Methylprednisolone (Systemic)

Introductory Information
Synthetic glucocorticoid; minimal mineralocorticoid activity.b, c, d
Class: 68:04 Adrenals; hs051 (VA primary)
Brands*: A-methaPred, Depo-Medrol, Medrol, Medrol Dosepak, Meprolone Unipak,
Solu-Medrol
*

also available generically

Generic Name: Methylprednisolone

CAS Number: 83-43-2
Synonym: 6--Methylprednisolone
Generic Name: Methylprednisolone Acetate
CAS Number: 53-36-1
Generic Name: Methylprednisolone Sodium Succinate
CAS Number: 2921-57-5

Uses
Treatment of a wide variety of diseases and conditions principally for glucocorticoid effects
as an anti-inflammatory and immunosuppressant agent and for its effects on blood and
lymphatic systems in the palliative treatment of various diseases.c, d
Usually, inadequate alone for adrenocortical insufficiency because of minimal
mineralocorticoid activity.c
Adrenocortical Insufficiency
Corticosteroids are administered in physiologic dosages to replace deficient endogenous
hormones in patients with adrenocortical insufficiency.a, c
Because production of both mineralocorticoids and glucocorticoids is deficient in
adrenocortical insufficiency, hydrocortisone or cortisone (in conjunction with liberal salt
intake) usually is the corticosteroid of choice for replacement therapy.a, c, d, m
If methylprednisolone is used, must also administer a mineralocorticoid (fludrocortisone),
particularly in infants.a, c, d

In suspected or known adrenal insufficiency, parenteral therapy may be used preoperatively

or during serious trauma, illness, or shock unresponsive to conventional therapy.d, e, m
In shock unresponsive to conventional therapy, IV therapy in conjunction with other therapy
for shock is essential; hydrocortisone is preferred, but a synthetic glucocorticoid like
methylprednisolone can be substituted.c, e
Adrenogenital Syndrome
Lifelong glucocorticoid treatment of congenital adrenogenital syndrome.a, c
In salt-losing forms, cortisone or hydrocortisone is preferred in conjunction with liberal salt
intake; a mineralocorticoid may be necessary in conjunction through at least 5-7 years of
age.c
A glucocorticoid, usually alone, for long-term therapy after early childhood.c
In hypertensive forms, a "short-acting" glucocorticoid with minimal mineralocorticoid
activity (e.g., methylprednisolone, prednisone) is preferred;c avoid long-acting
glucocorticoids (e.g., dexamethasone) because of tendency toward overdosage and growth
retardation.c
Hypercalcemia
Treatment of hypercalcemia associated with malignancy.a, c, d, m
Usually ameliorates hypercalcemia associated with bone involvement in multiple myeloma.c
Most effective long-term treatment for hypercalcemia associated with breast cancer in
postmenopausal women.c
Efficacy varies in other malignancies.c
Treatment of hypercalcemia associated with sarcoidosis

.c
.c

Treatment of hypercalcemia associated with vitamin D intoxication

Not effective for hypercalcemia caused by hyperparathyroidism

.c

Thyroiditis
Treatment of granulomatous (subacute, nonsuppurative) thyroiditis.a, c, d, m
Anti-inflammatory actions relieves fever, acute thyroid pain, and swelling.c
May reduce orbital edema in endocrine exophthalmos (thyroid ophthalmopathy).c
Usually reserved for palliative therapy in severely ill patients unresponsive to salicylates and
thyroid hormones.c

Rheumatic Disorders and Collagen Diseases

Short-term palliative treatment of acute episodes or exacerbations and systemic complications
of rheumatic disorders (e.g., rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, acute
gouty arthritis, posttraumatic osteoarthritis, synovitis of osteoarthritis, epicondylitis, acute
nonspecific tenosynovitis, ankylosing spondylitis, Reiter syndrome

, rheumatic fever

[especially with carditis]) and collagen diseases (e.g., acute rheumatic carditis,

systemic lupus erythematosus, dermatomyositis

, vasculitis

[polymyositis], polyarteritis nodosa

) refractory to more conservative measures.a, c, d, l, m

Relieves inflammation and suppresses symptoms but not disease progression.c

Rarely indicated as maintenance therapy.c
May be used as maintenance therapy (e.g., in rheumatoid arthritis, acute gouty arthritis,
systemic lupus erythematosus, acute rheumatic carditis) as part of a total treatment program
in selected patients when more conservative therapies have proven ineffective.a, b, c, d
Glucocorticoid withdrawal is extremely difficult if used for maintenance; relapse and
recurrence usually occur with drug discontinuance.c
Local injection can provide dramatic relief initially for articular manifestations of rheumatic
disorders (e.g., rheumatoid arthritis) that involve only a few persistently inflamed joints or for
inflammation of tendons or bursae;c inflammation tends to recur and sometimes is more
intense after drug cessation.c
Local injection used for the management of cystic tumors of an aponeurosis or tendon
(ganglia).d
Local injection can prevent invalidism by facilitating movement of joints that might
otherwise become immobile.c
Controls acute manifestations of rheumatic carditis more rapidly than salicylates and may be
life-saving; cannot prevent valvular damage and no better than salicylates for long-term
treatment.c

Adjunctively for severe systemic complications of Wegener's granulomatosis

, but

cytotoxic therapy is the treatment of choice.c

Primary treatment to control symptoms and prevent severe, often life-threatening
complications in patients with dermatomyositis

polyarteritis nodosa

, relapsing polychondritis

and giant-cell (temporal) arteritis

syndrome

and polymyositis

, polymyalgia rheumatica

, or mixed connective tissue disease

.a, c High dosage may be required for acute situations; after a response has

been obtained, drug must often be continued for long periods at low dosage.c
Polymyositis

associated with malignancy and childhood dermatomyositis may not

respond well.c
Rarely indicated in psoriatic arthritis, diffuse scleroderma

sclerosis), acute and subacute bursitis, or osteoarthritis

(progressive systemic

; risks outweigh benefits.a, c, d,

In osteoarthritis

, intra-articular injections may be beneficial but should be limited in

number as joint damage may occur.c, d

Dermatologic Diseases
Treatment of pemphigus and pemphigoid

, bullous dermatitis herpetiformis, severe

erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, uncontrollable

eczema

, cutaneous sarcoidosis

, mycosis fungoides, lichen planus, lichen

simplex chronicus (neurodermatitis), severe psoriasis, and severe seborrheic dermatitis.a, c, d, e

Usually reserved for acute exacerbations unresponsive to conservative therapy.c
Early initiation of systemic glucocorticoid therapy may be life-saving in pemphigus vulgaris
and pemphigoid

, and high or massive doses may be required.c

For control of severe or incapacitating allergic conditions (e.g., contact dermatitis, atopic
dermatitis) intractable to adequate trials of conventional treatment.a, d, e, f, m
Chronic skin disorders seldom an indication for systemic glucocorticoids.c
Intralesional or sublesional injections occasionally indicated for localized chronic skin
disorders, keloids, psoriatic plaques, alopecia areata, discoid lupus erythematosus,
necrobiosis lipoidica diabeticorum, granuloma annulared, m unresponsive to topical therapy.c
;c if used, exacerbation may occur when the drug is

Rarely indicated for psoriasis

withdrawn or dosage is decreased.c

Rarely indicated systemically for alopecia (areata, totalis, or universalis).c May stimulate hair
growth, but hair loss returns when the drug is discontinued.c
Allergic Conditions
For control of severe or incapacitating allergic conditions intractable to adequate trials of
conventional treatment and control of acute manifestations, including anaphylactic and
anaphylactoid reactions

, angioedema

serum sickness, allergic symptoms of trichinosis

, acute noninfectious laryngeal edema,

, asthma, urticarial transfusion

reactions, drug hypersensitivity reactions, and severe seasonal or perennial rhinitis.a, c, d, e, f, m

Systemic therapy usually reserved for acute conditions and severe exacerbations.c
For acute conditions, usually used in high dosage and with other therapies (e.g.,
antihistamines, sympathomimetics).c
Reserve prolonged treatment of chronic allergic conditions for disabling conditions
unresponsive to more conservative therapy and when risks of long-term glucocorticoid
therapy are justified.c

Ocular Disorders
To suppress a variety of allergic and nonpyogenic ocular inflammations.c
To reduce scarring in ocular injuries

.c

For the treatment of severe acute and chronic allergic and inflammatory processes involving
the eye and adnexa (e.g., allergic conjunctivitis, keratitis, allergic corneal marginal ulcers,
herpes zoster ophthalmicus, iritis and iridocyclitis, chorioretinitis, diffuse posterior uveitis
and choroiditis, anterior segment inflammation, optic neuritis, sympathetic ophthalmia,
temporal arteritis).a, c d, e, f, m
Acute optic neuritis optimally treated with initial high-dose IV therapy followed by chronic
oral therapy. Assists in recovery of vision and slows progression to clinically definite multiple
sclerosis.
Less severe allergic and inflammatory allergic conditions of the eye are treated with topical
(to the eye) corticosteroids.g
Topically applied glucocorticoids appear to be as effective as systemic steroids for the
treatment of most anterior ocular inflammations.c
Systemically in stubborn cases of anterior segment eye disease and when deeper ocular
structures are involved.c
Asthma
Adjunctively for moderate to severe exacerbations of asthma and for maintenance in
persistent asthma.c, g
Systemically (oral or IV) for treatment of moderate to severe acute exacerbations of asthma
(oral prednisone usually preferred); speeds resolution of airflow obstruction and reduces rate
of relapse.g
Because onset of effects is delayed, do not use alone for emergency treatment.c
Early systemic glucocorticoid therapy particularly important for asthma exacerbations in
infants and children.g
In hospital management of an acute asthma exacerbation, may give systemic adjunctive
glucocorticoids if response to oral inhalation therapy is not immediate, if oral corticosteroids
were used as self-medication prior to hospitalization, or if the episode is severe.c
For severe persistent asthma once initial control is achieved, high dosages of inhaled
corticosteroids are preferable to oral glucocorticoids for maintenance because inhaled
corticosteroids have fewer systemic effects.

Maintenance therapy with low doses of an orally inhaled corticosteroid is preferred treatment
for adults and children with mild persistent asthmac (i.e., patients with daytime symptoms of
asthma more than twice weekly but less than once daily, and nocturnal symptoms of asthma
more than twice per month).b
Orally as an adjunct to other therapy to speed resolution of all but the mildest exacerbations
of asthma when response to a short-acting inhaled 2-agonist is not prompt or sustained after
1 hour or in those who have a history of severe exacerbations.c
Oral glucocorticoids with minimal mineralocorticoid activity and relatively short half-life
(e.g., prednisone, prednisolone, methylprednisolone) are preferred.
COPD
For severe exacerbations of COPD

, a short (e.g., 1-2 weeks) course of oral

glucocorticoids can be added to existing therapy.

Effects in stable COPD are much less dramatic than in asthma, and role of glucocorticoids in
the management of stable COPD is limited to very specific indications.
Croup
Adjunctive treatment of croup

in pediatric patients.g

Decreases edema in laryngeal mucosa.g

Reduces need for hospitalization, shorter duration of hospitalization, and reduces need for
subsequent interventions (e.g., epinephrine).g
Sarcoidosis
Management of symptomatic sarcoidosis.a, c, d, e, f, m
Systemic glucocorticoids are indicated for hypercalcemia; ocular, CNS, glandular,
myocardial, or severe pulmonary involvement; or severe skin lesions unresponsive to
intralesional injections of glucocorticoids.c
Advanced Pulmonary and Extrapulmonary Tuberculosis
Systemically as adjunctive therapy with effective antimycobacterial agents (e.g.,
streptomycin, isoniazid) to suppress manifestations related to the host's inflammatory
response to the bacillus (Mycobacterium tuberculosis) and ameliorate complications in severe
pulmonary or extrapulmonary tuberculosis.a, m
Adjunctive glucocorticoid therapy may enhance short-term resolution of disease
manifestations (e.g., clinical and radiographic abnormalities) in advanced pulmonary

tuberculosis and also may reduce mortality associated with certain forms of extrapulmonary
disease (e.g., meningitis, pericarditis).
Systemic adjunctive glucocorticoids may reduce sequelae (e.g., intellectual impairment)
and/or improve survival in moderate to severe tuberculous meningitis; used in the treatment
of tuberculous meningitis with subarachnoid block or impending block concurrently with
appropriate antituberculous chemotherapy.a, d, e, f, m
Systemic adjunctive glucocorticoid therapy rapidly reduces the size of pericardial effusions
and the need for drainage procedures and decreases mortality (probably through control of
hemodynamically threatening effusion) in acute tuberculous pericarditis.
Hastens the resolution of pain, dyspnea, and fever associated with tuberculous pleurisy.c
Lipid Pneumonitis
Promotes the breakdown or dissolution of pulmonary lesions and eliminates sputum lipids in
lipid pneumonitis.c
Pneumocystis jiroveci Pneumonia
Systemic adjunctive glucocorticoids decrease the likelihood of deterioration of oxygenation,
respiratory failure, and/or death in moderate to severe Pneumocystis jiroveci (formerly
Pneumocystis carinii) pneumonia in AIDS

Prevents early deterioration in oxygenation associated with antipneumocystis therapy; initiate

adjunctive glucocorticoid therapy as early as possible in moderate to severe pneumocystis
pneumonia.
Not known whether patients with mild pneumocystis pneumonia (arterial oxygen pressure
>70 mm Hg or arterial-alveolar gradient <35 mm Hg on room air) will have clinically
important benefit with adjunctive glucocorticoid therapy.
Oral prednisone or parenteral methylprednisolone generally is preferred.
Loeffler's Syndrome
Symptomatic relief of acute manifestations of symptomatic Loeffler's syndrome not
manageable by other means.a, f
Berylliosis
Symptomatic relief of acute manifestations of berylliosis.a, d, f, m
Aspiration Pneumonitis
Symptomatic relief of acute manifestations of aspiration pneumonitis.a, d, f
Anthrax

Adjunct to anti-infective therapy in the treatment of anthrax

in an attempt to

ameliorate toxin-mediated effects associated with Bacillus anthracis infections.

For cutaneous anthrax

if there are signs of systemic involvement or extensive edema

involving the neck and thoracic region, anthrax meningitis

, and inhalational anthrax

that occurs as the result of exposure to anthrax spores in the context of biologic
warfare or bioterrorism if extensive edema, respiratory compromise, or meningitis is present.
Hematologic Disorders
Management of acquired (autoimmune) hemolytic anemia, pure red cell aplasia, idiopathic
thrombocytopenic purpura (ITP), secondary thrombocytopenia, erythroblastopenia, or
congenital (erythroid) hypoplastic anemia.a, d, e, f, m
High or even massive dosages decrease bleeding tendencies and normalize blood counts;
does not affect the course or duration of hematologic disorders.c
Glucocorticoids, immune globulin IV (IGIV), or splenectomy are first-line therapies for
moderate to severe ITP, depending on the extent of bleeding involved.
May not affect or prevent renal complications in Henoch-Schoenlein purpura.c
Insufficient evidence of effectiveness in aplastic anemia in children, but widely used.c
Shock
Although IV glucocorticoids may be life-saving in shock secondary to adrenocortical
insufficiency (see Adrenocortical Insufficiency under Uses), the value of the drugs in the
treatment of shock resulting from other causes

is controversial.c

Management of shock should be based on specific treatment of the primary cause and
secondary abnormalities, and glucocorticoids, if used, should be regarded only as adjunctive
supportive treatment.c
Value in adjunctive treatment of septic shock

is particularly controversial.

Conflicting evidence regarding effects of high-dose regimens on morbidity and mortality in

septic shock. In a clinical study, methylprednisolone was ineffective in the treatment of sepsis

syndrome and septic shock, and may increase the risk of mortality in certain patients (i.e.,
patients with increased Scr or those who develop secondary infections after treatment).e
Pericarditis
To reduce the pain, fever, and inflammation of pericarditis

, including that associated

with MI.c
Glucocorticoids can provide effective symptomatic relief, but aspirin considered the
treatment of choice for post-MI pericarditis because of greater evidence establishing benefit.
Important to distinguish between pain caused by pericarditis and that caused by ischemia
since management will differ.
Consider possibility that cardiac rupture may account for recurrent pain since use of
glucocorticoids may be a risk factor in its development.
Glucocorticoids may cause thinning of developing scar and myocardial rupture.
Management of tuberculous pericarditis. (See Advanced Pulmonary and Extrapulmonary
Tuberculosis under Uses.)
GI Diseases
Short-term palliative therapy for acute exacerbations and systemic complications of
ulcerative colitis, regional enteritis (Crohn's disease), and celiac disease

.a, c, d, e, f, m

Do not use if a probability of impending perforation, abscess, or other pyogenic infection.e

Rarely indicated for maintenance therapy in chronic GI diseases (e.g., ulcerative colitis,
celiac disease) since does not prevent relapses and may produce severe adverse reactions with
long-term administration.c
Occasionally, low dosages, in conjunction with other supportive therapy, may be useful for
disease unresponsive to the usual therapy indicated for chronic conditions.c
Management of mildly to moderately active and moderately to severely active Crohn's
disease .
Parenteral glucocorticoids recommended for patients with severe fulminant Crohn's disease.
Once patients respond to parenteral therapy, they should gradually be switched to an
equivalent regimen of an oral glucocorticoid.
Some experts state that glucocorticoids should not be used for the management of mildly to
moderately active Crohn's disease because of the high incidence of adverse effects and their
use should be reserved for patients with moderately to severely active disease.

Glucocorticoids should not be used for maintenance therapy of chronic GI diseases (e.g.,
ulcerative colitis, Crohn's disease) because they usually do not prevent relapses and the drugs
may produce severe adverse effects with long-term administration.a, c
Glucocorticoids have been used in the management of moderately to severely active Crohn's
disease and in mild esophageal or gastroduodenal Crohn's disease in pediatric patients.
Neoplastic Diseases
Alone or as a component of various chemotherapeutic regimens in the palliative treatment of
neoplastic diseases of the lymphatic system (e.g., leukemias and lymphomas in adults and
acute leukemias in children).a d, e, f, m
Treatment of breast cancer

; glucocorticoids alone not as effective as other agents

(e.g., cytotoxic agents, hormones, antiestrogens) and should be reserved for unresponsive
disease.c
Glucocorticoids alone or as a component of various combination chemotherapeutic regimens
for palliative treatment of advanced, symptomatic (i.e., painful) hormone-refractory prostate
cancer

Cancer Chemotherapy-induced Nausea and Vomiting

Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
.
Cerebral Edema
To decrease cerebral edema associated with brain tumors and neurosurgery.c, d, m
Cerebral edema associated with pseudotumor cerebri may also benefit, but efficacy of
glucocorticoids is controversial and remains to be established.c
Edema resulting from brain abscesses is less responsive than that resulting from brain
tumors.c
Pharmacologic management of cerebral edema is not a substitute for careful neurosurgical
evaluation and definitive management such as neurosurgery or other specific therapy.c, d, f
Head Injury
Efficacy of glucocorticoid therapy is not established in patients with head injury; such
therapy can be detrimental and is associated with a substantial increase in risk of death. Use

to improve outcome or reduce intracranial pressure not recommended in patients with head
injury.
Cerebral Malaria
Glucocorticoids are not effective and can have detrimental effects in the management of
cerebral malaria caused by Plasmodium falciparum; no longer recommended for this
condition.c
Acute Spinal Cord Injury
Some evidence indicates that large IV doses of glucocorticoids (i.e., methylprednisolone) can
improve motor and sensory function in patients with acute spinal cord injury

when

treatment is initiated promptly following injury (within 8 hours). It is not known whether
improvement in neurologic function with such therapy will routinely lead to specific
improvements in disability.
Low Back Pain
Has been used epidurally (alone or combined with a local anesthetic and/or an opiate
analgesic) for symptomatic relief of low back pain

