Names and pronunciation
(meth-il-pred-niss′oh-lone) DEPO-Medrol, Medrol, SOLU-Medrol
PDF page 871
Loading InternPractice…
Drug reference
(meth-il-pred-niss′oh-lone) DEPO-Medrol, Medrol, SOLU-Medrol
PDF page 871
Func. class.: Corticosteroid, synthetic
PDF page 871
Chem. class.: Glucocorticoid, interme- diate acting
PDF page 871
Do not confuse: methylPREDNISolone/predniSONE/ medroxyPROGESTERone/ methylTESTOSTERone
PDF page 871
ACTION: Decreases inflammation by suppression of migration of polymorpho- nuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization
PDF page 871
USES: Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis, acute lymphocytic leukemia, anaphylaxis, angioedema, asthma, Crohn’s disease, eczema, gouty arthritis
PDF pages 871, 872
CONTRAINDICATIONS: Hyper- sensitivity, intrathecal use, neonates Precautions: Pregnancy, breastfeeding, diabetes mellitus, glaucoma, osteoporo- sis, seizure disorders, ulcerative colitis, HF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, tartrazine, ben- zyl alcohol, corticosteroid hypersensitiv- ity, viral infection, TB, traumatic brain injury, Cushing syndrome, measles, vari- cella, fungal infections
PDF page 872
SIDE EFFECTS CNS: Depression, flushing, sweating, headache, mood changes CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia EENT: Fungal infections, increased intra- ocular pressure, blurred vision, cataracts GI: Diarrhea, nausea, abdominal disten- tion, GI hemorrhage, increased appetite, pancreatitis HEMA: Thrombocytopenia INTEG: Acne, poor wound healing, ecchymosis, petechiae MS: Fractures, osteoporosis, weakness MISC: Hypernatremia
PDF pages 872, 873
INTERACTIONS Increase: side effects—amphotericin B, diuretics Increase: GI bleeding—salicylates, NSAIDs; assess for GI bleeding Increase: methylPREDNISolone action— oral contraceptives, estrogens Increase: adrenal suppression—CYP3A4 inhibitors (aprepitant, antiretroviral pro- tease inhibitors, clarithromycin, danazol, delavirdine, diltiaZEM, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voricon- azole); dose may need to be decreased Decrease: methylPREDNISolone effect— CYP3A4 inducers (barbiturates, bosen- tan, carBAMazepine, efavirenz, phenyto- ins, nevirapine, rifabutin, rifAMPin); dose may need to be increased Decrease: effects of antidiabetics, vac- cines, somatrem Drug/Herb • Avoid use with St. John’s wort Drug/Food • Do not use with grapefruit/grapefruit juice; level of methylPREDNISolone will be increased Drug/Lab Test Increase: cholesterol, blood glucose Decrease: calcium, potassium, T4, T3, thy- roid 131I uptake test, urine 17-OHCS, 17-KS False negative: skin allergy tests
PDF page 873
DOSAGE AND ROUTES Adrenal insufficiency/inflammation • Adult: PO 4-48 mg in 4 divided doses; IM 10-120 mg (acetate); IM/IV 10-40 mg (succinate); INTRAARTICULAR 4-80 mg (acetate) • Child: IV 0.5-1.7 mg/kg in 3-4 divided doses (succinate) Multiple sclerosis • Adult: PO 200 mg/day × 1 wk, then 80 mg every other day × 30 days Most uses • Adult: IM/IV 40-250 mg q4-6hr Acute spinal cord injury (succinate) • Adult/child: IV 30 mg/kg over 15 min, then continuous infusion after 45 min, 5.4 mg/kg/hr × 23 hr Pneumocystitis jirovecii pneumona (AIDS) (Succinate) • Adult: IV 30 mg bid × 5 days, then 30 mg daily × 5 days, then 15 mg daily × 10 days
PDF page 872
Available forms: Tabs 2, 4, 8, 16, 32 mg; inj 20, 40, 80 mg/mL acetate; inj 40, 125, 500, 1000, 2000 mg/vial succinate
PDF page 872
Administer: • Titrated dose; use lowest effective dose PO route • With food or milk to decrease GI symptoms (PO) • Once-a-day dose should be given in AM to coincide with body’s normal corti- sol secretion IM route • IM inj deep in large muscle mass; ro- tate sites; avoid deltoid; use 21-G needle; after shaking suspension (parenteral); inj-site reaction may occur (induration, pain at site, atrophy) • In one dose in AM to prevent adrenal suppression; avoid SUBCUT administra- tion; may damage tissue IV route • Use only methylprednisolone sodium suc- cinate; never use acetate product Direct IV route • After diluting with diluent provided; agitate slowly; give ≤500 mg/≥1 min di- rectly over 3-15 min; doses ≥2 mg/kg or 250 mg should be given by intermittent IV infusion unless potential benefits out- weigh risks Intermittent/continuous INFUSION route • Dilute further in D5W, NS, D5NS; haze may form; give over 15-60 min; large dose (≥500 mg) should be given over 30-60 min Y-site compatibilities: Acetaminophen, acyclovir, amifostine, amphotericin B cholesteryl, amrinone, aztreonam, cefepime, CISplatin, cladribine, cyclo- phosphamide, cytarabine, DOPamine, DOXOrubicin, enalaprilat, famotidine, fludarabine, granisetron, heparin, mel- phalan, meperidine, methotrexate, met- roNIDAZOLE, midazolam, morphine, piperacillin/tazobactam, remifentanil, sodium bicarbonate, tacrolimus, tenipo- side, theophylline, thiotepa
PDF page 872
Assess: • Potassium depletion: parethesias, fa- tigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness • Edema, hypertension, cardiac symptoms • Mental status: affect, mood, behavioral changes, aggression • Monitor potassium, blood glucose, urine glucose while receiving long-term therapy; hypokalemia and hyperglycemia • Assess joint mobility, pain, edema if product given intraarticularly • B/P q4hr, pulse; notify prescriber of chest pain, crackles • I&O ratio; be alert for decreasing urinary output, increasing edema; weight daily; no- tify prescriber of weekly gain >5 lb • Adrenal insufficiency: weight loss, nausea, vomiting, confusion, anxiety, hypo- tension, weakness; plasma cortisol levels during long-term therapy (normal level: 138- 635 nmol/L SI units when drawn at 8 AM) • Growth in children receiving long- term treatment • Infection: increased temperature, WBC, even after withdrawal of product; M product masks infection • Beers: avoid in older adults with de- lirium or at high risk for delirium; assess for confusion, delirium frequently • Pregnancy/breastfeeding: use only if benefits outweigh risk to fetus, no well- controlled studies; do not breastfeed, ex- creted in breast milk
PDF page 873
Evaluate: • Therapeutic response: ease of respira- tions, decreased inflammation; de- creased symptoms of adrenal insuffi- ciency
PDF page 873
CLINICAL CONSIDERATIONS
PDF page 873
Patient and caregiver information: • To increase intake of potassium, cal- cium, protein • To carry emergency ID as corticoste- roid user, with product used and pre- scriber’s information • To notify prescriber if therapeutic re- sponse decreases; that dosage adjust- ment may be needed • Not to discontinue abruptly because adrenal crisis can result • To take PO with food, milk to decrease GI symptoms • To avoid OTC products: salicylates, al- cohol in cough products, cold prepara- tions unless directed by prescriber; to avoid vaccinations because immunosup- pression occurs • Adrenal insufficiency: nausea, an- orexia, fatigue, dizziness, dyspnea, weak- ness, joint pain • Cushingoid symptoms: buffalo hump, moon face, rapid weight gain, excess sweating, when to notify prescriber • Infection: to avoid persons with known infections; corticosteroids can mask symptoms of infection
PDF pages 873, 874
PHARMACOKINETICS Half-life >3½ hr (plasma), 18-36 hr (tissue); crosses placenta, enters breast milk in small amounts; metabo- lized in liver; excreted by kidneys (unchanged) PO: Peak 1-2 hr, duration 1½ days, well absorbed IM: Peak 4-8 days, duration 1-4 wk, well absorbed Intraarticular: Peak 1 wk
PDF page 873
• Adult: PO 4-48 mg in 4 divided doses; IM 10-120 mg (acetate); IM/IV 10-40 mg (succinate); INTRAARTICULAR 4-80 mg (acetate)
PDF page 872
• Adult: PO 200 mg/day × 1 wk, then 80 mg every other day × 30 days Most uses
PDF page 872
• Adult: IM/IV 40-250 mg q4-6hr Acute spinal cord injury (succinate)
PDF page 872
• Adult/child: IV 30 mg/kg over 15 min, then continuous infusion after 45 min, 5.4 mg/kg/hr × 23 hr Pneumocystitis jirovecii pneumona (AIDS) (Succinate)
PDF page 872
• Adult: IV 30 mg bid × 5 days, then 30 mg daily × 5 days, then 15 mg daily × 10 days
PDF page 872