Methylprednisolone

General

Medrol, Medrol Dosepack, Solu-Medrol, Depo-Medrol, and others
Corticosteroid

No	No	2	C

Key

Tabs: 2, 4, 8, 16, 24, 32 mg

Tabs, dose pack (Medrol Dosepack and others): 4 mg (21s)

Injection, Na succinate (Solu-Medrol and others): 40, 125, 500, 1000, 2000 mg (IV or IM use); may contain benzyl alcohol

Injection, Acetate (Depo-Medrol and others): 20, 40, 80 mg/mL (IM repository)

Dosing

Anti-inflammatory/immunosuppressive:

PO/IM/IV: 0.5–1.7 mg/kg/24 hr ÷ Q6–12 hr.
Asthma exacerbations (2007 National Heart, Lung, and Blood Institute Guideline Recommendations; dose until peak expiratory flow reaches 70% of predicted or personal best):
Child ≤12 yr (IM/IV/PO): 1 mg/kg/24 hr ÷ Q12 hr (max. dose: 60 mg/24 hr). Higher alternative regimen of 1 mg/kg/dose Q6 hr × 48 hr followed by 1–2 mg/kg/24 hr (max. dose: 60 mg/24 hr) ÷ Q12 hr has been suggested.
>12 yr and adult (IV/IM/PO): 40–80 mg/24 hr ÷ Q12–24 hr. Higher alternative regimen of 120–180 mg/24 hr ÷ Q6–8 hr × 48 hr followed by 60–80 mg/24 hr ÷ Q12 hr has been suggested.

Outpatient asthma exacerbation burst therapy (longer durations may be necessary):
PO:
Child ≤12 yr: 1–2 mg/kg/24 hr ÷ Q12–24 hr (max. dose: 60 mg/24 hr) × 3–10 days.
Child >12 yr and adult: 40–60 mg/24 hr ÷ Q12–24 hr × 3–10 days.
IM (use methylprednisolone acetate product) for patients vomiting or with adherence issues:
Child ≤12 yr: 7.5 mg/kg (max. dose: 240 mg) IM × 1.
Child >12 yr and adult: 240 mg IM × 1.

Acute spinal cord injury:
30 mg/kg IV over 15 min followed in 45 min by a continuous infusion of 5.4 mg/kg/hr × 23 hr.

Notes

See Chapter 30 for relative, steroid potencies and doses based on body surface area. Acetate form may also be used for intra-articular and intralesional injection and has longer times to max. effect and duration of action; it should NOT be given IV. Like all steroids, may cause hypertension, pseudotumor cerebri, acne, Cushing syndrome, adrenal axis suppression, GI bleeding, hyperglycemia, and osteoporosis.

Barbiturates, phenytoin, and rifampin may enhance methylprednisolone clearance. Erythromycin, itraconazole, and ketoconazole may increase methylprednisone levels. Methylprednisolone may increase cyclosporine and tacrolimus levels.