; although use remains

controversial and convincing evidence of efficacy is lacking, most experts consider such
therapy an option for short-term relief of acute, subacute, or chronic radicular pain in patients
with low back pain and radiculopathy associated with disk disease or herniation or spinal
stenosis when more conservative therapies (e.g., rest, analgesics, physical therapy) fail and as
a means of potentially avoiding surgery.
Limited evidence suggests that therapeutic facet joint

injections

and intradiscal glucocorticoid

are minimally effective or ineffective in the treatment of low back pain,

although facet joint injections may be useful in some patients with facet arthropathy.
Inclusion of a glucocorticoid in trigger point injections does not appear to be beneficial.
Sacroiliac joint injections performed using fluoroscopic guidance may provide temporary
pain relief in some patients when the principal source of spinal pain is the sacroiliac joint.

Oral glucocorticoids

have been used; however, they do not appear to be effective and

evidence supporting such use is lacking.

Bacterial Meningitis
Limited data in animals suggest that dexamethasone may be superior to methylprednisolone
in reversing certain CSF abnormalities (e.g., intracranial hypertension, elevated lactate
concentrations) associated with bacterial meningitis, and experience is insufficient to allow
recommendation of glucocorticoids other than dexamethasone for adjunctive therapy in
bacterial meningitis

Short-term IV adjunctive therapy with dexamethasone is preferred.

Multiple Sclerosis
Glucocorticoids are drugs of choice for the management of acute relapses of multiple
sclerosis

a, d, m

and have replaced corticotropin as the therapy of choice because of a

more rapid onset of action, more consistent effects, and fewer adverse effects.
Anti-inflammatory and immunomodulating effects accelerate neurologic recovery by
restoring the blood-brain barrier, reducing edema, and possibly improving axonal conduction.
Shortens the duration of relapse and accelerates recovery; remains to be established whether
the overall degree of recovery improves or the long-term course is altered.
Myasthenia Gravis
Management of myasthenia gravis

, usually when there is an inadequate response to

anticholinesterase therapy.
Parenterally for the treatment of myasthenic crisis.
Organ Transplants
In massive dosage, used concomitantly with other immunosuppressive drugs to prevent
rejection of transplanted organs

.c

Incidence of secondary infections is high with immunosuppressive drugs; limit to clinicians

experienced in their use.c
Trichinosis

Treatment of trichinosis with neurologic or myocardial involvement.a, d, e, f

Nephrotic Syndrome and Lupus Nephritis
Treatment of idiopathic nephrotic syndrome without uremia.a, d, e, f
Can induce diuresis and remission of proteinuria in nephrotic syndromea, c, d, e, f, m secondary
to lupus erythematosus or primary renal disease, especially when there is minimal renal
histologic change.b, d, m
Treatment of lupus nephritis.a, d, e
Carpal Tunnel Syndrome
Local injection of glucocorticoids (e.g., methylprednisolone, betamethasone) into the tissue
near the carpal tunnel has been used in a limited number of patients to relieve symptoms
(e.g., pain, edema, sensory deficit) of carpal tunnel syndrome

Dosage and Administration

General
Route of administration and dosage depend on the condition being treated and the patient
response.a
Alternate-day Therapy
Alternate-day therapy in which a single dose (twice the usual daily dosage) is administered
every other morning is the dosage regimen of choice for long-term oral glucocorticoid
treatment of most conditions.a, c This regimen provides relief of symptoms while minimizing
adrenal suppression, protein catabolism, and other adverse effects.a, c
If alternate-day therapy is preferred, only use a "short-acting" glucocorticoid that suppresses
the HPA axis <1.5 days after a single oral dose (e.g., methylprednisolone, prednisone,
prednisolone).c
Some conditions (e.g., rheumatoid arthritis, ulcerative colitis) require daily glucocorticoid
therapy because symptoms of the underlying disease cannot be controlled by alternate-day
therapy.c
Discontinuance of Therapy

 A steroid withdrawal syndrome consisting of lethargy, fever, and myalgia can develop
following abrupt discontinuance.c Symptoms often occur without evidence of adrenal
insufficiency (while plasma glucocorticoid concentrations were still high but were falling
rapidly).c
If used for only brief periods (a few days) in emergency situations, may reduce and discontinue
dosage quite rapidly.c
Very gradually withdraw systemic glucocorticoids until recovery of HPA-axis function occurs
following long-term therapy with pharmacologic dosages.c, d, e, m (See Adrenocortical
Insufficiency under Warnings.)
Exercise caution when transferring from systemic glucocorticoid to oral or nasal inhalation
corticosteroid therapy.c
Many methods of slow withdrawal or "tapering" have been described.c
In one suggested regimen, decrease by 2-4 mg every 3-7 days of until the physiologic dose (4
mg) is reached.c
Other recommendations state that decrements usually should not exceed 2 mg every 1-2
weeks.c
When a physiologic dosage has been reached, single 20-mg oral morning doses of
hydrocortisone can be substituted for whatever glucocorticoid the patient has been receiving.c
After 2-4 weeks, may decrease hydrocortisone dosage by 2.5 mg every week until a single
morning dosage of 10 mg daily is reached.c
For certain acute allergic conditions (e.g., contact dermatitis such as poison ivy) or acute
exacerbations of chronic allergic conditions, glucocorticoids may be administered short term
(e.g., for 6 days).c Administer an initially high dose on the first day of therapy, and then
withdraw therapy by tapering the dose over several days.c
Administration
Administer orally, by IV injection or infusion, or IM injection.a, d, e, f, m
Administer for local effect by intra-articular, intralesional, intrasynovial, soft-tissue, or
epidural injection.c, d, m
Generally reserve IM or IV therapy for patients who are not able to take the drug orally or for
use in an emergency situation.d, e After the initial emergency period, a longer-acting injectable
corticosteroid preparation or oral administration of a corticosteroid should be considered.b
Methylprednisolone acetate injections (in multiple-dose vials) contain benzyl alcohol; do not
administer intrathecally because of reports of severe adverse events with such use.m

Oral Administration
Methylprednisolone
Administer orally as tablets.a
IV Administration
Methylprednisolone Sodium Succinate
Administer by IV injection or infusion.e
Reconstitution of Methylprednisolone Sodium Succinate
Reconstitute by pressing on a plastic activator to force the diluent provided from the
manufacturer from an upper compartment of a 2-compartment vial to a lower compartment
containing sterile powder.e Alternately, use bacteriostatic water for injection with benzyl
alcohol for reconstitution.e
Dilution of Methylprednisolone Sodium Succinate
When administered by IV infusion, the drug can be added to 5% dextrose, or 0.9% sodium
chloride, or 5% dextrose in sodium chloride injection.e
Rate of Administration of Methylprednisolone Sodium Succinate
Direct IV injection: Administer over a period of several minutes.e
IM Administration
Do not administer IM for conditions prone to bleeding (e.g., idiopathic thrombocytopenic
purpura [ITP]).e
Methylprednisolone Acetate
Administer by IM injection.d, m
Because it is slowly absorbed, IM administration is not indicated when an immediate effect of
short duration is required.d
Commercially available single-dose vials are for single use only.d, m Although initially sterile,
multiple use of a single-dose vial may result in contamination, unless strict aseptic technique
is observed.m
Methylprednisolone Sodium Succinate
Administer by IM injection.e
Absorption from IM injection sites is rapid.b
Intra-articular, Intralesional, and Soft Tissue Administration
Methylprednisolone Acetate
Administer by intra-articular, intralesional, intrasynovial, or soft tissue injection.b, d, m (See
Dermatologic Effects under Cautions.)

