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methylprednisolone

(meth ill pred niss' oh lone)

methylprednisolone
Oral:
Medrol, Meprolone (CAN)

methylprednisolone sodium succinate


IV, IM injection:
A-Methapred, Solu-Medrol

Pregnancy Category C

Drug classes
Corticosteroid
Glucocorticoid
Hormone

Therapeutic actions
Enters target cells and binds to intracellular corticosteroid receptors, initiating many
complex reactions that are responsible for its anti-inflammatory and immunosuppressive
effects.

Indications
• Hypercalcemia associated with cancer
• Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg,
pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some
leukemias and lymphomas
• Trichinosis with neurologic or myocardial involvement
• Unlabeled use: Septic shock

Contraindications and cautions


• Contraindicated with infections, especially tuberculosis, fungal infections,
amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation;
allergy to tartrazine or aspirin in products labeled Medrol.
• Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis
with impending perforation, diverticulitis, active or latent peptic ulcer,
inflammatory bowel disease, CHF, hypertension, thromboembolic disorders,
osteoporosis, seizure disorders, diabetes mellitus, pregnancy.

Available forms
Tablets—2, 4, 8, 16, 24, 32 mg; powder for injection—40, 125, 500 mg/mL, 1, 2 g/vial
Dosages
ADULTS
Individualize dosage, depending on severity and response. Give daily dose before 9 AM
to minimize adrenal suppression. For maintenance, reduce initial dose in small
increments at intervals until the lowest satisfactory clinical dose is reached. If long-term
therapy is needed, consider alternate-day therapy with a short-acting corticosteroid. After
long-term therapy, withdraw drug slowly to prevent adrenal insufficiency.
Oral
4–48 mg/day. For alternate-day therapy, give twice the usual dose every other morning.
IV, IM
10–40 mg IV administered over 1 to several min. Give subsequent doses IV or IM.
Caution: Rapid IV administration of large doses (more than 0.5–1 g in less than 10–120
min) has caused serious cardiac complications.
PEDIATRIC PATIENTS
Individualize dosage on the basis of severity and response rather than by formulae that
correct doses for age or weight. Carefully observe growth and development in infants and
children on prolonged therapy. Minimum dose of methylprednisolone is 0.5 mg/kg per 24
hr.
• High-dose therapy: 30 mg/kg IV infused over 10–20 min; may repeat q 4–6 hr,
but no longer than 72 hr.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–2 hr 1.2–1.5 days
IV Rapid Rapid Unknown
IM Rapid 4–8 days 1–5 wk

Metabolism: Hepatic; T1/2: 78–188 min


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: No additional preparation is required.
Infusion: Inject directly into vein or into tubing of running IV; administer slowly, over 1–
20 min to reduce cardiac effects.
Incompatibilities: Do not combine with calcium gluconate, glycopyrrolate, insulin,
nafcillin, penicillin G sodium, tetracycline.

Adverse effects
Effects depend on dose, route, and duration of therapy.
• CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts,
increased IOP, glaucoma
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention,
thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias
• Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased
carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect),
increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels,
hypothalamic-pituitary-adrenal (HPA) suppression with systemic therapy longer
than 5 days
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea,
vomiting, increased appetite, weight gain
• Hypersensitivity: Anaphylactoid reactions
• Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, spontaneous fractures
• Other: Immunosuppression; aggravation or masking of infections; impaired
wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae;
subcutaneous fat atrophy

Interactions
Drug-drug
• Increased therapeutic and toxic effects with erythromycin, ketoconazole,
troleandomycin
• Risk of severe deterioration of muscle strength when given to myasthenia gravis
patients who are receiving ambenonium, edrophonium, neostigmine,
pyridostigmine
• Decreased steroid blood levels with barbiturates, phenytoin, rifampin
• Decreased effectiveness of salicylates
Drug-lab test
• False-negative nitroblue-tetrazolium test for bacterial infection
• Suppression of skin test reactions

Nursing considerations
Assessment
• History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis,
diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF,
hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes
mellitus; pregnancy; lactation
• Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP,
peripheral perfusion prominence of superficial veins, R and adventitious sounds,
serum electrolytes, blood glucose

Interventions
• Use caution with the 24-mg tablets marketed as Medrol; these contain tartrazine,
which may cause allergic reactions, especially in people who are allergic to
aspirin.
• Give daily dose before 9 AM to mimic normal peak corticosteroid blood levels.
• Increase dosage when patient is subject to stress.
• Taper doses when discontinuing high-dose or long-term therapy.
• Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
Teaching points
• Do not to stop taking the oral drug without consulting your health care provider.
• Avoid exposure to infections.
• Report unusual weight gain, swelling of the extremities, muscle weakness, black
or tarry stools, fever, prolonged sore throat, colds or other infections, worsening
of disorder.

Adverse effects in Italic are most common; those in Bold are life-threatening.