Methylprednisolone

methylprednisolone (meth ill pred niss' oh lone)

methylprednisolone Oral:

Medrol, Meprolone (CAN)

methylprednisolone sodium succinate IV, IM injection:

A-Methapred, Solu-Medrol Pregnancy Category C Drug classes

Corticosteroid Glucocorticoid Hormone Therapeutic actions

Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects. Indications

• • • • • •

Hypercalcemia associated with cancer Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas Trichinosis with neurologic or myocardial involvement Unlabeled use: Septic shock

Contraindications and cautions

• •

Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation; allergy to tartrazine or aspirin in products labeled Medrol. Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus, pregnancy.

Available forms

Tablets—2, 4, 8, 16, 24, 32 mg; powder for injection—40, 125, 500 mg/mL, 1, 2 g/vial

Dosages ADULTS

Individualize dosage, depending on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. For maintenance, reduce initial dose in small increments at intervals until the lowest satisfactory clinical dose is reached. If long-term therapy is needed, consider alternate-day therapy with a short-acting corticosteroid. After long-term therapy, withdraw drug slowly to prevent adrenal insufficiency. Oral

4–48 mg/day. For alternate-day therapy, give twice the usual dose every other morning. IV, IM

10–40 mg IV administered over 1 to several min. Give subsequent doses IV or IM. Caution: Rapid IV administration of large doses (more than 0.5–1 g in less than 10–120 min) has caused serious cardiac complications. PEDIATRIC PATIENTS

Individualize dosage on the basis of severity and response rather than by formulae that correct doses for age or weight. Carefully observe growth and development in infants and children on prolonged therapy. Minimum dose of methylprednisolone is 0.5 mg/kg per 24 hr. • High-dose therapy: 30 mg/kg IV infused over 10–20 min; may repeat q 4–6 hr, but no longer than 72 hr. Pharmacokinetics Route Oral IV IM

Onset Varies Rapid Rapid

Peak 1–2 hr Rapid 4–8 days

Duration 1.2–1.5 days Unknown 1–5 wk

Metabolism: Hepatic; T1/2: 78–188 min Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts

Preparation: No additional preparation is required. Infusion: Inject directly into vein or into tubing of running IV; administer slowly, over 1– 20 min to reduce cardiac effects. Incompatibilities: Do not combine with calcium gluconate, glycopyrrolate, insulin, nafcillin, penicillin G sodium, tetracycline. Adverse effects

Effects depend on dose, route, and duration of therapy. • CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP, glaucoma • CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias • Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia

•

• • • •

Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels, hypothalamic-pituitary-adrenal (HPA) suppression with systemic therapy longer than 5 days GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain Hypersensitivity: Anaphylactoid reactions Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures Other: Immunosuppression; aggravation or masking of infections; impaired wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae; subcutaneous fat atrophy

Interactions

Drug-drug • Increased therapeutic and toxic effects with erythromycin, ketoconazole, troleandomycin • Risk of severe deterioration of muscle strength when given to myasthenia gravis patients who are receiving ambenonium, edrophonium, neostigmine, pyridostigmine • Decreased steroid blood levels with barbiturates, phenytoin, rifampin • Decreased effectiveness of salicylates Drug-lab test • False-negative nitroblue-tetrazolium test for bacterial infection • Suppression of skin test reactions Nursing considerations Assessment

•

•

History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; pregnancy; lactation Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose

Interventions

• • • • •

Use caution with the 24-mg tablets marketed as Medrol; these contain tartrazine, which may cause allergic reactions, especially in people who are allergic to aspirin. Give daily dose before 9 AM to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress. Taper doses when discontinuing high-dose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Teaching points

• • •

Do not to stop taking the oral drug without consulting your health care provider. Avoid exposure to infections. Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of disorder.

Adverse effects in Italic are most common; those in Bold are life-threatening.