May infiltrate the tissue surrounding the joint with a local anesthetic (e.g., procaine
hydrochloride) before administration of methylprednisolone acetate.b, d
Examine joint fluid to exclude sepsis and avoid injection into an infected site; if joint sepsis is
evident, institute appropriate antibacterial therapy.c, d, m Symptoms of septic arthritis include
local swelling, further restriction of joint motion, fever, or malaise.c, d, m Do not inject
glucocorticoids into unstable joints and caution patients not to overuse joints in which the
inflammatory process still is active despite symptomatic improvement.c
Epidural Administration
Long-acting injectable suspension has been administered by epidural injection, although
safety of epidural injections using preserved formulations is controversial and epidural
administration of these formulations is not recommended by the manufacturer.c Limited
evidence suggests that large particles in glucocorticoid suspensions may cause embolic
vascular occlusion following inadvertent intra-arterial injection.
Inject into the epidural space near the site where the nerve roots pass before entering the
intervertebral foramen.
Epidural injections may be performed by caudal, interlaminar, or transforaminal approaches;
the transforaminal approach requires the smallest injection volume and appears to be the most
specific and possibly most effective route.
Because of the potential for complications related to improper needle placement or drug
administration, many experts state that epidural injections should be performed by an
experienced clinician using fluoroscopic guidance and contrast control to ensure that the
needle is correctly positioned and that the injection is not performed intravascularly,
intrathecally, or into tissues other than the epidural space.
Optimal technique, dosage, timing of initial injection, injection frequency, and maximum
number of injections remain to be established.
Dosage
Available as methylprednisolone, methylprednisolone acetate, and methylprednisolone
sodium succinate.a, b, d, e, m Dosage of methylprednisolone sodium succinate or
methylprednisolone acetate is expressed in terms of methylprednisolone or
methylprednisolone acetate, respectively.d, e, m
After a satisfactory response is obtained, decrease dosage in small decrements to the lowest
level that maintains an adequate clinical response, and discontinue the drug as soon as
possible.a, b, e

Monitor patients continually for signs that indicate dosage adjustment is necessary, such as
remissions or exacerbations of the disease and stress (surgery, infection, trauma).b
High dosages may be required for acute situations of certain rheumatic disorders and collagen
diseases; after a response has been obtained, drug often must be continued for long periods at
low dosage.c
High or massive dosages may be required in the treatment of pemphigus, exfoliative
dermatitis, bullous dermatitis herpetiformis, severe erythema multiforme, or mycosis
fungoides.c Early initiation of systemic glucocorticoid therapy may be life-saving in
pemphigus vulgaris.c Reduce dosage gradually to the lowest effective level, but
discontinuance may not be possible.c, d, m
Massive dosages may be required for treatment of shock.b
Increase dosage of rapidly acting corticosteroids in patients subjected to any unusual stress
before, during, and after the stressful situation.a, d, e, m
Pediatric Patients
Base pediatric dosage on severity of the disease and patient response rather than on strict
adherence to dosage indicated by age, body weight, or body surface area.b, e
Usual Dosage
Oral: 0.117-1.66 mg/kg daily or 3.3-50 mg/m2 daily, administered in 3 or 4 divided doses.b
>IM
Methylprednisolone sodium succinate: 0.03-0.2 mg/kg or 1-6.25 mg/m2 IM 1-2 times daily
has been used.b
Asthma
Oral: To gain prompt control of asthma in infants and children 4 years of age with very
poorly controlled, moderate-to-severe asthma (i.e., >3 exacerbations per year requiring oral
corticosteroids) and in children 5-11 years of age with asthma of comparable control and
severity (i.e., 2 exacerbations per year requiring oral corticosteroids): Methylprednisolone
1-2 mg/kg daily (maximum 60 mg daily) may be added to existing asthma therapy.
In children 11 years of age undergoing emergency department treatment for moderate-tosevere acute asthma exacerbations not controlled with an inhaled 2-adrenergic agonist: May
add methylprednisolone 1-2 mg/kg daily in 2 divided doses (maximum 60 mg daily).
Continue treatment until patient achieves a PEF of 70% of predicted or personal best.
Allergic Conditions
>IM

Methylprednisolone acetate: For control of severe or incapacitating allergic conditions (e.g.,

bronchial asthma, seasonal or perennial allergic rhinitis) intractable to adequate trials of
conventional therapy, initially, 1-2 mg/kg.
To gain prompt control of asthma in infants and children 4 years of age or children 5 years
of age with very poorly-controlled, moderate-to-severe asthma (as an alternative to a short
course of an oral corticosteroid) who are vomiting or noncompliant with oral corticosteroid
therapy: 7.5 mg/kg or 240 mg as a single dose of methylprednisolone acetate, respectively.
Relief of asthma symptoms should occur within 6-48 hours and persist for several days to 2
weeks.d
Relief of coryzal symptoms of allergic rhinitis should occur within 6 hours and persist for
several days to 3 weeks.d
>IV
Methylprednisolone sodium succinate: For control of severe or incapacitating allergic
conditions (e.g., bronchial asthma) intractable to adequate trials of conventional therapy,
initially, 1-2 mg/kg.
Croup
>IV
Methylprednisolone sodium succinate: Initialy, 1-2 mg/kg.
Pneumocystis jiroveci Pneumonia
>IV
Methylprednisolone sodium succinate in children >13 years of age with AIDS

and

moderate to severe Pneumocystis jiroveci pneumonia: 30 mg twice daily for 5 days, followed
by 30 mg once daily for 5 days, and then 15 mg once daily for 11 days (or until completion of
the anti-infective regimen). Initiate within 24-72 hours of initial antipneumocystis therapy.
Acute Spinal Cord Injury
>IV
Methylprednisolone sodium succinate: 30 mg/kg IV (administered over 15 minutes),
followed after 45 minutes by a continuous IV infusion of 5.4 mg/kg per hour for 23 hours.

Lupus Nephritis
>IV
Methylprednisolone sodium succinate: 30 mg/kg IV every other day for 6 doses.b
Adults
Usual Dosage
Oral: Initially, 2-60 mg daily, depending on disease being treated, and is usually divided into
4 doses.b
>IV or IM
Methylprednisolone sodium succinate: Usually, 10-250 mg; may repeat up to 6 times daily.b
>IV then IV or IM
Methylprednisolone sodium succinate: For high-dose therapy, administer 30 mg/kg over at
least 30 minutes.e May repeat every 4-6 hours for 48 hours.e Continue high-dose therapy only
until the condition stabilizes, usually 48-72 hours.e
For other conditions, 10-40 mg over several minutes.e Administer subsequent doses IV or IM
depending on response and clinical condition.e
>IM
Methylprednisolone acetate: 10-80 mg.b
Methylprednisolone acetate for maintenance of patients with rheumatoid arthritis: 40-120 mg
weekly.
When methylprednisolone acetate suspension is given as a temporary substitute for oral
therapy, dose of the suspension should be equal to the total daily oral dose of
methylprednisolone; administer IM once daily.d, m If a prolonged effect is desired, may
administer an IM dose of methylprednisolone acetate equal to 7 times the daily oral dose of
methylprednisolone once weekly.d, m
Intrarticular, Intrasynovial, Intralesional, or Soft-tissue Injection
Varies depending on location, size, and degree of inflammation.b, d, m In chronic cases, repeat
injections at intervals ranging from 1-5 weeks or more, depending on degree of relief
resulting from initial injection.d, m
Large Joints (e.g., knee): 20-80 mg of methylprednisolone acetate.d, m
Smaller Joints: 4-40 mg of methylprednisolone acetate repeated.d, m
Bursae, Ganglia, Tendinitis, Epicondylitis: 4-30 mg of methylprednisolone acetate; repeat if
necessary for recurrent or chronic conditions.d, m

Soft Tissue: 4-30 mg of methylprednisolone acetate for soft tissue infiltration; repeat if
necessary for recurrent or chronic conditions.d.
Asthma
Oral: In adults and adolescents with very poorly controlled, moderate-to-severe asthma (i.e.,
2 exacerbations per year requiring oral corticosteroids): May add methylprednisolone 40-60
mg daily as a single dose or in 2 divided doses to low-to-high maintenance dosages of the
inhaled corticosteroid and a long-acting inhaled 2-agonist bronchodilator. Continue with a
short course (usually 3-10 days) of oral corticosteroid therapy until patient achieves a PEF of
80% of his or her personal best and until symptoms resolve. May need a longer duration of
treatment in some patients. There is no evidence that tapering the dosage after improvement
will prevent a relapse.
In adults and adolescents with severe asthma who are inadequately controlled with a highdose inhaled corticosteroid, intermittent oral corticosteroid therapy, and a long-acting inhaled
2-agonist bronchodilator (based on consensus and clinical experience): May use
methylprednisolone 7.5-60 mg daily in the morning or every other day. May consider a short
course (2 weeks) of oral corticosteroids to confirm clinical response prior to implementing
long-term therapy with these agents. Once long-term oral corticosteroid therapy is initiated,
use the lowest possible effective dosage (i.e., alternate-day or once-daily administration);
monitor the patient carefully for adverse effects. Once asthma is well controlled, make
repeated attempts to reduce the oral corticosteroid dosage.
In adults and adolescents undergoing emergency department treatment for moderate-to-severe
acute asthma exacerbations not controlled with an inhaled 2-adrenergic agonist: May add
methylprednisolone 40-80 mg daily as a single dose or in 2 divided doses to an inhaled 2adrenergic agonist. Continue treatment until patient achieves a PEF of 70% of predicted or
personal best.
Dermatologic Diseases
>Intralesional Injection
Methylprednisolone acetate: 20-60 mg into the lesion.d For large lesions, it may be necessary
to administer 20-40 mg doses by repeated local injections spaced across the affected area.d
Usually, 1-4 injections are employed, with interval between injections varying with the type
of lesion treated and the duration of improvement observed with each injection.d
>IM
Methylprednisolone acetate: In patients with dermatologic lesions, usually, 40-120 mg of
methylprednisolone acetate once weekly for 1-4 weeks.d

