Methylprednisolone, Uses, Dosage, Side Effect, Interactions, Pregnancy

Methylprednisolone is a synthetic corticosteroid with anti-inflammatory and immunomodulating properties. Methylprednisolone binds to and activates specific nuclear receptors, resulting in altered gene expression and inhibition of proinflammatory cytokine production. This agent also decreases the number of circulating lymphocytes, induces cell differentiation, and stimulates apoptosis in sensitive tumor cell populations.

Methylprednisolone and its derivatives, methylprednisolone sodium succinate and methylprednisolone acetate, are synthetic glucocorticoids used as anti-inflammatory or immunosuppressive agents. They are synthetic (man-made) corticosteroids. Corticosteroids are naturally-occurring chemicals produced by the adrenal glands located adjacent to the kidneys.

Mechanism of Action of Methylprednisolone

Unbound glucocorticoids cross cell membranes and bind with high affinity to specific cytoplasmic receptors, modifying transcription and protein synthesis. By this mechanism, glucocorticoids can inhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses. The antiinflammatory actions of corticosteroids are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes.

Or

Glucocorticoids are capable of suppressing the inflammatory process through numerous pathways. They interact with specific intracellular receptor proteins in target tissues to alter the expression of corticosteroid-responsive genes. Glucocorticoid-specific receptors in the cell cytoplasm bind with steroid ligands to form hormone-receptor complexes that eventually translocate to the cell nucleus. There these complexes bind to specific DNA sequences and alter their expression. The complexes may induce the transcription of mRNA leading to synthesis of new proteins. Such proteins include lipocortin, a protein known to inhibit PLA2a and thereby block the synthesis of prostaglandins, leukotrienes, and PAF. Glucocorticoids also inhibit the production of other mediators including AA metabolites such as COX, cytokines, the interleukins, adhesion molecules, and enzymes such as collagenase.

Indications of Methylprednisolone

• Adjunctive therapy for short-term administration in rheumatoid arthritis.
• Inflammatory Conditions
• Adrenogenital Syndrome
• Allergic Rhinitis
• Osteoarthritis
• Asthma
• Atopic Dermatitis
• Dermatologic Lesion
• Gout
• Immunosuppression
• Neuralgia
• Plaque Psoriasis
• Psoriasis
• Transverse Myelitis
• Acne Rosacea
• Acute Gouty Arthritis
• Adrenal cortical hypofunctions
• Adrenocortical Hyperfunction
• Ankylosing Spondylitis 
• Anterior Segment Inflammation
• Aspiration Pneumonitis
• Asthma Bronchial
• Atopic Dermatitis (AD)
• Bullous dermatitis herpetiformis
• Congenital Adrenal Hyperplasia (CAH)
• Congenital Hypoplastic Anemia
• Conjunctivitis, Seasonal Allergic
• Corneal Inflammation
• Cushing’s Syndrome
• Dermatitis, Contact
• Drug hypersensitivity reaction
• Epicondylitis
• Erythroblastopenia
• Hypercalcemia
• Idiopathic Thrombocytopenic Purpura (ITP)
• Inflammatory Reaction
• Iridocyclitis
• Leukaemia,
• Loeffler’s syndrome
• Malignant Lymphomas
• Mycosis Fungoides (MF)
• Ophthalmia, Sympathetic
• Perennial Allergic Rhinitis 
• Post-traumatic Osteoarthritis
• Sarcoidosis
• Seasonal Allergic Rhinitis
• Secondary thrombocytopenia
• Serum Sickness
• Severe Seborrheic Dermatitis
• Stevens-Johnson Syndrome
• Synovitis
• Systemic Lupus Erythematosus (SLE)
• Trichinosis
• Tuberculosis
• Tuberculosis Meningitis
• Ulcerative Colitis (UC)
• Uveitis
• Acquired immune hemolytic anemia
• Acute nonspecific tenosynovitis
• Acute rheumatic carditis
• Diffuse posterior uveitis
• Exfoliative erythroderma
• Non-suppurative Thyroiditis
• Severe Psoriasis
• Varicella-zoster virus acute retinal necrosis

Therapeutic Indications

Allergic Rhinitis

Strengths: 80 to 120 mg IM

Alopecia

Alternatively, Methylprednisolone Dosepak

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Acetate suspension

• Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
• For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
• For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
• For relief of seborrheic dermatitis: 80 mg IM weekly to control condition
• Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to

Dermatologic Lesion

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, Methylprednisolon

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Acetate suspension

• Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
• For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
• For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
• For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Psoriasis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, Methylprednisolone 

• weight gain,
• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Acetate suspension

• Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks

Dermatological Disorders

• Initial dose: 4 to 48 mg orally once a day or in divided doses.

Alternatively, Methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Acetate suspension

• Initial dose: 40 to 120 mg IM once a week for 1 to 4 week
• For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
• For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
• For relief of seborrheic dermatitis: 80 mg IM weekly to control condition
• Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.

Keloids

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, Methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Acetate suspension

• Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
• For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
• Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.

