methylprednisolone

methylprednisolone

(meth ill pred niss' oh lone)

methylprednisolone

Oral:

Medrol

methylprednisolone acetate

IM injection:

depMedalone, Depo-Medrol, Depopred–40, Depopred–80

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 MS, and palliation in some leukemias and lymphomas

·        Trichinosis with neurologic or myocardial involvement

·        Unlabeled use: Septic shock, respiratory distress syndrome, acute spinal cord injury

Contraindications and cautions

·        Contraindicated with infections, especially TB, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation; allergy totartrazine 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—4, 8, 16, 24, 32 mg; powder for injection—40, 125, 500 mg/mL, 1, 2 g/vial; suspension for injection—20, 40, 80 mg/mL

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 min to several min. Give subsequent doses IV or IM.

WARNING: Rapid IV administration of large doses (more than 0.5–1 g in less than 10–120 min) has caused serious cardiac complications.

Methylprednisolone acetate

Rheumatoid arthritis, maintenance: 40–120 mg IM weekly.

Adrenogenital syndrome: 40 mg IM q 2 wk.

Dermatologic lesions: 40–120 mg IM weekly for 1–4 wk.

Asthma and allergic rhinitis: 80–120 mg IM.

Intralesional: 20–60 mg.

Intra-articular dose depends on site of injection: 4–10 mg (small); 10–40 mg (medium); 20–80 mg (large joints).

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; T_1/2: 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, 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.

·        WARNING: Taper doses when discontinuing high-dose or long-term therapy to allow adrenal recovery.

·        WARNING: 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.