Methylprednisolone acetate: In seborrheic dermatitis, 80 mg weekly may be adequate to

control the condition.d, m
Adrenogenital Syndrome
>IM
Methylprednisolone acetate: 40 mg every 2 weeks.d, m
Allergic Conditions
Oral: For certain conditions (e.g., contact dermatitis, including poison ivy), 24 mg (6 tablets)
for the first day, which is then tapered by 4 mg daily until 21 tablets have been administered.
(See Tapered Dosage Schedule table.)b
>Tapered Dosage Schedule
Day Administer 8 mg (2 tablets) twice daily (before breakfast and at bedtime)b and 4 mg (1
1
tablet) twice daily (after lunch and dinner).
Day Administer 4 mg (1 tablet) 3 times daily (before breakfast, after lunch, and after
2
dinner) and 8 mg (2 tablets) at bedtime.b
Day Administer 4 mg (1 tablet) 4 times daily (before breakfast, after lunch, after dinner, and
3
at bedtime).b
Day Administer 4 mg (1 tablet) 3 times daily (before breakfast, after lunch, and at
4
bedtime).b
Day
Administer 4 mg (1 tablet) twice daily (before breakfast and at bedtime).b
5
Day
Administer 4 mg (1 tablet) before breakfast.b
6
Some clinicians suggest tapering the dosage of the drug over 12 days may be associated with
a lower incidence of flare-up of the dermatitis than that associated with 6-day therapy.b
>IM
Methylprednisolone acetate: In acute severe dermatitis due to poison ivy, 80-120 mg as a
single dose.d, m In chronic contact dermatitis, repeated injections at 5- to 10-day intervals may
be necessary.d
Methylprednisolone acetate: For control of severe or incapacitating allergic conditions (e.g.,
bronchial asthma, seasonal or perennial allergic rhinitis) intractable to adequate trials of
conventional therapy, 80-120 mg.d, m Relief of coryzal symptoms of allergic rhinitis should
occur within 6 hours and persist for several days to 3 weeks.
To gain prompt control of asthma in patients with very poorly controlled, moderate-to-severe
asthma (as an alternative to a short course of an oral corticosteroid) who are vomiting or

noncompliant with oral corticosteroid therapy: 240 mg of methylprednisolone acetate as a

single dose. Relief of asthma symptoms should occur within 6-48 hours and persist for
several days to 2 weeks.d, m
Acute Exacerbations of Multiple Sclerosis
>IV
For moderate to severe relapses, 1 g daily for 3-5 days, followed by 60 mg of oral prednisone
daily, tapering the dosage over 12 days.
Alternatively, 1 g or 15 mg/kg of IV methylprednisolone tapered over 15 days to 1 mg/kg,
followed by oral prednisone or prednisolone in gradually decreasing dosages over several
weeks to months.c
Oral: 160 mg daily for 1 week, followed by 64 mg every other day for a month.a, d, e, f
Pneumocystis jiroveci Pneumonia
>IV
In adults with AIDS

and moderate to severe Pneumocystis jiroveci pneumonia, 30

mg twice daily for 5 days, followed by 30 mg once daily for 5 days, and then 15 mg once
daily for 11 days (or until completion of the anti-infective regimen). Initiate within 24-72
hours of initial antipneumocystis therapy.
Shock
>IV
Life-threatening shock: massive doses of methylprednisolone as the sodium succinate such as
30 mg/kg by direct IV injection (over 3-15 minutes) initially and repeated every 4-6 hours if
needed or 100-250 mg by direct IV injection (over 3-15 minutes) initially and repeated at 2to 6-hour intervals as required.b
Alternatively, following the initial dose by direct IV injection, additional doses of 30 mg/kg
may be administered by slow continuous IV infusion every 12 hours for 24-48 hours.b
Continue high-dose therapy only until the patient's condition has stabilized and usually not
beyond 48-72 hours.b
Acute Spinal Cord Injury
>IV

Methylprednisolone sodium succinate: Initially, 30 mg/kg of methylprednisolone by rapid IV

injection over 15 minutes, followed in 45 minutes by IV infusion of 5.4 mg/kg per hour for
23 hours (total dose administered over 24 hours), has been recommended.
Lupus Nephritis
>IV
Methylprednisolone sodium succinate: 1 g IV (over a 1-hour period) daily for 3 consecutive
days ("pulse" therapy).b
"Pulse" therapy has been followed by long-term oral prednisone or prednisolone therapy (0.51 mg/kg per day).
Optic Neuritis
>IV
1 g daily for 3 days followed by oral prednisone 1 mg/kg daily for 11 days has been used.
Cautions
Contraindications
Known hypersensitivity to methylprednisolone, any ingredient in the respective formulation,
or any other corticosteroid.d, m
IM administration in patients with idiopathic thrombocytopenic purpura.m
Systemic fungal infections,a, d, m except when administered as an intra-articular injection for
localized joint conditions.d, m
Concurrent administration of live or live, attenuated vaccines in patients receiving
immunosuppressive doses of corticosteroids.a, d, e, m (See Specific Drugs under Interactions.)
Intrathecal administration of methylprednisolone acetate.d, m
Methylprednisolone sodium succinate injection preparations containing benzyl alcohol in
premature neonates.e, m
Methylprednisolone acetate injection preparations (in multiple-dose vials) containing benzyl
alcohol in premature infants.m
Epidural administration in patients with local or systemic infection; individuals with bleeding
disorders or receiving concurrent anticoagulant therapy (e.g., warfarin, heparin, antiplatelet
agents); patients with known hypersensitivity to local anesthetic agents, contrast agents, or
glucocorticoids; and patients who experienced complications with prior glucocorticoid
injections.

Warnings/Precautions
Warnings
Adrenocortical Insufficiency
When given in supraphysiologic doses for prolonged periods, glucocorticoids may cause
decreased secretion of endogenous corticosteroids by suppressing pituitary release of
corticotropin (secondary adrenocortical insufficiency).c
The degree and duration of adrenocortical insufficiency is highly variable among patients and
depends on the dose, frequency and time of administration, and duration of glucocorticoid
therapy.c
Acute adrenal insufficiency (even death) may occur if the drugs are withdrawn abruptly or if
patients are transferred from systemic glucocorticoid therapy to local (e.g., inhalation)
therapy.c
Withdraw methylprednisolone very gradually following long-term therapy with
pharmacologic dosages.c, d, e, m (See Discontinuance of Therapy under Dosage and
Administration.)
Adrenal suppression may persist up to 12 months in patients who receive large dosages for
prolonged periods.c
Until recovery occurs, signs and symptoms of adrenal insufficiency may develop if subjected
to stress (e.g., infection, surgery, trauma) and replacement therapy may be required.c, d, e, f, m
Since mineralocorticoid secretion may be impaired, sodium chloride and/or a
mineralocorticoid should also be administered.c, e, f, m
If the disease flares up during withdrawal, dosage may need to be increased and followed by
a more gradual withdrawal.c
Immunosuppression
Increased susceptibility to infections secondary to glucocorticoid-induced
immunosuppression.d, e, m Certain infections (e.g., varicella [chickenpox], measles) can have a
more serious or even fatal outcome in such patients.d, e, m (See Increased Susceptibility to
Infection under Warnings.)
Administration of live virus vaccines, including smallpox, is contraindicated in patients
receiving immunosuppressive dosages of glucocorticoids.a, d, e, m If inactivated viral or
bacterial vaccines are administered to such patients, the expected serum antibody response
may not be obtained.e May undertake indicated immunization procedures in patients
receiving glucocorticoids as replacement therapy (e.g., Addison's disease).a, d, e, f, m

Increased Susceptibility to Infection

Glucocorticoids, especially in large doses, increase susceptibility to and mask symptoms of
infection.a, d, e, f, m, f
Infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic
infections in any organ system, may be associated with glucocorticoids alone or in
combination with other immunosuppressive agents.a, d, e, m
Infections may be mild, but they can be severe or fatal, and localized infections may
disseminate.a, d, e, m
Do not inject methylprednisolone acetate intra-articularly, bursally, or into a tendon for local
effect in patients with acute infection.d, m
Do not use, except in life-threatening situations, in patients with viral infections or bacterial
infections not controlled by anti-infectives.c
Some infections (e.g., varicella [chickenpox], measles) can have a more serious or even fatal
outcome, particularly in children.d, m
Children and any adult who are not likely to have been exposed to varicella or measles should
avoid exposure to these infections while receiving glucocorticoids.d, m
If exposure to varicella or measles occurs in susceptible patients, treat appropriately (e.g.,
VZIG, IG, acyclovir).a, d, e, m
Fatal outcome (e.g., in those developing hemorrhagic varicella) may not always be avoided
even if appropriate therapy is initiated aggressively.
Immunosuppression may result in activation of latent infection or exacerbation of intercurrent
infections (e.g., those caused by Candida, Mycobacterium, Toxoplasma, Strongyloides,
Pneumocystis, Cryptococcus, Nocardia, Ameba).m
Use with great care in patients with known or suspected Strongyloides (threadworm)
infection.e Immunosuppression may lead to Strongyloides hyperinfection and dissemination
with widespread larval migration, often accompanied by severe enterocolitis and potentially
fatal gram-negative septicemia.a, d, e, m
Corticosteroids may exacerbate fungal infections and should not be used in the presence of
such infections,a, d, e, f, m unless they are needed to control drug reactions.d, m
Not effective and can have detrimental effects in the management of cerebral malaria.c, d, m Do
not use corticosteroids in celebral malaria.d, m
Can reactivate tuberculosis.a, d, e, f, m Include chemoprophylaxis in patients with a history of
active tuberculosis undergoing prolonged glucocorticoid therapy.a, c, d, m Observe closely for
evidence of reactivation.d Restrict use in active tuberculosis to those with fulminating or

disseminated tuberculosis in which glucocorticoids are used in conjunction with appropriate

chemoprophylaxis.a, d, e, m, c, d, m
Can reactivate latent amebiasis.c Exclude possible amebiasis in any patient who has been in
the tropics or who has unexplained diarrhea prior to initiating therapy.c, d, m
Rarely, epidural abscess reported following epidural glucocorticoid injection; infectious
complications (e.g., bacterial meningitis) also reported.
Musculoskeletal Effects
Muscle wasting, muscle pain or weakness, delayed wound healing, and atrophy of the protein
matrix of the bone resulting in osteoporosis, vertebral compression fractures, aseptic necrosis
of femoral or humeral heads, or pathologic fractures of long bones are manifestations of
protein catabolism that may occur during prolonged therapy with glucocorticoids.c These
adverse effects may be especially serious in geriatric or debilitated patients.c A high protein
diet may help to prevent adverse effects associated with protein catabolism.c
An acute, generalized myopathy can occur with the use of high doses of glucocorticoids,
particularly in patients with disorders of neuromuscular transmission (e.g., myasthenia
gravis) or in patients receiving concomitant therapy with neuromuscular blocking agents
(e.g., pancuronium).d, e, m
Tendon rupture, particularly of the Achilles tendon.
Osteoporosis and related fractures are one of the most serious adverse effects of long-term
glucocorticoid therapy.
To minimize the risk of glucocorticoid-induced bone loss, the smallest possible effective
dosage and duration should be used. Topical and inhaled preparations should be used
whenever possible.
Before initiating glucocorticoid therapy in postmenopausal women, consider that they are
especially prone to osteoporosis.c
Withdraw glucocorticoids if osteoporosis develops, unless their use is life-saving.c
Glucocorticoid-induced bone loss can be both prevented and treated. Baseline measurement
of bone mass density (BMD) at the lumbar spine and/or hip should be obtained when
initiating long-term (e.g., exceeding 6 months) glucocorticoid therapy and appropriate
preventive therapy should be initiated. Longitudinal measurements may be repeated as often
as every 6 months to detect possible bone loss. Less frequent (e.g., annually) follow-up
probably is sufficient in patients who are receiving therapy to prevent bone loss.
Skeletal wasting is most rapid during the initial 6 months of therapy, and trabecular bone is
affected to a greater degree than is cortical bone.

