Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: methylprednisolone

BRAND NAME: Medrol, Depo-Medrol

DRUG CLASS AND MECHANISM: Methylprednisolone is a synthetic (man-made) corticosteroid. Corticosteroids are naturally-occurring chemicals produced by the adrenal glands located adjacent to the kidneys. Corticosteroids affect metabolism in various ways and modify the immune system. Corticosteroids also block inflammation and are used in a wide variety of inflammatory diseases affecting many organs.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 2, 4, 8, 16, 24, and 32 mg. Injection: 20, 40, and 80 mg/ml.

STORAGE: Tablets should be kept at room temperature, between 20° and 25°C (68-77°F).

PRESCRIBED FOR: Methylprednisolone is used to achieve prompt suppression of inflammation. Examples of inflammatory conditions for which methylprednisolone is used include rheumatoid arthritis, systemic lupus erythematosus, acute gouty arthritis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. Severe allergic conditions that fail conventional treatment also may respond to methylprednisolone. Examples include bronchial asthma, allergic rhinitis, drug-induced dermatitis, and contact and atopic dermatitis. Chronic skin conditions treated with methylprednisolone include dermatitis herpetiformis, pemphigus, severe psoriasis and severe seborrheic dermatitis. Chronic allergic and inflammatory conditions of the uvea, iris, conjunctiva and optic nerves of the eyes also are treated with methylprednisolone.

DOSING: Dosage requirements of corticosteroids vary among individuals and the diseases being treated. In general, the lowest effective dose is used. The initial oral dose is 4-48 mg daily depending on the disease. The initial dose should be adjusted based on response. Corticosteroids given in multiple doses throughout the day are more effective but also more toxic than the same total daily dose given once daily, or every other day. Methylprednisolone should be taken with food.

DRUG INTERACTIONS: Troleandomycin (TAO), an infrequently used macrolide antibiotic, reduces the liver's ability to metabolize methylprednisolone (and possibly other corticosteroids). This interaction can result in higher blood levels of methylprednisolone and a higher probability of side effects. Erythromycin and clarithromycin (Biaxin) are likely to share this interaction, and ketoconazole (Nizoral) also inhibits the metabolism of methylprednisolone. Estrogens, including birth control pills, can increase the effect of corticosteroids by 50% by mechanisms that are not completely understood. For all of the above interactions, the dose of methylprednisolone may need to be lowered. Cyclosporin reduces the metabolism of methylprednisolone while methylprednisolone reduces the metabolism of cyclosporin. When given together, the dose of both drugs may need to be reduced to avoid increased side effects.

Methylprednisolone may increase or decrease the effect of blood thinners [for example, warfarin (Coumadin)]. Blood clotting should be monitored and therapy adjusted in order to achieve the desired level of blood thinning (anti-coagulation).

Phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may increase the metabolism of methylprednisolone and other corticosteroids, resulting in lower blood levels and reduced effects. Therefore, the dose of methylprednisolone may need to be increased if treatment with phenobarbital is begun.

PREGNANCY: Methylprednisolone has not been adequately evaluated in pregnant women.

NURSING MOTHERS: Methylprednisolone has not been adequately evaluated in nursing mothers.

SIDE EFFECTS: Adverse effects of methylprednisolone depend on dose, duration and frequency of administration. Short courses of methylprednisolone are usually well-tolerated with few, mild side effects. Long term, high doses of methylprednisolone may produce predictable and potentially serious side effects. Whenever possible, the lowest effective doses of methylprednisolone should be used for the shortest length of time to minimize side effects. Alternate day dosing also can help reduce side effects.

Side effects of methylprednisolone and other corticosteroids range from mild annoyances to serious irreversible bodily damage. Side effects include fluid retention, weight gain, high blood pressure, potassium loss, headache, muscle weakness, puffiness of the face, hair growth on the face, thinning and easy bruising of the skin, glaucoma, cataracts, peptic ulceration, worsening of diabetes, irregular menses, growth retardation in children, convulsions, and psychic disturbances. Psychic disturbances may include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior.