Methylprednisolone

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

Descriptive text is not available for this imageDescriptive text is not available for this imageDescriptive text is not available for this imageDescriptive text is not available for this imageDescriptive text is not available for this image
C2NoNoNo
Key
  • Tabs: 2, 4, 8, 16, 32 mg
  • Tabs, dose pack (Medrol Dosepack and generics): 4 mg (21s)
  • Injection, Na succinate (Solu-Medrol and generics): 40, 125, 500, 1000 mg (IV or IM use); multidose vials contain benzyl alcohol
  • Injection, acetate suspension (Depo-Medrol and generics; for IM, intrasynovial, and soft tissue injection): 20 mg (5 mL), 40 mg (1, 5, 10 mL), 80 mg/mL (1, 5 mL); multidose vials contain benzyl alcohol

Dosing

Descriptive text is not available for this image

  • Antiinflammatory/immunosuppressive:
    • PO/IM/IV (use succinate salt for 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 (IV/IM/PO; use succinate salt for IV/IM): 1–2 mg/kg/24 hr ÷ Q12 hr ( max. dose: 60 mg/24 hr). An alternative regimen for ≤5 yr old of 1 mg/kg/dose Q6 hr × 24 hr followed by oral corticosteroids to complete a 3–5 day course has been suggested.
    • Child >12 yr and adult (IV/IM/PO; use succinate salt for IV/IM): 40–80 mg/24 hr ÷ Q12–24 hr
  • 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 ≤4 yr: 7.5 mg/kg ( max. dose: 240 mg) IM × 1
      • Child >4 yr, adolescent, 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

Descriptive text is not available for this image

  • See Chapter 10 for relative steroid potencies. 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. Use with caution with systemic sclerosis. Like all steroids, may cause hypertension, leukocytosis, pseudotumor cerebri, acne, Cushing syndrome, adrenal axis suppression, GI bleeding, hyperglycemia, and osteoporosis. Hypertrophic cardiomyopathy has been reported in premature infants.
  • Barbiturates, phenytoin, and rifampin may enhance methylprednisolone clearance. Erythromycin, itraconazole, and ketoconazole may increase methylprednisolone levels. Methylprednisolone may increase cyclosporine and tacrolimus levels.