients with sensitivity to aspirin.
- Unless contraindicated, give low-sodium diet that's high in potassium and protein. Administer potassium supplements as needed.
- Elderly patient may be more susceptible to osteoporosis with prolonged use.
- Gradually reduce drug dosage after long-term therapy, as ordered.
- Alert:
Don't confuse Solu-Medrol with Solu-Cortef (hydrocortisone sodium succinate) or methylprednisolone with medroxyprogesterone.
I.V. administration
- Use only methylprednisolone sodium succinate for I.V. use; never use acetate form. Reconstitute according to manufacturer's directions using supplied diluent, or use bacteriostatic water for injection with benzyl alcohol.
- When administering as direct injection, inject diluted drug into vein or free-flowing compatible I.V. solution over at least 1 minute. For treatment of shock, give massive doses over at least 10 minutes to prevent arrhythmias and circulatory collapse. When administering as an intermittent or continuous infusion, dilute solution according to manufacturer's instructions, and give over prescribed duration. If used for continuous infusion, change solution every 24 hours.
- Compatible solutions include D5W, normal saline, and dextrose 5% in normal saline.
Patient teaching
- Tell patient not to discontinue drug abruptly or without doctor's consent.
- Instruct patient to take oral form of drug with milk or food.
- Teach patient symptoms of early adrenal insufficiency: fatigue, muscular weakness, joint pain, fever, anorexia, nausea, dyspnea, dizziness, and fainting.
- Instruct patient to carry a card identifying his need for supplemental systemic glucocorticoids during stress. This card should contain doctor's name, name of drug, and dose taken.
- Warn patient on long-term therapy about cushingoid symptoms (moonface, buffalo hump) and to notify doctor of sudden weight gain or swelling.
- Advise patient receiving long-term therapy to consider exercise or physical therapy. Also tell patient to ask doctor about vitamin D or calcium supplement.
- Instruct patient to avoid exposure to infections (such as chickenpox or measles) and to contact doctor if such exposure occurs.
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING