Methylprednisolone (Oral)

As a corticosteroid, Methylprednisolone is effective in suppressing the immune system and decreasing inflammation, making it useful in the treatment of allergies, asthma and arthritis among others.

Overview

Methylprednisolone, which is often marketed as Solu-Medrol and Depo-Medrol among others, is a corticosteroid which is used to decrease inflammation and suppress the immune system. It is typically prescribed to treat allergies, rheumatic disorders, croup, COPD, multiple sclerosis and certain cancers. It can also be effective as a second-line therapy for tuberculosis.

It was first approved for medical use in 1955. Currently listed as an essential medicine by the World Health Organization, Methylprednisolone is considered vital for any health system because of its efficacy and low wholesale cost.

The anti-inflammatory actions of Methylprednisolone are thought to involve lipocortins, a form of inhibitory protein which controls the synthesis of inflammation mediators such as leukotrienes and prostaglandins.

Type Of Medicine

  • Corticosteroid

Conditions Treated

Side Effects

Like most medicines, Methylprednisolone can cause some unwanted side effects in addition to its desired effects. The most common side effects reported by patients undergoing treatment with this medication include the following:

  • Agitation
  • Aggression
  • Blurred vision
  • Anxiety
  • Decreased amount of urine
  • Dizziness
  • Irregular heartbeat or pulse
  • Headache
  • Irritability
  • Changes in mood
  • Depression
  • Nervousness
  • Rattling, noisy breathing
  • Tingling or numbness in the legs or arms
  • Shortness of breath
  • Pounding in the ears
  • Swelling of the hands, feet, fingers or lower legs
  • Difficulty speaking, thinking or walking
  • Troubled breathing while in a resting position
  • Weight gain

As the patient continues to take Methylprednisolone as prescribed by a physician, many (if not all) of the previously mentioned side effects should begin to lessen.

If side effects persist over a prolonged period or appear to get worse, the patient should contact their doctor as soon as possible. In many cases, a doctor or pharmacist will be able to recommend ways to alleviate symptoms using over the counter remedies or prescription drugs.

Most patients only experience very minimal side effects while taking Methylprednisolone. Methylprednisolone is designed to alleviate symptoms of potentially serious inflammatory conditions, and as such, it is generally prescribed by a doctor because the benefits of treating these conditions outweigh the risk of experiencing side effects which cause mild, temporary discomfort.

Other side effects which are experienced less frequency, albeit often enough to warrant mentioning, include the following:

  • Abdominal pain
  • Cramps and burning sensations
  • Backache
  • Black, bloody or tarry stools
  • Hoarseness or coughing
  • Darkening of the skin
  • A decrease in height (particularly in older people)
  • Decreased vision
  • Dry mouth
  • Diarrhea
  • Eye pain
  • Excess tears
  • Facial hair growth in females
  • Fatigue
  • Fainting
  • Dry, flushed skin
  • Chills
  • Fever
  • Increased incidence of fractures
  • Fruit-like breath odor
  • Round or full neck, face or trunk
  • Indigestion and heartburn
  • An increase in hunger
  • An increase in thirst
  • Increased need to urinate
  • Loss of sexual ability or desire
  • Loss of appetite
  • Muscle tenderness or pain
  • Menstrual irregularity
  • Lower back or side pain
  • Muscle weakness or wasting
  • Nausea
  • Pain in ribs, arms, legs or back
  • Difficult or painful urination
  • Sleeplessness
  • Skin rash
  • Sweating
  • Difficulty sleeping
  • Difficulty healing
  • Weight loss (unexplained)
  • Changes in vision
  • Vomiting
  • Unusual weakness or tiredness
  • Abnormal fat deposits on the face
  • Dry scalp
  • Acne
  • Red face
  • Swelling of the stomach
  • Thinning of hair on the scalp

Methylprednisolone can affect the psychology of the patient. He or she may therefore experience confusion, anxiety, mood swings and memory problems while taking this medication. It should be prescribed with caution in patients with a history of mental health conditions such as depression, bipolar disorder or schizophrenia.

In extremely rare cases, Methylprednisolone can cause allergic reactions. This is most prominent in younger patients (under the age of 12), patients with milk or bovine allergies, and patients with asthma. Symptoms of allergic reaction can include itching and swelling of the tongue, face and throat, extreme dizziness and difficulty breathing. Medical attention should be sought in the event of a patient experiencing these symptoms.

Not all side effects may have been reported. Patients who think they may have experienced a side effect which is not listed on the literature provided with this medication should contact their doctor and report their findings to the FDA.

