II. Indications
- Anti-inflammatory
- Acute Asthma Exacerbation
- Multiple Sclerosis flare
- Optic Neuritis
III. Mechanism
IV. Medications
- Methylprednisolone tablets 2 mg, 4 mg, 8 mg, 16 mg, 32 mg
- Medrol Dose Pack (contains 21 tablets, each 4 mg in Blister pack with taper schedule over 7 days)
- Methylprednisolone Sodium succinate IV Solution (Solu-Medrol)
- Avoid in milk protein Hypersensitivity
- Avoid Benzyl Alcohol containing solution for intrathecal use or newborns
- Methylprednisolone Acetate IM Solution (Depo-Medrol)
- Duration of IM Injection is variable (1-6 days)
- Also used for Intra-articular Corticosteroid
V. Dosing: General Anti-inflammatory Dosing
- Adult
- Parenteral (Solu-Medrol) 10 to 125 mg (typically 60 mg) IV or IM every 4 to 12 hours
- Oral (Medrol) 4 to 48 mg orally daily
- Medrol Dose pack: tapers from max of 24 mg orally over 7 days
- Avoid Medrol dose pack (replace with Prednisone 30 mg orally daily for 5 to 6 days to have similar effect)
- Depo-Medrol: 4 to 120 mg IM every 1 to 2 weeks
- Child
- Dose: 1-2 mg/kg/dose orally, IV or IM every 6 to 12 hours
- Maximum: 125 mg/dose (typically up to 60 mg/dose)
VI. Dosing: Acute Asthma Exacerbation
- Methylprednisolone (Solu-Medrol) 1 mg/kg/dose (up to 60 mg) IV every 6 hours (or 80 mg IV every 8 hours)
VII. Dosing: Multiple Sclerosis (Adults)
-
Multiple Sclerosis Flare
- Initial 3 day course of Methylprednisolone IV or Oral (similar efficacy for oral dosing)
- Methylprednisolone 1000 mg orally daily (or in divided doses) for 3 days OR
- Methylprednisolone 1000 mg in 500 ml D5W infused over 4 to 6 hours each morning for 3 days
- Next: Steroid Taper after first 3 days (examples only, dosing varies widely, consult neurology for local protocol)
- Methylprednisolone 500 mg daily IV or Oral for 3 days, then 250 mg daily IV or Oral for 3 days
- Initial 3 day course of Methylprednisolone IV or Oral (similar efficacy for oral dosing)
-
Optic Neuritis
- Methylprednisolone 250 mg IV every 6 hours (or 1 g daily) for 3 days
- Typically followed by oral Corticosteroid course
- Methylprednisolone 250 mg IV every 6 hours (or 1 g daily) for 3 days
VIII. Pharmacokinetics
- Medium potency
- Medium anti-inflammatory potency
- No Mineralocorticoid Activity
- Medium Half-Life (36 hours)
IX. Adverse Effects
X. Safety
- See Systemic Corticosteroid
- Unknown safety in pregnancy
- Avoid in Lactation
XI. Resources
- Methylprednisolone Tablets (DailyMed)
- Methylprednisolone Sodium succinate injection powder for solution or Solu-Medrol (DailyMed)
- Methylprednisolone acetate or Depo-Medrol (DailyMed)
XII. References
- Swadron and Hope in Herbert (2018) EM:Rap 18(9):16-8
- Dvorin (2020) Am Fam Physician 101(2): 89-94 [PubMed]
- Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| methylprednisolone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| METHYLPREDNISOLONE 16 MG TAB | Generic | $1.58 each |
| METHYLPREDNISOLONE 32 MG TAB | Generic | $3.49 each |
| METHYLPREDNISOLONE 4 MG DOSEPK | Generic | $0.14 each |
| METHYLPREDNISOLONE 4 MG TABLET | Generic | $0.17 each |
| METHYLPREDNISOLONE 40 MG/ML VL | Generic | $8.70 per ml |
| METHYLPREDNISOLONE 8 MG TABLET | Generic | $0.96 each |
| METHYLPREDNISOLONE 80 MG/ML VL | Generic | $13.30 per ml |
| depo-medrol (on 7/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DEPO-MEDROL 80 MG/ML VIAL | Generic | $13.30 per ml |
| medrol (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MEDROL 4 MG DOSEPAK | Generic | $0.14 each |