Calcium and vitamin D supplementation, bisphosphonate (e.g., alendronate, risedronate), and

a weight-bearing exercise program that maintains muscle mass are suitable first-line therapies
aimed at reducing the risk of adverse bone effects.
Calcitonin may be considered as second-line therapy for patients who refuse or do not
tolerate bisphosphonate therapy or in whom the drugs are contraindicated.
Fluid and Electrolyte Disturbances
Sodium retention with resultant edema, potassium loss, hypokalemic alkalosis, and elevation
of BP may occur with average and large doses of corticosteroids.a, d, e, m These effects are less
frequent with synthetic glucocorticoids than with hydrocortisone or cortisone, but may occur,
especially when synthetic glucocorticoids are given in high dosage for prolonged periods.a, c,
d, e, m

Edema and CHF (in susceptible patients) may occur.c

Dietary salt restriction is advisable and potassium supplementation may be necessary.a, c, e, m

Increased calcium excretion and possible hypocalcemia.a, c, e
Ocular Effects
Prolonged use may result in posterior subcapsular and nuclear cataracts (particularly in
children), exophthalmos, and/or increased IOP which may result in glaucoma or may
occasionally damage the optic nerve.a, c, d, e, m
May enhance the establishment of secondary bacterial, fungal and viral infections of the eye.d,
e

Use with caution in patients with active ocular herpes simplex infections for fear of corneal
perforation.c, m
Transient blindness, amblyopia, acute retinal necrosis syndrome, and intraocular hemorrhage
have occurred following epidural glucocorticoid injection.
Endocrine and Metabolic Effects
Administration over a prolonged period may produce various endocrine disorders including
hypercorticism (cushingoid state) and amenorrhea or other menstrual difficulties.c
Increased or decreased motility and number of sperm in some men.c
May decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate
diabetes mellitus, especially in patients predisposed to diabetes mellitus.c If glucocorticoid
therapy is required in patients with diabetes mellitus, changes in insulin or oral antidiabetic
agent dosage or diet may be necessary.c
Administer by epidural injection with caution in patients with diabetes mellitus.
Exaggerated response to the glucocorticoids in hypothyroidism; use with caution.a, c, d, e, m
Changes in thyroid status may require dosage adjustment.d, m

Cardiovascular Effects
Use with extreme caution in recent MI since an association between use of glucocorticoids
and left ventricular free-wall rupture has been suggested.c, d, m
Use with caution in patients with CHF and hypertension.a, d, m
Bradycardia has occurred during or after IV administration of large doses of
methylprednisolone sodium succinate; may be unrelated to rate or duration of infusion.c, e
Cardiac arrhythmias, circulatory collapse, and/or cardiac arrest reported following rapid (<10
minutes) administration of large IV doses of methylprednisolone sodium succinate.e
Administer by epidural injection with caution in patients with CHF.
Dermatologic Effects
Dermal and/or subdermal changes forming depressions in the skin at the injection site
reported with methylprednisolone acetate injectable suspension (Depo-Medrol).m Exercise
care to minimize the incidence of dermal and subdermal atrophy; do not exceed
recommended doses of the injections.m
For intralesional use, administer multiple small injections into the area of the lesion,
whenever possible.d, m
Avoid injection or leakage into the dermis; avoid injection into the deltoid muscle, because of
high incidence of sub-Q atrophy.d, m
Kaposi's sarcoma has been reported in patients receiving glucocorticoid therapy;
discontinuance of such therapy may result in clinical improvement of the disease.a, d, m
Sensitivity Reactions
Anaphylactic or anaphylactoid reactions with or without circulatory collapse, cardiac arrest,
or bronchospasm.c, d, e, m Take appropriate precautionary measures prior to administration,
especially in patients with a history of allergy to any drug.d, e
Urticaria and other allergic or hypersensitivity reactions reported.a, d, e, f, m
General Precautions
Monitoring
Prior to initiation of long-term glucocorticoid therapy, perform baseline ECGs, blood
pressures, chest and spinal radiographs, glucose tolerance tests, and evaluations of HPA-axis
function in all patients.c, d, e
Perform upper GI radiographs in patients predisposed to GI disorders, including those with
known or suspected peptic ulcer disease.c, d
During long-term therapy, perform periodic height, weight, chest and spinal radiographs,
hematopoietic, electrolyte, glucose tolerance, and ocular and blood pressure evaluations.

Genitourinary Effects
Increased or decreased motility and number of sperm in some men.c
Nervous System Effects
May precipitate mental disturbances ranging from euphoria, insomnia, mood swings,
depression and anxiety, and personality changes to frank psychoses.a, d, e, m Use may aggravate
emotional instability or psychotic tendencies.a, d, e, m
Use with caution in patients with myasthenia gravis.a
Aseptic meningitis, arachnoiditis, exacerbation of pain, spinal cord trauma, subdural
injection, intracranial air injection, increased intracranial pressure, nerve injury, seizures,
bladder or bowel dysfunction, paraparesis or paralysis, sensory disturbances, and brain
damage reported following epidural and/or intrathecal glucocorticoid injection. Unclear
whether these effects involved improper needle placement or were related to administration
of the drug and/or preservatives.
Results from a multicenter, randomized, placebo controlled study with methylprednisolone
hemisuccinate (an IV corticosteroid) showed an increase in early (at 2 weeks) and late (at 6
months) mortality in patients with cranial trauma who were determined not to have other
clear indications for corticosteroid treatment.d, m Do not use high doses of systemic
corticosteroids, including methylprednisolone acetate (Depo-Medrol), for treatment of
traumatic brain injury.d, m
GI Effects
Corticosteroids should be used with caution in patients with diverticulitis, nonspecific
ulcerative colitis (if there is a probability of impending perforation, abscess, or other
pyogenic infection), or those with recent intestinal anastomoses.a, d, m
Use with caution in patients with active or latent peptic ulcer.a, d, m Manifestations of
peritoneal irritation following GI perforation may be minimal or absent in patients receiving
corticosteroids.c, d, m Suggest concurrent administration of antacids between meals to prevent
peptic ulcer formation in patients receiving high dosages of corticosteroids.c, d, e
Specific Populations
Pregnancy
Category C.d, f, m
If substantial dosage received during pregnancy, carefully observe infant for signs of
hypoadrenalism.a
Fluoroscopy (recommended for ensuring proper needle placement for epidural injections) is
contraindicated in pregnant women.

Lactation
Glucocorticoids are distributed into milk and could suppress growth, interfere with
endogenous glucocorticoid production, or cause other adverse effects in nursing infants.c, d, m
Discontinue nursing or the drug.m
Pediatric Use
The effects of glucocorticoids on the pathophysiology and course of diseases are considered
to be similar in adults and children.c, d, m Evidence of safety and efficacy of corticosteroids in
pediatric patients is based on treatment of nephrotic syndrome (in patients >2 years of age)
and aggressive leukemias and lymphomas (in patients >1 month of age).c, d, m Evidence of
safety and efficacy in other pediatric indications (e.g., severe asthma and wheezing) is based
on controlled trials in adults.c, d
Adverse effects in pediatric patients are similar to those in adults.c, d, m As in adults, perform
periodic evaluations of height, weight, IOP, and BP.c, d Children, like adults, also should
undergo clinical evaluation for the presence of infection, psychosocial disturbances,
thromboembolism, peptic ulcers, cataracts, and osteoporosis.c, d, m
With long-term use, may delay growth and maturation in children and adolescents.c, d, m
Monitor carefully the growth and development of pediatric patients receiving prolonged
corticosteroid therapy.a, c, d, m Titrate dosage to the lowest effective level.c Alternate-day
therapy with glucocorticoids that cause shorter HPA-axis suppression than does
dexamethasone (e.g., prednisone, prednisolone, methylprednisolone) may minimize growth
suppression and should be instituted if growth suppression occurs.c
Glucocorticoid-induced osteoporosis and associated fractures are common in children and
adolescents receiving long-term systemic therapy. In addition, may prevent achievement of
peak bone mass during adolescence by inhibiting bone formation. Methods for monitoring
bone mineralization (e.g., dual-energy x-ray absorptiometry [DEXA]) in children and
adolescents are similar to those in adults.
Ensure children and adolescents consistently ingest either through diet or supplementation
adequate calcium and vitamin D.
Methylprednisolone sodium succinate (in single-dose vials) and methylprednisolone acetate
(in multiple-dose vials) injection preparations containing benzyl alcohol are contraindicated
in premature infants.e, m Administration of injections preserved with benzyl alcohol has been
associated with toxicity in neonates (gasping syndrome).c, d, e, m (See Contraindications under
Cautions.)
Geriatric Use

