Methyl Prednisolone

Methylprednisolone

Mechanism :

Methylprednisolone is an extremely potent glucocorticoid. Glucocorticoids are adrenocortical steroids, both naturally occurring and synthetic, which are readily absorbed from the gastrointestinal tract.

Indication :

• Juvenile idiopathic arthritis
• Connective tissue disorders – severe, life threatening
• Vasculitis
• Graft rejection
• Demyelinating disorders
• Status asthmaticus
• Pneumocystis jiroveci pneumonia in AIDS patients

Contraindications :

Systemic fungal infections and known hypersensitivity to components.

Dosing :

Inflammation:

0.5-1.7 mg/kg/day IV/IM/PO in 2 divided doses.

Severe JIA, Connective tissue disorders, demyelination:

IV 30 mg/kg/day for 3 days. Max: 1 gm/day.

Status asthmaticus:

<12 years: 1-2 mg/kg IV/IM in 2 divided doses till peak expiratory flow is 70% of predicted. Max: 60 mg/day.

>12 years: 40-80 mg/day IM in 2 divided doses, till peak expiratory flow is 70% of predicted. Max: 60 mg/day.

Pneumocystis jiroveci pneumonia in AIDS patients:

>13 years: 30 mg IV every 12 hours for 5 days, then 30 mg IV every 24 hours for 5 days, then 15 mg IV every 24 hours for 11 days.

Adverse Effect :

Most adverse effects are caused by increased mineralocorticoid activity and include increased blood pressure, edema, cardiac enlargement precipitating in congestive heart failure, potassium loss leading to hypocalcemic alkalosis.

Others: Muscle weakness with loss of muscle mass, steroid myopathy, osteoporosis leading to vertebral compression fractures and pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads, peptic ulcer leading to perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis, impaired wound healing, thin fragile skin, bruising, petechiae and ecchymosis, facial erythema, increased sweating, subcutaneous fat atrophy, purpura, striae, hyperpigmentation of the skin and nails, hirsutism, increased intracranial pressure leading to papilledema, convulsions, vertigo, headache, and severe mental disturbances, menstrual irregularities, development of the cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, and increased requirements for insulin or oral hypoglycemic agents in diabetics, posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos, hyperglycemia, glycosuria, and negative nitrogen balance due to protein catabolism.

Interaction :

Amphotericin B or Potassium-Depleting Diuretics: Hypokalemia. Check serum potassium levels at frequent intervals and use potassium supplements if necessary.
Digitalis Glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oral Anticoagulants: Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.
Antidiabetic drugs: Diminished antidiabetic effect. Monitor for symptoms of hyperglycemia
Aspirin: increased ulcerogenic effect, decreased pharmacologic effect of aspirin.
Barbiturates, Phenytoin, or Rifampin: Increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.
Anabolic Steroids such as Oxymetholone, Methandrostenolone, Norethandrolone: Enhanced tendency toward edema.
Vaccines: Neurological complications and lack of antibody response.

Renal Dose :

Hepatic Dose :