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:
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.
Higher doses of diabetes medications may be required because corticosteroids increase blood glucose.
Cholestyramine (Questran, Questran Light) may reduce blood levels of oral corticosteroids by reducing absorption from the stomach and intestines.
Live vaccines or inactivated vaccines may not be as effective in patients receiving prolonged corticosteroid therapy because steroids depress the immune system. Vaccines should be administered after corticosteroid therapy is completed.
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. Prolonged use of methylprednisolone can depress the ability of the body's adrenal glands to produce corticosteroids. Abruptly stopping methylprednisolone in these individuals can cause symptoms of corticosteroid insufficiency, with accompanying nausea, vomiting, and even shock. Therefore, withdrawal of methylprednisolone usually is accomplished by gradually lowering the dose. Gradually tapering methylprednisolone not only minimizes the symptoms of corticosteroid insufficiency, it also reduces the risk of an abrupt flare of the disease being treated.
Methylprednisolone and other corticosteroids can mask signs of infection and impair the body's natural immune response to infection. Patients on corticosteroids are more susceptible to infections and can develop more serious infections than individuals not on corticosteroids. For example, chickenpox and measles viruses can produce serious and even fatal illnesses in patients on high doses of methylprednisolone. Live virus vaccines, such as smallpox vaccine, should be avoided in patients taking high doses of methylprednisolone since even vaccine viruses may cause disease in these patients. Some infectious organisms, such as tuberculosis (TB) and malaria, can remain dormant in patients for years. Methylprednisolone and other corticosteroids can allow these infections to reactivate and cause serious illness. Patients with dormant TB may require anti-TB medications while undergoing prolonged corticosteroid treatment.
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