Dosing & Uses
Dosage Forms & Strengths
powder for injection
Day 1: 8 mg PO before breakfast, 4 mg after lunch and after dinner, and 8 mg at bedtime
Day 2: 4 mg PO before breakfast, after lunch, and after dinner and 8 mg at bedtime
Day 3: 4 mg PO before breakfast, after lunch, after dinner, and at bedtime
Day 4: 4 mg PO before breakfast, after lunch, and at bedtime
Day 5: 4 mg PO before breakfast and at bedtime
Day 6: 4 mg PO before breakfast
May be tapered over 12 days (to decrease chance of dermatitis flareup)
Acute Exacerbations of Multiple Sclerosis
160 mg IV once daily for 1 week, then 64 mg IV every other day for 1 month
Pneumocystis (carinii) jiroveci Pneumonia in AIDS Patients (Off-label)
30 mg IV q12hr for 5 days, then 30 mg IV q24hr for 5 days, then 15 mg IV q24hr for 11 days
Acute Spinal Cord Injury (Off-label)
Next 23 hours: 5.4 mg/kg/hr IV by continuous infusion
Severe Lupus Nephritis (Off-label)
0.5-1 g IV over 1 hour once daily for 3 days
Methylprednisolone: Usual dosing range, 2-60 mg/day PO divided q6-24hr
Methylprednisolone acetate: Usual dosing range, 10-80 mg IM every 1-2 weeks; as temporary substitute for PO, given in daily IM dose equal to daily PO dose; for prolonged effect, given in weekly IM dose equal to 7 times daily PO dose; unlike methylprednisolone sodium succinate, may not be given IV
Methylprednisolone sodium succinate: Usual dosing range, 10-250 mg IM/IV up to q4hr PRN
Dosage Forms & Strengths
powder for injection
>12 years: 40-80 mg/day IM divided q12-24hr until peak expiratory flow is 70% of predicted or personal best; not to exceed 60 mg/day
Pneumocystis (carinii) jiroveci Pneumonia in AIDS Patients (Off-label)
>13 years: 30 mg IV q12hr for 5 days, then 30 mg IV q24hr for 5 days, then 15 mg IV q24hr for 11 days
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Delayed wound healing
Growth suppression (children)
Pituitary adrenal axis suppression
Pseudotumor cerebri (on withdrawal)
Sodium and water retention
Untreated serious infections
Systemic fungal infection (except intra-articular injection in localized joint conditions)
IM route is contraindicated in idiopathic thrombocytopenic purpura
Premature infants (formulations containing benzyl alcohol only)
Traumatic brain injury (high doses)
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, history of seizure disorders, multiple sclerosis, thromboembolic disorders, myocardial infarction
Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing
Minimal mineralocorticoid activity
Use in septic shock or sepsis syndrome not proven effective and may increase mortality in some patients including patients with elevated serum creatinine and patients who develop secondary infections
Clearance of corticosteroids may increase in hyperthyroid patients and decrease in hypothyroid ones; dose adjustments may be necessary
Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
May cause hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, or hyperglycemia
Prolonged corticosteroid use may result in elevated IOP, glaucoma, or cataracts
Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)
Injection may result in dermal and/or subdermal changes forming depressions in the skin at injection site; to minimize incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections; avoid injection into deltoid muscle due to high incidence of subcutaneous atrophy
Increased dosage of rapidly acting corticosteroids indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation
Not for use in the treatment of traumatic brain injury
Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion
Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in situation of stress occurring during that period, hormone therapy should be reinstituted
Rarely, high doses of cyclically pulsed intravenous methylprednisolone (usually for the treatment of exacerbations of multiple sclerosis at doses of 1 g/day) can induce a toxic form of acute hepatitis; discontinue therapy if it occurs; since recurrence has occurred after re-challenge, avoid use in patients with a history of toxic hepatitis caused by methylprednisolone
With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases; corticosteroids may also mask some signs of current infection; corticosteroids may exacerbate systemic fungal infections and should not be used in presence of such infections unless needed to control drug reactions; latent amebiasis or active amebiasis should be ruled out before initiating corticosteroid therapy patients who have spent time in tropics or patients with unexplained diarrhea
Lowest possible dose should be used to control condition under treatment; when reduction in dosage possible, reduction should be gradual
Risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
Kaposi’s sarcoma reported in patients receiving corticosteroid therapy, most often for chronic conditions; discontinuation of therapy may result in clinical improvement
Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not affect the ultimate outcome or natural history of the disease
Psychic derangements may appear when corticosteroids used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids
- Serious neurologic events, some resulting in death, have been reported with epidural injection
- Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
- These serious neurologic events have been reported with and without use of fluoroscopy
- Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
Methylprednisolone preserved with benzyl alcohol
- Methylprednisolone preserved with benzyl alcohol should not be administered to neonates, infants, pregnant women, or breastfeeding women
- Benzyl alcohol is associated with serious adverse events and death, particularly in pediatric patients (gasping syndrome, characterized by CNS depression, metabolic acidosis, and gasping respirations)
Pregnancy & Lactation
Pregnancy category: C
Lactation: Drug enters milk; use with caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Potent glucocorticoid with minimal to no mineralocorticoid activity
Modulates carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis
Controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level
Onset: 1-2 hr (PO); 4-8 days (IM); 1 week (intra-articular)
Duration: 30-36 hr (PO); 1-4 weeks (IM)
Peak plasma time: 31 min (IV)
Vd: 0.7-1.5 L/kg
Extensively metabolized in liver
Half-life: 3-3.5 hr
Dialyzable: Hemodialysis, slightly
Total body clearance: 16-21 L/hr
Excretion: Urine (mainly, as metabolites), feces (minimally)
Solution: D5/0.5 NS, D5/NS, D5W, LR, NS
Additive: Chloramphenicol sodium succinate, cimetidine, clindamycin, dopamine, granisetron, heparin, norepinephrine, penicillin G potassium, ranitidine, theophylline, verapamil
Syringe: Diatrizoate meglumine, diatrizoate meglumin/diatrizoate sodium, granisetron, iohexol, iopamidol, iothalamate meglumine, ioxalate meglumine/ioxalate sodium, metoclopramide
Y-site (partial list): Acyclovir, amifostine, amiodarone, cisplatin, dopamine, enalaprilat, famotidine, heparin, inamrinone, linezolid, meperidine, metronidazole, midazolam, morphine, sodium bicarbonate
Additive: Aminophylline(?), calcium gluconate, cytarabine(?), glycopyrrolate, metaraminol, nafcillin, penicillin G sodium
Y-site: Allopurinol, amsacrine, ciprofloxacin, cisatracurium(?), diltiazem(?), etoposide phosphate, fenoldopam, filgrastim, gemcitabine, heparin/hydrocortisone(?), ondansetron, paclitaxel, potassium chloride(?), propofol, sargramostim, vinorelbine, vitamins B and C(?)
Reconstitute for IM/IV injection with BWI containing 0.9% benzyl alcohol
Inject directly into vein or into tubing of running IV
Injection: Administer over at least 1 minute
Infusion: Further dilute reconstituted mixture with D5W, NS, D5/NS, or other compatible solution
Push: Administer over 10-20 minutes
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
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