Adult Dosing
Intra-articular, intra-lesional, soft tissue injection (methylprednisolone acetate)
- 4-80 mg injected into site q1-5 wks
Corticosteroid-responsive conditions
Methylprednisolone acetate
Methylprednisolone sodium succinate
High-dose pulse therapy (methylprednisolone sodium succinate)
- 30 mg/kg IV q4-6 hrs for up to 48-72 hrs
Congenital adrenal hyperplasia (methylprednisolone acetate)
Multiple sclerosis, acute exacerbation (methylprednisolone sodium succinate)
- Initially 160 mg IM qd for 7 days then 64 mg IM every other day for 1 month
Acute spinal cord injury (methylprednisolone succinate)
- 30 mg/kg IV (over 15 min) initially, followed 45 min later with 5.4 mg/kg/hr for 23 hrs
Goodpastures syndrome [Non-FDA Approved]
- For life threatening pulmonary hemorrhage, some recommend 1 gram IV daily (infused over 1 hour) for 3 days, followed by a gradual taper and transition to oral medications
Acute asthma exacerbation [Non-FDA Approved]
Note: Dosage varies with the condition being treated
Pediatric Dosing
Corticosteroid-responsive conditions
Methylprednisolone sodium succinate
- 0.5-1.7 mg/kg/day IV/IM divided q6-12 hrs
Acute spinal cord injury (methylprednisolone succinate)
- 30 mg/kg (over 15 min) initially, followed 45 min later with 5.4 mg/kg/hr for 23 hrs
Status asthmaticus (methylprednisolone succinate)
- Start: 2 mg/kg x1 IV then 0.5-1 mg/kg IV q6 hrs
Lupus nephritis (methylprednisolone succinate)
- 30 mg/kg IV qod for 6 doses
Croup [Non-FDA Approved]
- 1 mg/kg IV once (some providers continue with additional corticosteroids orally or injected depending on severity and response)
Goodpastures syndrome [Non-FDA Approved]
- 1-2 mg/kg/day IV divided q6-12 hours, converted to oral agents when possible
Kawasaki Diseases [Non-FDA Approved]
- 30 mg/kg administered over 2-3 hrs as an infusion, given daily for 1-3 days
Note: Dosage varies with the condition being treated
[Outline]
For IM administration
Methylprednisolone acetate, methylprednisolone sodium succinate
- Allergic states: Control of severe or incapacitating allergic conditions
- Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme
- Endocrine disorders: Primary or secondary adrenocortical insufficiency
- GI diseases: To tide the patient over a critical period of the disease in regional enteritis (systemic therapy), ulcerative colitis
- Hematologic disorders: Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia ( Diamond blackfan anemia), pure red cell aplasia, select cases of secondary thrombocytopenia
- Neoplastic diseases: For palliative management of leukemias and lymphomas
- Nervous system disorders: Acute exacerbations of multiple sclerosis and cerebral edema associated with primary or metastatic brain tumor or craniotomy
- Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids
- Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or due to lupus erythematosus
- Respiratory diseases: Berylliosis, symptomatic sarcoidosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis
- Rheumatic disorders: Adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid arthritis (
- Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concomitantly with appropriate antituberculous chemotherapy
For intra-articular or soft tissue administration
Methylprednisolone acetate
- As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis
For intralesional administration
Methylprednisolone acetate
- Intralesional use in alopecia areata, discoid lupus erythematosus, keloids, localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques, necrobiosis lipoidica diabeticorum
- Note: Methylprednisolone acetate is not for IV use while methylprednisolone sodium succinate is for IV or IM use
See Supplemental Patient Information
- The acetate and sodium succinate product has Benzyl alcohol present that is potentially toxic when administered locally to neural tissue. Particularly neonates are prone to toxicity (hypotension, metabolic acidosis) and small preterm infants are prone to increased incidence of kernicterus. Even rare occasions of death have occurred. Consider the daily metabolic load of benzyl alcohol if the patient requires more than the recommended dosages or other medications containing this preservative
