METHYLPREDNISOLONE

METHYLPREDNISOLONE (meth-ill-pred-niss'oh-lone) Medrol METHYLPREDNISOLONE ACETATE Depo-Medrol METHYLPREDNISOLONE SODIUM SUCCINATE A-Methapred, Solu-Medrol Classifications: hormone; adrenal corticosteroid; antiinflammatory; Therapeutic: adrenal corticosteroid; antiinflammatory Prototype: Prednisone Pregnancy Category: C

Availability

Methylprednisolone: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg tablets

Methylprednisolone Acetate: 20 mg/mL, 40 mg/mL, 80 mg/mL injection

Methylprednisolone Sodium Succinate: 40 mg, 125 mg, 500 mg, 1 g, 2 g powder for injection

Action

Intermediate-acting synthetic adrenal corticosteroid with similar glucocorticoid activity and has considerably fewer sodium and water retention effects than hydrocortisone. It inhibits phagocytosis, and release of allergic substances. It also modifies the immune response of the body to various stimuli. Sodium succinate form is characterized by rapid onset of action and is used for emergency therapy of short duration.

Therapeutic Effect

Has antiinflammatory and immunosuppressive properties.

Uses

An antiinflammatory agent in the management of acute and chronic inflammatory diseases, for palliative management of neoplastic diseases, and for control of severe acute and chronic allergic processes. High-dose, short-term therapy: management of acute bronchial asthma, prevention of fat embolism in patient with long-bone fracture. Short term management of rheumatic disorders.

Unlabeled Uses

Acetate form used as a long-acting contraceptive and for spinal cord injury, lupus nephritis, multiple sclerosis.

Contraindications

Systemic fungal infections; pregnacy (category C), lactation.

Cautious Use

Cushing's syndrome; GI disease, GI ulceration; hepatic disease; renal disease; hypertension; varicella, vaccinia; CHF; diabetes mellitus; glaucoma; coagulopathy; emotional instability or psychotic tendencies.

Route & Dosage

Inflammation Adult: PO 2–60 mg/d in 1 or more divided doses IM (Acetate) 10–80 mg/wk weekly or every other week; (Succinate) 10–80 mg daily IV 10–40 mg prn or 30 mg/kg q4–6h x 48 h Child: PO/IM/IV 0.5–1.7 mg/kg/d divided q6–12h Status Asthmaticus Adult/Child: IV 2 mg/kg then 1–5 mg/kg qh Acute Spinal Cord Injury Adult/Child: IV 30 mg/kg over 15 min, followed in 45 min by 5.4 mg/kg/h x 23 h Obesity Dose on IBW or ABW, whichever is lower.

Administration

Oral

• Crush tablet before and give with fluid of patient's choice.
• Note: Preparation less irritating if given with food.
• Use alternate day therapy when given over long period.

Intramuscular

• Give injection deep into large muscle (not deltoid).

Intravenous Note: Do NOT use methylprednisolone acetate for IV. PREPARE: Direct/Intermittent: Available in ACT-O-Vial from which the desired dose may be withdrawn after initial dilution with supplied diluent. May be further diluted according to physician's orders.   ADMINISTER: Direct: Give each 500 mg or fraction thereof over 2–3 min.  Intermittent: Give over 15–30 min.   INCOMPATIBILITIES Solution/additive: Dextrose 5%/sodium chloride 0.45%, aminophylline, calcium gluconate, glycopyrrolate, metaraminol, nafcillin, penicillin G sodium. Y-site: Allopurinol, amsacrine, ciprofloxacin, cisatracurium (≥2 mg/mL concentration), diltiazem, docetaxel, etoposide, filgrastim, fenoldopam, gemcitabine, ondansetron, paclitaxel, potassium chloride, propofol, sargramostim, vinorelbine.

• Store at 15°–30° C (59°–86° F). Do not freeze.

Adverse Effects (≥1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI: Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine: Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis. Metabolic: Hypokalemia.

Interactions

Drug: Amphotericin B, furosemide, thiazide diuretics increase potassium loss; with attenuated virus vaccines, may enhance virus replication or increase vaccine adverse effects; isoniazid, phenytoin, phenobarbital, rifampin decrease effectiveness of methylprednisolone because they increase metabolism of steroids.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 1–2 h PO; 4–8 d IM. Duration: 1.25–1.5 d PO; 1–5 wk IM. Metabolism: In liver. Half-Life: >3.5 h; HPA suppression: 18–36 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Monitor periodically kidney and liver function, thyroid function, CBC, serum electrolytes, weight, and total cholesterol.
• Monitor diabetics for loss of glycemic control.
• Monitor serum potassium and report S&S of hypokalemia (see Appendix F).
• Monitor for and report S&S of Cushing's syndrome (see Appendix F).

Patient & Family Education

• Consult physician for any of the following: slow wound healing, significant insomnia or confusion, or unexplained bone pain.
• Do not alter established dosage regimen (i.e., not to increase, decrease, or omit doses or change dose intervals). Withdrawal symptoms (rebound inflammation, fever) can be induced with sudden discontinuation of therapy.
• Report onset of signs of hypocorticism adrenal insufficiency immediately: Fatigue, nausea, anorexia, joint pain, muscular weakness, dizziness, fever.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug