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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

I.V. administration

Patient teaching

*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

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