- Take special care to avoid contamination; strictly follow aseptic technique. Use disposable sterile syringes and needles
- Dermal and/or subdermal changes forming depressions in the skin at the injection site have occurred
- Take utmost care to avoid exceeding recommended doses to minimize the incidence of dermal and subdermal atrophy. Make multiple small injections into the area of the lesion. Undertake precautions against injection or leakage into the dermis while intra-articular and intramuscular injection. Avoid injection into the deltoid muscle to prohibit higher incidence of subcutaneous atrophy
- Use appropriate technique and take utmost care to assure proper placement of drug
- Rare occasions of anaphylactoid reactions has occurred
- Administer increased dosage of rapidly acting corticosteroids in patients on corticosteroid therapy subjected to any unusual stress before, during, or after the stressful situation
- Mortality has occurred in patients with cranial trauma. Avoid using higher doses of systemic corticosteroids for the treatment of traumatic brain injury
- Elevation of blood pressure, salt and water retention and increased excretion of potassium have occurred with average and large doses of corticosteroids. Dietary salt restriction and potassium supplementation may be essential
- Association between the use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction exists; exercise caution in such patients
- Monitor patients for hypothalamic-pituitary adrenal (HPA) axis suppression. Cushing’s syndrome, and hyperglycemia with chronic use of this drug
- Withdrawal of therapy is associated with reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency. Gradually reduce dosage to minimize drug induced secondary adrenocortical insufficiency. Insufficiency persists for months after discontinuation of therapy; reinstitute hormone therapy in any situation of stress
- Persons who are on corticosteroids are more prone to infections than are healthy individuals. There is decreased resistance and inability to localize infection when corticosteroids are used. Infections with any pathogen (viral, fungal, protozoan, or helminthic), in any location of the body is associated with the use of corticosteroids alone or in combination with other immunosuppressive agents. Therapy may mask some signs of current infection. Avoid using intra-articularly, intrabursally or for intratendinous administration for local effect in the presence of acute local infection
- Therapy is associated with exacerbation of systemic fungal infections. Avoid usage in presence of such infections unless they are essential for controlling drug reactions
- Activation of latent disease may occur or there may be an exacerbation of recurrent infections due to pathogens, including those caused by amoeba, candida, cryptococcus, mycobacterium, nocardia, pneumocystis, taxoplasma. Rule out latent amebiasis or active amebiasis before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea. Use with utmost care in patients with known or suspected strongyloides (threadworm) infestation. Avoid using in cerebral malaria
- Restrict use of corticosteroids in active tuberculosis to cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. Closely observe patients using corticosteroids having latent tuberculosis or tuberculin reactivity. Provide chemoprophylaxis during prolonged use
- Administration of live or live, attenuated vaccines is contraindicated in patients using immunosuppressive doses of corticosteroids. Killed or inactivated vaccines can be used
- Chicken pox and measles with serious or even fatal outcome have occurred in pediatric and adult patients. Take utmost care to avoid exposure in pediatric and adult patients who have not had these diseases. On exposure to chicken pox, provide prophylaxis with varicella zoster immune globulin (VZIG). If exposed to measles, provide prophylaxis with immunoglobulin (IG). On occurrence of chicken pox provide treatment with antiviral agents
- Posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, with enhancement of secondary ocular infections due to bacteria, fungi or viruses have occurred. Avoid usage for treating optic neuritis. Avoid usage in active ocular herpes simplex
- Kaposi’s sarcoma has occurred in patients
