methylprednisolone, Medrol, Depo-Medrol, Solu-Medrol (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
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).
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. Combining corticosteroids with potassium depleting drugs (for example, diuretics, amphotericin B) may result in low blood potassium (hypokalemia), resulting in heart failure.
Medically Reviewed by a Doctor on 3/20/2013
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