Insufficient experience in patients 65 years of age to determine whether geriatric patients

respond differently than younger adults; select dosage with caution.d, m Other clinical
experience to date has not identified any differences in responses between geriatric and
younger patients.d, m
With prolonged therapy, muscle wasting, muscle pain or weakness, delayed wound healing,
and atrophy of the protein matrix of the bone resulting in osteoporosis, vertebral compression
fractures, aseptic necrosis of femoral or humeral heads, or pathologic fractures of long bones
may occur.c May be especially serious in geriatric or debilitated patients.c
Select dosage with caution, usually initiating therapy at the low end of the dosing range,
because of age-related decreases in hepatic, renal, and/or cardiac function and potential for
concomitant disease and drug therapy.d, m
Before initiating glucocorticoid therapy in postmenopausal women, consider that such
women are especially prone to osteoporosis.c
Use with caution in patients with osteoporosis.e
Hepatic Impairment
Patients with cirrhosis show an exaggerated response to glucocorticoids.a, c, d, e, m
Renal Impairment
Use with caution.a, d, e, m
Common Adverse Effects
Associated with long-term therapy: Bone loss, cataracts, indigestion, muscle weakness, back
pain, bruising, oral candidiasis.i, j
Interactions
Metabolized by CYP3A4.c
Drugs Affecting Hepatic Microsomal Enzymes
Inhibitors of CYP3A4 (e.g., ketoconazole, macrolide antibiotics): Potential pharmacokinetic
interaction (increased plasma concentrations and decreased corticosteroid clearance); may
require decrease of corticosteroid dosage to avoid potential adverse effects).c, d, e, m
Inducers of CYP3A4 (e.g., barbiturates, carbamazepine, ephedrine, phenytoin, rifampin):
Potential pharmacokinetic interaction (increased metabolism of corticosteroids); may require
increase of corticosteroid dosage).a, c, d, m
Specific Drugs and Skin Tests
Drug
Aminoglutethimide

Interaction
Comments
May result in a loss of corticoidinduced adrenal suppressiond, m

Epidural injection: Potential for Improve patient safety by excluding

Analgesics, opiate

serious injuries (e.g., brain

typical epidural doses (volumes in

damage, death) when

excess of intrathecal test doses) of

glucocorticoids are combined

local anesthetics and/or opiate

with local anesthetics and/or

analgesics from epidural

opiate analgesics
glucocorticoid injections
Epidural injection: Potential for Improve patient safety by excluding

Anesthetics, local

serious injuries (e.g., brain

typical epidural doses (volumes in

damage, death) when

excess of intrathecal test doses) of

glucocorticoids are combined

local anesthetics and/or opiate

with local anesthetics and/or

analgesics from epidural

opiate analgesics
glucocorticoid injections
Conflicting reports of alterations Monitor coagulation indices to
Anticoagulants, oral

in the anticoagulant responsea, c, d, maintain desired anticoagulant

e, m

effecta, c, d, e

Concomitant use with

Anticholinesterases

corticosteroids may produce

severe weakness in patients with
d, m

myasthenia gravis
Increased blood glucose
Antidiabetic therapy

Barbiturates

Carbamazepine
Cholestyramine

Withdraw anticholinesterases at
least 24 hours before initiating
corticosteroid therapyd, m
May require dosage adjustment of

concentrations in diabetes

concurrent insulin and/or oral

mellitusm
May enhance metabolism of

hypoglycemic agentsm

corticosteroidsm

Increase dosage of

Increase the clearance of

methylprednisolonea, c, d, m

methylprednisolonea, c, e
May enhance metabolism of

Increase dosage of corticosteroidsd,

corticosteroidsm
Increased clearance of oral

corticosteroidsm
May decrease hepatic

Contraceptives (oral; metabolism of some

including estrogens)

corticosteroids, thus increasing

Cyclosporine

their effectsd, m
Plasma concentrations of

Consider possibility of exacerbated

cyclosporine may be increased

toxicity (convulsions), as well as

during concomitant therapy with

Digitalis glycosides
Isoniazid

Ketoconazole

Macrolide antibiotics
(e.g., erythromycin,
troleandomycin)

methylprednisolone.c Mutual

need for dosage adjustment with

inhibition of metabolism with

concomitant usea, c, e

concomitant usea, e
Increased risk of arrhythmias
associated with hypokalemiad, m
Serum isoniazid concentration
may be decreasedd, m
Decreased metabolism of certain
corticosteroids c, d, m

methylprednisolone to avoid
potential adverse effectsc, d, e

Increased plasma concentrations

of corticosteroidsc, d, m
Decreased clearance of
methylprednisolone

Titrate dosage of

a, c, d, e

Titrate dosage of
methylprednisolone to avoid
potential adverse effectsa, d, e
Use concurrently with cautiona, c, d, m
Observe patients receiving both

Increases the risk of adverse GI drugs closely for adverse effects of

NSAIAs

effectsa, c, d, m

either drugc

Decreased serum salicylate

May be necessary to increase

concentrations;c, d when

salicylate dosage when

corticosteroids are discontinued, corticosteroids are administered

serum salicylate concentration

concurrently or decrease salicylate

may increase, possibly resulting dosage when corticosteroids are

in salicylate intoxicationa, c, d, e, m discontinuedc
Use aspirin and corticosteroids with

Phenytoin

May enhance metabolism of

corticosteroidsc, d, m
methylprednisolonec, d, e, m
Enhance the potassium-wasting

Potassium-depleting

effects of glucocorticoidsc

drugs (diuretics,

Use of hydrocortisone with

amphotericin B)

amphotericin B may result bin

Rifampin

caution in hypoprothrombinemiad
Increase dosage of

Monitor for development of

hypokalemiac, d, m

cardiac enlargement and CHFd, m

May enhance metabolism of
Increase dosage of
corticosteroidsc, d, m

methylprednisolonec, d, e

Skin tests

May suppress reaction to skin

testsd, m
Defer generally routine
administration of vaccines or
May cause a diminished response toxoids until corticosteroid therapy
to toxoids and live or inactivated is discontinuedc, d, m
vaccinesc d, m

May need serologic testing to

May potentiate replication of

ensure adequate antibody response

Vaccines and toxoids some organisms contained in

for immunizationb Additional doses

live, attenuated vaccinesc, d, m

of the vaccine or toxoid may be

Can aggravate neurologic

necessaryb

reactions to some vaccines

May undertake immunization

(supraphysiologic dosages) c

procedures in patients receiving

nonimmunosuppressive doses of
glucocorticoidsc

Pharmacokinetics
Absorption
Bioavailability
Absorption from IM injection of methylprednisolone sodium succinate is rapid.b
Systemic absorption of methylprednisolone acetate occurs slowly following intra-articular,
intrabursal, intrasynovial, intradermal, or soft tissue injection; c, d, m Absorption from intraarticular injection sites is usually very slow and continues for about 7 days.b
Onset
Following IM administration (80-120 mg) in patients with severe poison ivy, relief onset
within 8-12 hours.d
Following oral administration in patients with asthma, effects may not be evident for several
hours.
Duration
The duration of anti-inflammatory activity of methylprednisolone approximately equals the
duration of HPA-axis suppression, about 1.25-1.5 days for a single 40-mg oral dose.c
Distribution
Extent

Most glucocorticoids are removed rapidly from the blood and distributed to muscles, liver,
skin, intestines, and kidneys.c
Glucocorticoids appear in breast milk and the placenta.c
Elimination
Metabolism
Metabolized in most tissues, but mainly in the liver, to inactive compounds.c
Half-life
Approximately 2.5-3.5 hours following oral administration of methylprednisolone or IV or
IM administration of methylprednisolone sodium succinate.h
Special Populations
The metabolic clearance of corticosteroids may be decreased in patients with hypothyroidism
and increased in those with hyperthyroidism.d, m
Stability
Storage
Oral
Tablets
20-25C.a
Tight, light-resistant containers at 15-30C (methylprednisolone tablets).f
Parenteral
Powder for Injection
Store unreconstituted at 20-25C.e Store reconstituted solution at 20-25C; use reconstituted
solution within 48 hourse
Suspension for Injection
20-25C.d, m
Single-dose vials of methylprednisolone acetate injectable suspension (Depo-Medrol) are
not intended for multiple-dose withdrawal; discard any remaining suspension.d
Avoid contamination of multiple-dose vials of methylprednisolone acetate injectable
suspension by using strict aseptic technique.m Use povidone-iodine solution or similar
product to cleanse the vial top prior to aspiration of contents.m Although initially sterile, such
vials may become contaminated; use of disposable sterile syringes and needles is necessary.m
Similar to other corticosteroids, methylprednisolone acetate suspension is heat labile; do not
autoclave when it is desirable to sterilize the outside of the vial.d, m
Compatibility
For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral
Methylprednisolone Acetate
The manufacturer states that methylprednisolone acetate should not be diluted or mixed with
other solutions because of possible physical incompatibilities.d
Methylprednisolone Sodium Succinate
Must reconstitute only with diluent provided by the manufacturer or bacteriostatic water for
injection with benzyl alcohol.e The manufacturers state that reconstituted solution may be
diluted with 5% dextrose, or 0.9% sodium chloride, or 5% dextrose in sodium chloride
injection.e
Solution Compatibility (Methylprednisolone Sodium Succinate)k
Compatible
Amino acids 4.25%, dextrose 25%
Dextrose 5% in sodium chloride 0.45 or 0.9%
Ringer's injection, lactated
Sodium chloride 0.9%
Variable
Dextrose 5% in water (compatibility concentration dependent)
Drug Compatibility (Methylprednisolone Sodium Succinate)
>Admixture Compatibilityk
Compatible
Chloramphenicol sodium succinate
Cimetidine HCl
Clindamycin phosphate
Dopamine HCl
Granisetron HCl
Heparin sodium
Norepinephrine bitartrate
Penicillin G potassium
Ranitidine HCl
Theophylline
Verapamil HCl
Incompatible
Calcium gluconate
Glycopyrrolate
Metaraminol bitartrate
Nafcillin sodium
Penicillin G sodium
Variable
Aminophylline

