Methylprednisolone
Methylprednisolone ⚕️: Injectable preparation Solu-Medrone® 40 mg contains lactose.
⚠️ Do not use in patients with cow’s milk allergy.
Always check the BNF for up-to-date dosing and safety advice.
Mode of Action 🔬
- Glucocorticoid steroid hormone.
- Binds intracellular receptors → alters gene transcription → reduces inflammation, immune activation, and capillary permeability.
Indications / Dose 💊
- General range: 2–40 mg PO daily; 10–500 mg IM/slow IV.
- Multiple sclerosis (MS) relapse:
- 500 mg PO OD × 5 days.
- 1 g IV OD × 3–5 days (not licensed but widely used).
- Graft rejection: 1 g IV OD × 3 days.
- Other uses: Vasculitis, autoimmune and inflammatory disorders (e.g., lupus, severe asthma exacerbation).
Dose Table 📊
| Indication | Starting Dose | Frequency | Route |
| MS flare | 500 mg | OD × 5 days | PO |
| MS flare | 1 g | OD × 3–5 days | IV |
| Graft rejection | 1 g | OD × 3 days | IV |
⚠️ Always check the BNF / manufacturer datasheet before prescribing.
Interactions 🔄
- See BNF for full list (CYP3A4 interactions, reduced vaccine efficacy, ↑ risk with NSAIDs/anticoagulants).
Cautions ⚠️
- Consider PPI cover to reduce peptic ulcer risk.
- Give early in the day ⏰ to avoid insomnia.
- Screen for active infections or TB before high-dose therapy.
Contraindications 🚫
- Uncontrolled heart failure.
- Severe uncontrolled hypertension.
- Active peptic ulcer disease.
Side Effects 💥
- Mood change / psychiatric disturbance.
- Hypertension, worsening diabetes, fluid retention/oedema.
- Peptic ulceration, GI bleed.
- Osteoporosis, avascular necrosis of femoral head.
- Cushingoid features: weight gain, moon face, striae.
- Immunosuppression → ↑ infection risk.
References 📚
💡 Clinical Pearls
- Always warn about infection risk, mood changes, and gastric side effects.
- High-dose IV courses (e.g., in MS relapse) are short-term and not usually tapered.
- Long-term use requires gradual tapering to avoid adrenal crisis.
- Solu-Medrone 40 mg contraindicated in cow’s milk allergy 🐄🚫.