Dosage

As with all medicines, it is incredibly important for the patient to only take Methylprednisolone as prescribed by a qualified doctor. This means patients should avoid taking more of this medicine than advised, either in dose size or in frequency of use. In addition to this, patients should stop taking Methylprednisolone if advised to do so by a doctor, even if they still have a supply of the drug remaining.

Methylprednisolone should be taken with food to reduce the level of stomach upset experienced by the patient as a result of corticosteroid use. If a daily dose of Methylprednisolone is prescribed, it should preferably be taken in the morning. Dosage will vary dependent on the needs of each patient. It is therefore important for the patient to listen attentively to the doctor's instructions at the time the medication is prescribed. Alternatively, the instructions printed on the packaging the medicine comes in can be followed these instructions should be the same or very similar to the prescribing doctor's instructions.

When determining the optimal dose size, a doctor will take various factors into account. Medicine strength, the number of doses needed per day, the period of time between doses and the duration the patient is expected to take the medicine will all play a role. While the manufacturer of Methylprednisolone provides general dose instructions, it should be reiterated that these are merely recommendations which can be altered by the prescribing doctor.

Typical adult dosage for Alopecia, Dermatologic Lesion, Lichen Simplex Chronicus, Psoriasis, Dermatological Disorder, Granuloma Annulare, Lichen Planus, Keloids, Rheumatoid Arthritis, Adrenogenital Syndrome, Acute Gout, Allergic Reaction, Bursitis, Nephrotic Syndrome, Osteoarthritis, Rejection Prophylaxis, Rejection Reversal, Tendonitis, Anti-Inflammatory, Neoplastic Disease, Epicondylitis, Synovitis:

Methylprednisolone should be taken orally, at an initial dose between 4mg to 48mg once a day, or in divided doses. This dose should be adjusted or maintained until a satisfactory response is obtained, before being decreased gradually in small decrements to the lowest possible dose that will maintain an adequate response.

In many cases, the Methylprednisolone Dosepak regimen may be most suitable, as follows:

  • Day 1: 24mg (8mg in the morning, 4mg at lunch, 4mg at dinner, 8mg at bedtime)
  • Day 2: 20mg (4mg in the morning, 4mg at lunch, 4mg at dinner, 8mg at bedtime)
  • Day 3: 16mg (4mg in the morning, 4mg at lunch, 4mg at dinner, 4mg at bedtime)
  • Day 4: 12mg (4mg in the morning, 4mg at lunch, 4mg at bedtime)
  • Day 5: 8mg (4mg in the morning, 4mg at bedtime)
  • Day 6: 4mg (4mg in the morning only)

Usual adult dose for asthma:

For acute asthma, Methylprednisolone should be prescribed to be taken orally via burst therapy, at a dose between 32mg to 64mg once a day. This should be taken by the patient until symptoms are resolved. Therapy typically takes three to ten days, but in severe cases may be longer.

For maintenance, the patient should take between mg to 48mg once per day or every other day. The maintenance dose should be gradually decreased until the lowest effective dose is ascertained.

Typical adult dose for Multiple Sclerosis:

160mg, taken orally once a day for a week, followed by 64mg taken orally once every second day for at least one month.

There are no strict recommended dose sizes for children below the age of 12, although this medication can be prescribed for children. The manufacturer simply leaves pediatric dose size and scheduling to be determined by the prescribing doctor.

Patients are warned against taking double doses of this medicine. If the patient misses a dose, they can simply take the missed dose as soon as they realize unless it is closer to the time when the next dose should be taken. In this instance, the patient should omit the missed dose, take the next scheduled dose and continue with their schedule as normal from then onwards.

If the patient experiences signs of an overdose (extremely fast or slow heartbeat, difficulty breathing, loss of consciousness, loss of co-ordination, flushed skin, seizures) they may require immediate medical attention. The patient or their caregiver should therefor call the local poison control center on 1-800-222-1222 or emergency services on 911.

Interactions

All drugs have the potential to interact with other drugs or chemicals within the body. These interactions can change the effect of one or more of the involved medications. This can lead to a medication becoming ineffective in combating the condition it was prescribed to alleviate. In other cases, interactions can give rise to potentially serious or even fatal side effects. Because these risks exist, patients are advised to keep a detailed list of all medications they are presently taking, including dosage information. This extends to over the counter remedies, complimentary medicines, vitamins and herbal supplements as well as prescribed drugs.

