methylprednisolone, Medrol, Depo-Medrol, Solu-Medrol

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GENERIC NAME: methylprednisolone

BRAND NAME: Medrol, Depo-Medrol, Solu-Medrol

DRUG CLASS AND MECHANISM: Methylprednisolone family of products include methylprednisolone, methylprednisolone acetate (Medrol, Depo-medrol), and methylprednisolone sodium acetate (Solu-medrol). They will be called methylprednisolone in this monograph. They are synthetic (man-made) corticosteroids. Corticosteroids are naturally-occurring chemicals produced by the adrenal glands located adjacent to the kidneys. Corticosteroids affect metabolism in various ways and modify the immune system. Corticosteroids also block inflammation and are used in a wide variety of inflammatory diseases affecting many organs. The FDA approved methylprednisolone in October 1957.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 4, 8, 16, 24, and 32 mg. Injectable suspension: 20, 40, and 80 mg/ml. Powder for Injection: 40, 125, 500, 1000, and 2000 mg.

STORAGE: Methylprednisolone preparations should be kept at room temperature, between 20 C and 25 C (68 F to 77 F).

PRESCRIBED FOR: Methylprednisolone is used to achieve prompt suppression of inflammation. Examples of inflammatory conditions for which methylprednisolone is used include rheumatoid arthritis, systemic lupus erythematosus, acute gouty arthritis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. Severe allergic conditions that fail conventional treatment also may respond to methylprednisolone. Examples include bronchial asthma, allergic rhinitis, drug-induced dermatitis, and contact and atopic dermatitis. Chronic skin conditions treated with methylprednisolone include dermatitis herpetiformis, pemphigus, severe psoriasis and severe seborrheic dermatitis. Chronic allergic and inflammatory conditions of the uvea, iris, conjunctiva and optic nerves of the eyes also are treated with methylprednisolone. Methylprednisolone is used for treating shock and multiple sclerosis although their use in these conditions is controversial.

DOSING: Dosage requirements of corticosteroids vary among individuals and the diseases being treated. In general, the lowest effective dose is used. The oral dose range is 2-60 mg daily depending on the disease. Depo-medrol doses are 10-80 mg injected into muscle every 1-2 weeks, and Solu-medrol doses are 10-250 mg intravenous or intramuscular injections up to 6 times daily. The initial dose should be adjusted based on response. Corticosteroids given in multiple doses throughout the day are more effective but also more toxic than the same total daily dose given once daily, or every other day.

Oral methylprednisolone should be taken with food.

DRUG INTERACTIONS: Troleandomycin (TAO), an infrequently used macrolide antibiotic, reduces the liver's ability to metabolize methylprednisolone (and possibly other corticosteroids). This interaction can result in higher blood levels of methylprednisolone and a higher probability of side effects. Erythromycin and clarithromycin (Biaxin) are likely to share this interaction, and ketoconazole (Nizoral) also inhibits the metabolism of methylprednisolone. Estrogens, including birth control pills, can increase the effect of corticosteroids by 50% by mechanisms that are not completely understood. For all of the above interactions, the dose of methylprednisolone may need to be lowered. Cyclosporine reduces the metabolism of methylprednisolone while methylprednisolone reduces the metabolism of cyclosporine. When given together, the dose of both drugs may need to be reduced to avoid increased side effects. Methylprednisolone may increase or decrease the effect of blood thinners, for example, warfarin (Coumadin). Blood clotting should be monitored and therapy adjusted in order to achieve the desired level of blood thinning (anti-coagulation).




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