- Therapy is associated wit inhibition of bone growth in pediatric patients and the development of osteoporosis at any age
- Monitor intraocular pressure if steroid therapy is used for >6 wks
- An acute myopathy has occurred with high doses of corticosteroids
- Monitor electrolytes, BP, weight; postprandial glucose, urinalysis, height (pediatrics), Perform chest x-ray if prolonged therapy; advise for ophthalmic. examination if therapy for >6wks; Monitor BMD if prolonged therapy or >65 yrs; consider upper GI x-ray if history of peptic ulcer disease or significant dyspepsia
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Osteoporosis
- Risk of osteoporosis
- Recent MI
- CHF
- Risk of GI perforation
- Cirrhosis
- Hypertension
- TB infection
- Diabetes mellitus
- History of seizure disorder
- Stress
- Inactive ocular HSV infection
- Optic neuritis
- Myasthenia gravis
- Psychiatric disorder
- Active or latent amebiasis infection
- Strongyloides infection
- Chronic treatment (use lowest possible dose)
- Pediatric population (use lowest possible dose)
Supplemental Patient Information
- Warn patients to avoid discontinuing the use of corticosteroids abruptly or without medical supervision
Pregnancy Category:C
Breastfeeding: Limited literature indicates that maternal doses of methylprednisolone up to 8 mg/day produces low levels in milk and unexpected to cause any adverse effects in breastfed infants. With high maternal doses, especially IV doses, avoiding breastfeeding for 3-4 hrs after a dose to decrease the dose received by the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 February 2011. Manufacturer advises to make a decision to continue nursing, or discontinue the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
- Depo-Medrol
- A-methapred
- Solu-Medrol
US Availability
methylprednisolone acetate (generic)
- INJ: 40 mg/mL (1, 5, 10 mL vial)
- INJ: 80 mg/mL (1, 5 mL vial)
methylprednisolone sodium succinate (generic)
- PWDR for INJ: 40 mg/vial
- PWDR for INJ: 125 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1000 mg/vial
Depo-Medrol (methylprednisolone acetate)
- INJ: 20 mg/mL (5 mL vial)
- INJ: 40 mg/mL (5, 10 mL vial )
- INJ: 80 mg/mL (5 mL vials)
A-methapred (methylprednisolone sodium succinate)
- PWDR for INJ: 40 mg/vial
- PWDR for INJ: 125 mg/vial
- PWDR for INJ: 500 mg/vial
(Discontinued)
- PWDR for INJ: 1000 mg/vial
(Discontinued)
Solu-Medrol (methylprednisolone sodium succinate)
- PWDR for INJ: 40 mg/vial (1 mL vial)
- PWDR for INJ: 125 mg/vial (2 mL vial)
- PWDR for INJ: 500 mg/vial (4 mL vial)
- PWDR for INJ: 1000 mg/vial
- PWDR for INJ: 2000 mg/vial
Canadian Trade Name(s)
Canadian Availability
methylprednisolone acetate (generic)
- INJ: 40 mg/mL
- INJ: 80 mg/mL
methylprednisolone sodium succinate (generic)
- PWDR for INJ: 40 mg/vial
- PWDR for INJ: 125 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1000 mg/vial
Depo-Medrol (methylprednisolone acetate)
- INJ: 20 mg/mL (5 mL vial)
- INJ: 40 mg/mL (2, 5 mL vial)
- INJ: 80 mg/mL (5 mL vial)
Solu-Medrol (methylprednisolone sodium succinate)
- PWDR for INJ: 40 mg/vial
- PWDR for INJ: 125 mg/vial
- PWDR for INJ: 500 mg/vial
- PWDR for INJ: 1000 mg/vial
UK Trade Name(s)
UK Availability
Depo-Medrone (methylprednisolone acetate)
- INJ: 40 mg/mL (1, 2, 3 mL vial)
Solu-Medrol (methylprednisolone sodium succinate)
- PWDR for INJ: 40 mg/vial (with 1 mL solvent)
- PWDR for INJ: 125 mg/vial (with 2 mL solvent)
- PWDR for INJ: 500 mg/vial (with 8 mL solvent)
- PWDR for INJ: 1000 mg/vial (with 16 mL solvent)
- PWDR for INJ: 2000 mg/vial (with 32 mL solvent)
Australian Trade Name(s)
- Depo-Medrol
- Depo-Nisolone
- Solu-Medrol
Australian Availability
Depo-Medrol, Depo-Nisolone (methylprednisolone acetate)
- INJ: 40 mg/mL (1 mL vial)
Solu-Medrol (methylprednisolone sodium succinate)
- PWDR for INJ: 40 mg/mL (1 mL vial)
- PWDR for INJ: 125 mg/2 mL
- PWDR for INJ: 500 mg (with 8 mL solvent)
- PWDR for INJ: 1000 mg (with 16 mL solvent)
- PWDR for INJ: 2000 mg (with 32 mL solvent)
- PWDR for INJ: 500, 1000 mg vial
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Depo-Medrol 20 MG/ML SUSP [Vial] (PFIZER U.S.)
5 ml = $28.64
10 ml = $46.26 - Solu-MEDROL 40 MG SOLR [Vial] (PFIZER U.S.)
1 mg = $12.99
3 mg = $19.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