Below is a partial list of drugs known to negatively interact with Methylprednisolone. Patients who are undergoing treatment with one or more of these medicines should notify their doctor or healthcare provider before taking their first dose of Methylprednisolone:

  • Zoster Vaccine Live
  • Yellow Fever Vaccine
  • Voriconazole
  • Vigabatrin
  • Varicella Virus Vaccine
  • Typhoid Vaccine, Live
  • Trovafloxacin
  • Troleandomycin
  • Tofacitinib
  • Thalidomide
  • Teriflunomide
  • Telithromycin
  • Telaprevir
  • Talimogene Laherparepvec
  • Sparfloxacin
  • Smallpox Vaccine
  • Saquinavir
  • Rufinamide
  • Rubella Virus Vaccine
  • Rotavirus Vaccine
  • Rosiglitazone
  • Roflumilast
  • Rofecoxib
  • Rocuronium
  • Ritonavir
  • Rilonacept
  • Rifapentine
  • Rifampin
  • Rifabutin
  • Posaconazole
  • Poliovirus Vaccine, Live, Trivalent
  • Piroxicam
  • Pioglitazone
  • Pindolol
  • Phenytoin
  • Phenylbutazone
  • Phenolphthalein
  • Phenobarbital
  • Perindopril
  • Pentobarbital
  • Penbutolol
  • Pancuronium
  • Ombitasvir/Paritaprevir/Ritonavir
  • Ofloxacin
  • Norfloxacin
  • Nelfinavir
  • Nefazodone
  • Natalizumab
  • Nalidixic Acid
  • Mumps Virus Vaccine/Rubella Virus Vaccine
  • Mumps Virus Vaccine
  • Moxifloxacin
  • Mifepristone
  • Metrizamide
  • Metformin
  • Mestranol/Norethindrone
  • Mephobarbital
  • Mephenytoin
  • Meningococcal Polysaccharide Vaccine
  • Meningococcal Group B Vaccine
  • Meningococcal Conjugate Vaccine
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Measles Virus Vaccine/Rubella Virus Vaccine
  • Measles Virus Vaccine/Mumps Virus Vaccine/Rubella Virus Vaccine/Varicella Virus Vaccine
  • Measles Virus Vaccine/Mumps Virus Vaccine/Rubella Virus Vaccine
  • Measles Virus Vaccine
  • Lopinavir/Ritonavir
  • Lomefloxacin
  • Levofloxacin
  • Leflunomide
  • Ketoconazole
  • Itraconazole
  • Iopamidol
  • Iohexol
  • Insulin Aspart Protamine
  • Insulin Aspart
  • Insulin
  • Influenza Virus Vaccine, Live, Trivalent
  • Influenza Virus Vaccine, Inactivated
  • Influenza Virus Vaccine, H5N1
  • Influenza Virus Vaccine, H1N1, Live
  • Influenza Virus Vaccine, H1N1, Inactivated
  • Infliximab
  • Indomethacin
  • Indium Oxyquinoline In-111
  • Indinavir
  • Indapamide
  • Idelalisib
  • Grepafloxacin
  • Golimumab
  • Gemifloxacin
  • Gatifloxacin
  • Fosamprenavir
  • Fingolimod
  • Etanercept
  • Esterified Estrogens
  • Esomeprazole/Naproxen
  • Erythromycin/Sulfisoxazole
  • Erythromycin
  • Ertugliflozin/Sitagliptin
  • Ertugliflozin/Metformin
  • Ertugliflozin
  • Eprosartan/Hydrochlorothiazide
  • Eprosartan
  • Eplerenone
  • Ephedrine/Phenobarbital/Theophylline
  • Enoxacin
  • Emtricitabine/Nelfinavir/Tenofovir
  • Emtricitabine/Lopinavir/Ritonavir/Tenofovir
  • Diltiazem
  • Digoxin
  • Digitoxin
  • Diflunisal
  • Diethylstilbestrol
  • Dienogest/Estradiol
  • Dienestrol Topical
  • Dicumarol
  • Diclofenac/Misoprostol
  • Diclofenac
  • Dichlorphenamide
  • Diazoxide
  • Desirudin
  • Delavirdine
  • Delafloxacin
  • Deferasirox
  • Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir
  • Conivaptan
  • Cobicistat/Darunavir
  • Cobicistat
  • Clarithromycin
  • Ciprofloxacin
  • Cinoxacin
  • Certolizumab
  • Captopril
  • Capreomycin
  • Candida Albicans Extract
  • Candesartan/Hydrochlorothiazide
  • Candesartan
  • Canakinumab
  • Canagliflozin/Metformin
  • Canagliflozin
  • Calcium Carbonate/Magnesium Hydroxide/Simethicone
  • Calcium Carbonate/Magnesium Hydroxide
  • Calcium Carbonate/Famotidine/Magnesium Hydroxide
  • Bupropion/Naltrexone
  • Bupropion
  • Boceprevir
  • Bendroflumethiazide/Nadolol
  • Bendroflumethiazide
  • Benazepril/Hydrochlorothiazide
  • Benazepril
  • Belladonna/Ergotamine/Phenobarbital
  • Belladonna/Caffeine/Ergotamine/Pentobarbital
  • Belladonna/Butabarbital
  • BCG
  • Bazedoxifene/Conjugated Estrogens
  • Baclofen/Flurbiprofen/Lidocaine Topical
  • Azithromycin/Trovafloxacin
  • Atazanavir/Cobicistat
  • Atazanavir
  • Amprenavir
  • Amoxicillin/Clarithromycin/Omeprazole
  • Amoxicillin/Clarithromycin/Lansoprazole
  • Adalimumab

Warnings

In addition to advising their doctor of any drugs they currently take and allergies they have, the patient should also be willing to discuss their medical history, including any current health problems. This is because some conditions could be exacerbated by corticosteroid use.

Patients should be made aware of how corticosteroids work. Corticosteroids are not curatives, and it is important that corticosteroid therapy is not abruptly stopped. If treatment is stopped abruptly, unpleasant withdrawal symptoms may occur.

During times of stress on the body, such as surgery or during infection, it may be beneficial for greater quantities of Methylprednisolone to be administered. Patients should also discuss with their healthcare provider whether it is a good idea to carry a medical ID card which identifies their corticosteroid use.

Patients taking immunosuppressing doses of Methylprednisolone should be aware that they are at greater risk of infection and should therefore avoid direct exposure to infectious diseases such as chickenpox or measles. If exposed to an infectious illness, the patient should consult their healthcare professional as soon as possible.

Common adverse reactions to Methylprednisolone include weight gain, changes in the tolerance of glucose, high blood pressure, changes in behavior and/or mood, increased appetite and fluid retention.

This medicine should not be used in patients who are allergic to it, or patients who have a fungal infection anywhere in the body. Patients should discuss the risks of doing so with their healthcare provider.

To ensure this medicine is safe for them to use, patients should inform their doctor if they have ever had any of the following conditions:

Patients should also inform their doctor if they have diabetes. This is because certain steroid medicines like Methylprednisolone can potentially increase the levels of glucose in the blood and/or urine. While taking Methylprednisolone, the patient may need to adjust the level of their diabetes medication.

It is currently unknown whether Methylprednisolone causes complications or harms unborn babies. Patients who are pregnant or intending on becoming pregnant soon should discuss the risks of using Methylprednisolone with their doctor.

It is not known whether Methylprednisolone is excreted into breastmilk, or whether it could affect a nursing baby, although FDA guidelines recommend that breastfeeding should be refrained from while using any form of steroid.

Methylprednisolone can interfere with the results of certain medical tests. Patients should inform all their doctors or healthcare providers when they are undergoing treatment with Methylprednisolone.

Storage

Methylprednisolone tablets should be kept in a cool, dry place, away from sources of light, heat and moisture. This medicine is therefore unsuitable for storage in a bathroom cabinet. It should instead be kept out of the reach of children and pets, in a dedicated, locked medicine cabinet if possible.

Patients who need to dispose of unwanted, unused or expired Methylprednisolone should do so in a hygenic and safe manner, in accordance with state law and FDA guidelines. Methylprednisolone tablets should not be flushed down a toilet or drain. Patients are advised to find out about drug take back programs in their area. Many pharmacies will recycle or dispose of unused medicines for free. Patients are advised to avail of such programs.

Summary

Methylprednisolone is a greatly beneficial corticosteroid. However, it can also pose a risk to patients, particularly those who fail to communicate effectively with their physicians. As a treatment designed to reduce inflammation and suppress the immune system, Methylprednisolone provides relief of allergies, reduces pain associated with various conditions and can be useful in the treatment of asthma and other lung conditions. It also can create feelings of dizziness and anxiety, as well as affecting vision.

These and other side effects can affect the day-to-day functioning of the patient, impairing their abilities and give rise to potentially dangerous situations if the correct precautions are not taken. Because of this, it is important for the patient to tell their doctor as much as they can about their own medical history, including any medications they may be currently taking. This is because there are hundreds of medicines which could interact with Methylprednisolone, and several medical conditions which could be worsened by corticosteroid use.

When taken correctly, Methylprednisolone helps to provide relief of the symptoms of various inflammatory illnesses which would otherwise have been untreatable. This means that Methylprednisolone provides the patient with a greater quality of life because they feel less pain and can move more freely. To achieve this, patient and doctor must work together to find the best dosage and most appropriate frequency of Methylprednisolone use.