Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: methylprednisolone
BRAND NAME: Medrol, Depo-Medrol
DRUG CLASS AND MECHANISM: Methylprednisolone is a synthetic (man-made)
corticosteroid. 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.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 2, 4, 8, 16, 24, and 32 mg. Injection: 20, 40,
and 80 mg/ml.
STORAGE: Tablets should be kept at room temperature, between 20° and
25°C (68-77°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.
DOSING: Dosage requirements of corticosteroids vary among individuals
and the diseases being treated. In general, the lowest effective dose is used.
The initial oral dose is 4-48 mg daily depending on the disease. 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. 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. Cyclosporin reduces the metabolism of methylprednisolone
while methylprednisolone reduces the metabolism of cyclosporin. 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).
Phenobarbital, phenytoin
(Dilantin), and rifampin
(Rifadin, Rimactane) may increase the metabolism of
methylprednisolone and other corticosteroids, resulting in lower blood levels
and reduced effects. Therefore, the dose of methylprednisolone may need to be
increased if treatment with phenobarbital is begun.
PREGNANCY: Methylprednisolone has not been adequately evaluated in
pregnant women.
NURSING MOTHERS: Methylprednisolone has not been adequately evaluated
in nursing mothers.
SIDE EFFECTS: Adverse effects of methylprednisolone depend on dose,
duration and frequency of administration. Short courses of methylprednisolone
are usually well-tolerated with few, mild side effects. Long term, high doses of
methylprednisolone may produce predictable and potentially serious side effects.
Whenever possible, the lowest effective doses of methylprednisolone should be
used for the shortest length of time to minimize side effects. Alternate day
dosing also can help reduce side effects.
Side effects of methylprednisolone and other corticosteroids range from mild
annoyances to serious irreversible bodily damage. Side effects include fluid
retention, weight gain, high blood pressure, potassium loss, headache, muscle
weakness, puffiness of the face, hair growth on the face, thinning and easy
bruising of the skin, glaucoma, cataracts,
peptic ulceration, worsening of
diabetes,
irregular menses, growth retardation in children, convulsions, and
psychic disturbances. Psychic disturbances may include depression, euphoria,
insomnia, mood swings, personality changes, and even
psychotic behavior.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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