methylprednisolone, Medrol, Depo-Medrol, Solu-Medrol (cont.)

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By interfering with the patient's immune response, methylprednisolone can prevent vaccines from being effective. Methylprednisolone also can interfere with the TB skin test and cause falsely negative results in patients with dormant TB infections.

Methylprednisolone impairs calcium absorption and new bone formation. Patients on prolonged treatment with methylprednisolone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. In rare individuals, destruction of large joints can occur while undergoing treatment with methylprednisolone or other corticosteroids (aseptic necrosis). These patients experience severe pain in the joints involved, and can require joint replacement. The reason behind such destruction is not clear. Methylprednisolone can be used in pregnancy, but is generally avoided.



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, from 20 C to 25 C (68 F to 77 F).

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).

Medically Reviewed by a Doctor on 1/2/2015

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