Rheumatoid Arthritis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

INTRA-ARTICULAR INJECTION Acetate suspension

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection

Acetate suspension

• Initial dose: 40 mg IM every 2 weeks

Acute Gout

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferres
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
• Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.
• Acetate suspension (IM only): For prolonged systemic effect:
• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
• For conditions of the tendinous or bursal structures: 4 to 30 mg
• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered.
• Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
• Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

Bursitis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considere

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg

Nephrotic Syndrome

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered

Acetate suspension (IM only); For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-
• For conditions of the tendinous or bursal structures: 4 to 30 mg

Osteoarthritis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• weight gain,
• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
• Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg

Tendonitis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
• Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg

Neoplastic Diseases

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg

Epicondylitis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injectio
• Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg
• Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone 

• Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime
• Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
• Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
• Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
• Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
• Day 6: 4 mg orally (4 mg before breakfast)

Parenteral

• weight gain,
• Sodium succinate (IV or IM); in emergency situations, IV is preferred
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
• Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect

• Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

INTRA-ARTICULAR Administration

• General guidance: Actual doses may vary with severity of condition
• Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
• Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
• Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
• Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration

• For conditions of the tendinous or bursal structures: 4 to 30 mg

Asthma 

• Burst therapy: 32 to 64 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best

.Parenteral

• Sodium succinate: IV administration may be used if rapid hormonal effect of maximum intensity is required.
• High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally 48 to 72 hours; following initial emergency period, a longer-acting injectable or oral preparation should be considered
• Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension: For prolonged systemic effect

• 240 mg IM once (guideline dosing); 80 to 120 mg IM (manufacturer dosing)
• Initial dose: 6 to 48 mg orally once a day or every other day
• Maintenance dose: Gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Multiple Sclerosis

160 mg orally once a day for 1 week; then 64 mg orally every other day for 1 month

Nephrotic Syndrome

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• Sodium succinate: IV or IM; in emergency situations, IV is preferred
• Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
• As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM 

• Initial dose: 0.11 to 1.6 mg/kg/day IM

Inflammatory

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• Sodium succinate: IV or IM; in emergency situations, IV is preferred
• Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
• As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses
• Acetate suspension: For prolonged systemic effect; IM only
• Initial dose: 0.11 to 1.6 mg/kg/day IM.

Pediatric Neoplastic Diseases

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• Sodium succinate: IV or IM; in emergency situations, IV is preferred
• Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
• As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses
• Acetate suspension: For prolonged systemic effect; IM only
• Initial dose: 0.11 to 1.6 mg/kg/day IM

Pediatric Asthma

0 to 11 years of age

Initial dose: 0.8 to 1.6 mg/kg oral or IV (succinate) once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best

• Therapy is usually required for 3 to 10 days but in some cases, may be longer
• Maximum dose: 48 mg

12 years or older

• Initial dose: 32 to 48 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory

IM (acetate)

• 0 to 4 years of age: 7.5 mg/kg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)
• 5 years or older: 240 mg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)

Pediatric Juvenile Rheumatoid Arthritis

• Initial dose: 4 to 48 mg orally once a day or in divided doses
• Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral

• SUCCINATE: May administer IM or IV
• Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses throughout the day
• As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses throughout the day

ACETATE suspension: IM administration only

• Initial dose: 0.11 to 1.6 mg/kg IM once a day

Allergic Reaction

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate

• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day
• Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Pediatric Dose for Alopecia

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.
• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day
• Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral

• When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.
• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day

Pediatric Psoriasis

• Initial dose: 4 to 48 mg orally once a day or in divided doses

Succinate

• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day
• Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Dermatological Disorders

• Initial dose: 4 to 48 mg orally once a day or in divided doses
• When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate

• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day
• Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Allergic Urticaria

• Initial dose: 4 to 48 mg orally once a day or in divided doses.

Succinate

• Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
• Alternatively, 3.2 to 4.8 mg/m2/day
• Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Side Effects of Methylprednisolone

The most common side effects

• Fluid retention
• Weight gain,
• Mouth sores,
• Drying of the skin
• Change in skin color
• Diarrhea
• Any signs of infection, or a skin rash.
• Stomach pain, especially if it comes along with fever and diarrhea or constipation
• Yellowing of the skin or eyes
• Loss of appetite
• Constipation
• Sleepiness or unusual drowsiness
• Clumsiness or unsteadiness
• Dizziness
• Drowsiness
• Dry mouth
• false sense of well-being
• increased watering of mouth
• lightheadedness
• constipation;
• vision changes;
• breast swelling (in men or women); or
• decreased sex drive, impotence, or difficulty having an orgasm.
• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• restless muscle movements in your eyes, tongue, jaw, or neck;

Common

• Drowsiness and lightheadedness the day after taking the medicine.
• Confusion.
• Numbed emotions.
• Visual disturbances such as blurred vision or double vision.
• Shaky movements and unsteady walk (ataxia).
• Loss of memory (amnesia).
• Muscle weakness.
• Dizziness.
• Headache.
• Skin rashes.
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain.
• Difficulty in passing urine (urinary retention).
• Changes in sex drive.
• Low blood pressure (hypotension).
• Blood disorders.
• Jaundice.
• Unexpected aggression, restlessness or irritability (tell your doctor if you experience this).
• Nightmares or hallucinations (tell your doctor if you experience this).

