Methylprednisolone (Tab/Inj)
Generic Name: Methylprednisolone (Tab/Inj)
Therapeutic Class: Glucocorticoid (Corticosteroid)
Indications
Methylprednisolone is a potent anti-inflammatory steroid used in:
- Endocrine Disorders: Adrenocortical insufficiency, congenital adrenal hyperplasia.
- Rheumatic & Collagen Diseases: Rheumatoid arthritis, SLE, acute rheumatic carditis, and gouty arthritis.
- Dermatologic Diseases: Stevens-Johnson syndrome, severe psoriasis, and exfoliative dermatitis.
- Allergic States: Bronchial asthma, contact dermatitis, and drug hypersensitivity reactions.
- Ophthalmic & Respiratory: Optic neuritis, symptomatic sarcoidosis, and aspiration pneumonitis.
- Hematologic & Neoplastic: Autoimmune hemolytic anemia, leukemias, and lymphomas.
Presentation & Strengths
- Tablets: 2 mg, 4 mg, 8 mg, and 16 mg.
- Acetate Injection (IM/Intra-articular): 40 mg/ml, 80 mg/2 ml (Depot form).
- Sodium Succinate (IM/IV): 40 mg, 125 mg, 500 mg, and 1 gm vials for acute use.
Description
Methylprednisolone is a synthetic glucocorticoid with approximately **5 times** the anti-inflammatory potency of Hydrocortisone. It has significantly less mineralocorticoid (salt-retaining) activity than Prednisolone. It works by diffusing across cell membranes and binding with high affinity to specific cytoplasmic receptors, altering gene expression to inhibit cytokine production and inflammatory cell migration.
Dosage & Administration
Dosage is highly individualized based on the severity of the condition.
- Oral: Initially 4 mg to 48 mg per day. High-dose pulse therapy may use higher doses.
- IV (Pulse Therapy): 500 mg to 1 gm daily for 3 days in acute flares (e.g., Multiple Sclerosis or Lupus Nephritis).
- IM (Acetate): 40 mg to 120 mg every 1–4 weeks depending on the condition.
- Note: Always taper the dose slowly to avoid adrenal crisis if used for more than 7–10 days.
Side Effects
Short-term high doses are generally well-tolerated, but long-term use can cause:
- Cushingoid features (Moon face, buffalo hump).
- Hyperglycemia and increased risk of Diabetes.
- Osteoporosis and muscle weakness.
- Peptic ulceration and gastrointestinal bleeding.
- Immunosuppression and delayed wound healing.
- Insomnia and mood swings (Steroid psychosis).
Pregnancy & Lactation
Pregnancy: Category C. Crosses the placenta; risk of fetal adrenal suppression. Use only if benefits outweigh risks.
Lactation: Excreted in breast milk. High doses may suppress growth or interfere with endogenous corticosteroid production in the infant.
Lactation: Excreted in breast milk. High doses may suppress growth or interfere with endogenous corticosteroid production in the infant.
Precautions & Interactions
Contraindications: Systemic fungal infections and hypersensitivity.
Precautions: Do not give live vaccines to patients on immunosuppressive doses. Use with caution in patients with hypertension or peptic ulcers.
Interactions: Enzyme inducers (Rifampin, Phenytoin) decrease its effect. It may increase the risk of GI bleeding when taken with NSAIDs.
Precautions: Do not give live vaccines to patients on immunosuppressive doses. Use with caution in patients with hypertension or peptic ulcers.
Interactions: Enzyme inducers (Rifampin, Phenytoin) decrease its effect. It may increase the risk of GI bleeding when taken with NSAIDs.
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