Cytarabine
>Y-Site Compatibilityk
Compatible
Acyclovir sodium
Amifostine
Amiodarone HCl
Amphotericin B cholesteryl sulfate complex
Aztreonam
Bivalirudin
Cefepime HCl
Cisplatin
Cladribine
Cyclophosphamide
Cytarabine
Dexmedetomidine HCl
Dopamine HCl
Doxorubicin HCl
Doxorubicin HCl liposome injection
Enalaprilat
Famotidine
Fludarabine phosphate
Gatifloxacin
Granisetron HCl
Heparin sodium
Hetastarch in lactated electrolyte injection (Hextend)
Inamrinone lactate
Linezolid
Melphalan HCl
Meperidine HCl
Methotrexate sodium
Metronidazole
Midazolam HCl
Milrinone lactate
Morphine sulfate
Nicardipine HCl
Piperacillin sodium-tazobactam sodium
Remifentanil HCl
Sodium bicarbonate
Tacrolimus
Teniposide
Theophylline
Thiotepa
Topotecan HCl

Incompatible
Allopurinol sodium
Amsacrine
Ciprofloxacin
Docetaxel
Etoposide phosphate
Fenoldopam mesylate
Filgrastim
Gemcitabine HCl
Ondansetron HCl
Paclitaxel
Propofol
Sargramostim
Vinorelbine tartrate
Variable
Diltiazem HCl
Heparin sodium with hydrocortisone sodium succinate
Potassium chloride
Vitamin B complex with C
Actions
Principally an anti-inflammatory or immunosuppressant agent.d
Exhibits potent anti-inflammatory activity and minimal mineralocorticoid properties.c
Decreases inflammation by stabilizing leukocyte lysosomal membranes, preventing release of
destructive acid hydrolases from leukocytes; or reducing leukocyte adhesion to capillary
endothelium.c
Inhibits macrophage accumulation in inflamed areas.c
Reduces capillary wall permeability and edema formation.c
Antagonizes histamine activity and release of kinin from substrates.c
Reduces fibroblast proliferation, collagen deposition, and subsequent scar tissue formation.c
Stimulates erythroid cells of bone marrow, prolongs survival time of erythrocytes and platelets,
and produces neutrophilia and eosinopenia.c
Promotes gluconeogenesis, redistribution of fat from peripheral to central areas of the body,
and protein catabolism, which results in negative nitrogen balance.c
Reduces intestinal absorption and increase renal excretion of calcium.c, e
Suppresses the immune response by reducing activity and volume of the lymphatic system,
producing lymphocytopenia.c

 Decreases immunoglobulin and complement concentrations and passage of immune complexes

through basement membranes.c
Depresses reactivity of tissue to antigen-antibody interactions.c

Advice to Patients
In patients receiving long-term therapy, importance of not discontinuing the drug abruptly or
without supervision of a clinician.b, d, m
Importance of notifying a clinician of any infections, signs of infections (e.g., fever, sore
throat, pain during urination, muscle aches), or injuries that develop during therapy or within
12 months after therapy is discontinued.c, d, m
Importance of carrying identification cards listing the diseases being treated, the glucocorticoid
regimen, and the name and telephone number of the clinician.c
When surgery is required, importance of informing the attending physician, dentist, or
anesthesiologist of recent (within 12 months) glucocorticoid therapy.c
In immunosuppressed patients, importance of avoiding exposure to certain infections (e.g.,
chickenpox, measles) and of the importance of obtaining medical advice if such exposure
occurs.a, d, e, m
Importance of informing clinicians of existing or contemplated concomitant therapy, including
prescription and OTC drugs.a, c
Importance of women informing clinicians if they are or plan to become pregnant or plan to
breast-feed.a
Importance of informing patients of other important precautionary information.a, c (See
Cautions.)

Preparations
Excipients in commercially available drug preparations may have clinically important effects
in some individuals; consult specific product labeling for details.
Methylprednisolone
Routes
Oral

Dosage Forms
Tablets

Strengths
2 mg
4 mg*

Brand Names
Medrol (scored)
Medrol (scored)
Medrol Dosepak
Meprolone Unipak

Manufacturer
Pfizer
Pfizer
Pfizer
Major

Methylprednisolone Tablets
Medrol (scored)
Pfizer
Methylprednisolone Tablets
16 mg
Medrol (scored)
Pfizer

32 mg
Medrol (scored)
Pfizer
* available from one or more manufacturer, distributor, and/or repackager by generic
8 mg

(nonproprietary) name
Methylprednisolone Acetate
Routes
Parenteral

Dosage Forms
Injectable
suspension

Strengths Brand Names

Manufacturer
20
Depo-Medrol
Pfizer
mg/mL*
40
Depo-Medrol
Pfizer
mg/mL*
Methylprednisolone Acetate Injectable
Suspension
80
mg/mL*

Depo-Medrol

Pfizer

Methylprednisolone Acetate Injectable

Suspension
* available from one or more manufacturer, distributor, and/or repackager by generic
(nonproprietary) name
Methylprednisolone Sodium Succinate
Routes
Parenteral

Dosage
Forms
For
injection

Strengths
40 mg (of
methylprednisolone)*

Brand Names

Manufacturer

A-methaPred

Hospira

Methylprednisolone Sodium

125 mg (of
methylprednisolone)*

Succinate Injection
Solu-Medrol

Pfizer

A-methaPred

Hospira

Methylprednisolone Sodium

500 mg (of
methylprednisolone)*

Succinate Injection
Solu-Medrol

Pfizer

A-methaPred

Hospira

A-methaPred ADD-Vantage Hospira

Methylprednisolone Sodium

1 g (of
methylprednisolone)

Succinate Injection
Solu-Medrol

Pfizer

A-methaPred

Hospira

A-methaPred ADD-Vantage Hospira

Methylprednisolone Sodium
Succinate Injection
Solu-Medrol
2 g (of

Pfizer

Solu-Medrol

Pfizer
methylprednisolone)
* available from one or more manufacturer, distributor, and/or repackager by generic
(nonproprietary) name
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This
pricing information was updated 03/2011. For the most current and up-to-date pricing
information, please visit www.drugstore.com. Actual costs to patients will vary depending on
the use of specific retail or mail-order locations and health insurance copays.
Depo-Medrol 20MG/ML Suspension (PFIZER U.S.): 5/$28.64 or 10/$46.26
Medrol 16MG Tablets (PFIZER U.S.): 30/$102.99 or 90/$299.96
Medrol 32MG Tablets (PFIZER U.S.): 25/$127.99 or 75/$367.97
Medrol 4MG Tablets (PFIZER U.S.): 25/$44.7 or 75/$122.64
Medrol 8MG Tablets (PFIZER U.S.): 30/$70.97 or 90/$198.35
MethylPREDNISolone 16MG Tablets (CADISTA): 50/$147 or 150/$419.98
MethylPREDNISolone 4MG Tablets (TEVA PHARMACEUTICALS USA): 30/$17.99 or
90/$29.97
MethylPREDNISolone 8MG Tablets (PRASCO LABORATORIES): 25/$45.99 or
75/$125.97
Use is not currently included in the labeling approved by the US Food and Drug
Administration.
References
a. Pfizer. Medrol (methylprednisolone) tablets prescribing information. New York, NY; 2006
Nov.

b. AHFS drug information 2004. McEvoy GK, ed. Methylprednisolone. Bethesda, MD:
American Society of Health-System Pharmacists; 2004:2914-5.
c. AHFS drug information 2005. McEvoy GK, ed. Corticosteroids general statement. Bethesda,
MD: American Society of Health-System Pharmacists; 2005:2908-21.
d. Pfizer. Depo-Medrol (methylprednisolone acetate) injectable suspension (single-dose vials)
prescribing information. New York, NY; 2009 Apr.
e. Pfizer. Solu-Medrol (methylprednisolone sodium succinate) sterile powder for injection
prescribing information. New York, NY; 2009 May.
f. BarrLaboratories. Methylprednisolone tablets prescribing information. Pomona, NY; 2001
Nov.
g. Behrman RE, Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed.
Philadelphia: Saunders; 2004:1407-8.
h. Woodward HM. Upjohn Company unpublished data (personal communication), 1976.
i. Walsh LJ, Wong CA, Oborne J et al. Adverse effects of oral corticosteroids in relation to dose
in patients with lung disease. Thorax. 2001; 56:279-84. [PubMed 11254818] [Free Fulltext
PMC]
j. Bello CE, Garrett SD. Therapeutic issues in oral glucocorticoid use. Lippincotts Prim Care
Pract. 1999; 3:333-41. [PubMed 10711134]
k. Trissel LA. Handbook on injectable drugs. 13th ed. Bethesda, MD: American Society of
Health-System Pharmacists; 2005:1001-1010.
l. USP DI: drug information for the health care provider. 24th ed. Greenwood Village, CO:
Thomson Micromedex; 2004;1:940-6.

m. Pfizer. Depo-Medrol (methylprednisolone acetate) injectable suspension (multiple-dose

vials) prescribing information. New York, NY; 2009 May.