Rare

• agitation
• anxiety
• behavioural changes, including aggressiveness, angry outbursts, bizarre behaviour, or decreased inhibitions
• confusion
• increased trouble sleeping
• memory problems
• muscle spasms
• shortness of breath

Drug Interactions of Methylprednisolone

Methylprednisolone may interact with following drugs, supplyments, & may change the efficacy of drugs

• abatacept
• anakinra
• Amphotericin B
• Antibiotics
• Anticholinesterase agents such as donepezil, rivastigmine, and galantamine
• Anticoagulants such as warfarin
• Antidiabetic agents
• anti-tumour necrosis factor agents (e.g., adalimumab, etanercept, infliximab, )
• azathioprine
• “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• beta-blockers (e.g., carvedilol,  metoprolol, propranolol)
• carbamazepine
• clonidine
• clozapine
• corticosteroids (e.g.dexamethasone, hydrocortisone,  prednisone)
• cyclosporine
• diltiazem
• imatinib
• Estrogens, including oral contraceptives
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methotrexate
• methyldopa
• mycophenolate
• phenobarbital
• phenytoin
• rituximab
• tacrolimus
• verapamil

The avobe list is not the sufficient drugs interactions list, please always consult your doctor or pharmacist before taking this drug.

Pregnancy & Lactation

There are no adequate or well-controlled studies of the use of methylprednisolone in pregnant women. Complications, including cleft palate, stillbirth, and premature abortion, have been reported when corticosteroids were administered during pregnancy in animals. If these drugs must be used during pregnancy, the potential risks should be discussed with the patient. Babies born to women receiving large doses of corticosteroids during pregnancy should be monitored for signs of adrenal insufficiency, and appropriate therapy should be initiated, if necessary. Corticosteroids have been shown to impair fertility in male rats.

Lactation

A patient who was 6 weeks postpartum and predominantly breastfeeding her infant received 24 mg of depot methylprednisolone plus 15 mg of lidocaine intralesionally for tenosynovitis of the wrist. Thirty hours after the injection, lactation ceased. Her breasts were soft and not engorged at that time. Thirty-six hours later, lactation resumed slowly, reaching normal milk production 24 hours later. The author hypothesized that the suppression might have occurred because the injection was in a highly mobile joint, which might have caused rapid release of the corticosteroid.[9] Large doses of triamcinolone injected into the shoulder and into the wrist have also been reported to cause temporary drop or cessation of lactation.

References

1. • DrugBank

     http://www.drugbank.ca/drugs/DB00959
     http://www.drugbank.ca/drugs/DB00959#targets
     http://www.drugbank.ca/drugs/DB00959#enzymes
     http://www.drugbank.ca/drugs/DB00959#transporters

     https://www.drugs.com/methylprednisolone.html

   • EPA DSStox

     https://comptox.epa.gov/dashboard/dsstoxdb/results?search=DTXSID7023300

   • European Chemicals Agency (ECHA)

     https://echa.europa.eu/substance-information/-/substanceinfo/100.001.343

     https://echa.europa.eu/information-on-chemicals/cl-inventory-database/-/discli/details/120271

     https://www.webmd.com/drugs/2/drug-6470/methylprednisolone-oral/details/list-contraindications

   • Human Metabolome Database (HMDB)

     http://www.hmdb.ca/metabolites/HMDB0015094

   • ClinicalTrials.gov

     https://clinicaltrials.gov/

   • DailyMed

     https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=METHYLPREDNISOLONE

   • FDA Pharm Classes

     https://www.accessdata.fda.gov/spl/data/1e7e9224-bfdb-4d47-89cc-4abff02d4c61/1e7e9224-bfdb-4d47-89cc-4abff02d4c61.xml

     https://www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162549.htm

   • NCIt

     https://ncit.nci.nih.gov/ncitbrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&ns=NCI_Thesaurus&code=C647

   • FDA/SPL Indexing Data

     https://www.fda.gov/ForIndustry/DataStandards/SubstanceRegistrationSystem-UniqueIngredientIdentifierUNII/

   • HSDB

     https://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs+hsdb:@term+@rn+@rel+83-43-2

     https://www.webmd.com/drugs/2/drug-6470/methylprednisolone-oral/details/list-contraindications

   • FDA Orange Book

     https://www.fda.gov/Drugs/InformationOnDrugs/ucm129662.htm

   • MassBank of North America (MoNA)

     http://mona.fiehnlab.ucdavis.edu/spectra/browse?inchikey=VHRSUDSXCMQTMA-PJHHCJLFSA-N

   • PubMed Health

     http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0001175/

     http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011175/

     http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011173/

   • Springer Nature Read more …
   • WHO ATC

     https://www.whocc.no/atc/

     https://www.whocc.no/atc_ddd_index/

   • Wikipedia

     https://en.wikipedia.org/wiki/Methylprednisolone

     https://pubchem.ncbi.nlm.nih.gov

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