Solu-Medrol 40mg Inj, 1 Vial

Manufacturer PFIZER U.S. Active Ingredient Methylprednisolone Injection(meth il pred NIS oh lone) Pronunciation meth il pred NIS oh lone
It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems. This is not a list of all health problems that this drug may be used for. Talk with the doctor.
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Drug Class
Glucocorticoid
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Pharmacologic Class
Corticosteroid
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Pregnancy Category
Category C
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FDA Approved
Jan 1957
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

Methylprednisolone is a type of steroid medicine. It works by reducing inflammation (swelling and redness) and calming down your immune system. It's used to treat many conditions like severe allergies, asthma, arthritis, and certain skin or blood disorders.
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How to Use This Medicine

To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Take this medication exactly as directed, and adhere to all guidelines provided. This medication is administered via injection.

If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage method.

If you miss a dose, contact your doctor immediately to receive guidance on the appropriate course of action.
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Lifestyle & Tips

  • Avoid contact with people who are sick or have infections, as this medicine can weaken your immune system.
  • Report any signs of infection (fever, sore throat, body aches) to your doctor immediately.
  • Follow a diet rich in calcium and vitamin D, and engage in weight-bearing exercise to help protect your bones, especially with long-term use.
  • Limit sodium intake to help prevent fluid retention.
  • Do not stop this medication suddenly, especially after prolonged use, as it can lead to serious withdrawal symptoms. Your doctor will guide you on how to slowly reduce the dose.

Dosing & Administration

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Adult Dosing

Standard Dose: Highly variable depending on indication. For acute severe conditions, 10-40 mg IV initially, then adjusted based on response. For multiple sclerosis exacerbations, 160 mg/day IV for 7 days, then 64 mg every other day for 1 month.
Dose Range: 10 - 250 mg

Condition-Specific Dosing:

acuteExacerbations: 10-40 mg IV initially, then adjusted
multipleSclerosis: 160 mg/day IV for 7 days, then 64 mg every other day for 1 month
shock: 30 mg/kg IV over 10-20 minutes, repeated every 4-6 hours if needed
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Pediatric Dosing

Neonatal: Not established for routine use; use with extreme caution if necessary (e.g., 0.5-1.7 mg/kg/day IV divided doses)
Infant: 0.5-1.7 mg/kg/day IV divided doses, or 10-30 mg/kg/dose IV for acute conditions (max 250 mg/dose)
Child: 0.5-1.7 mg/kg/day IV divided doses, or 10-30 mg/kg/dose IV for acute conditions (max 250 mg/dose)
Adolescent: Similar to adult dosing, adjusted by weight and condition
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Dose Adjustments

Renal Impairment:

Mild: No specific adjustment needed
Moderate: No specific adjustment needed
Severe: No specific adjustment needed
Dialysis: Not significantly removed by hemodialysis; no dose adjustment needed

Hepatic Impairment:

Mild: No specific adjustment needed
Moderate: May require dose reduction in severe hepatic impairment due to decreased metabolism, monitor closely
Severe: May require dose reduction in severe hepatic impairment due to decreased metabolism, monitor closely

Pharmacology

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Mechanism of Action

Methylprednisolone is a synthetic glucocorticoid that binds to specific intracellular glucocorticoid receptors. This complex then translocates to the nucleus, where it modulates gene expression, leading to the synthesis of anti-inflammatory proteins (e.g., lipocortins) and inhibition of pro-inflammatory mediators (e.g., cytokines, prostaglandins, leukotrienes). It suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (IV administration)
Tmax: Immediate (IV)
FoodEffect: Not applicable for IV formulation

Distribution:

Vd: 0.7-1.5 L/kg
ProteinBinding: Approximately 77% (primarily to albumin and transcortin)
CnssPenetration: Yes (readily crosses blood-brain barrier)

Elimination:

HalfLife: Plasma half-life: 2.4-3.5 hours; Biological half-life: 18-36 hours
Clearance: Not available (variable)
ExcretionRoute: Renal (as inactive metabolites)
Unchanged: <5%
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Pharmacodynamics

OnsetOfAction: Rapid (within minutes to hours, depending on effect)
PeakEffect: Variable, generally within 1-2 hours for anti-inflammatory effects
DurationOfAction: 18-36 hours (biological half-life)

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or changed sputum production, painful urination, mouth sores, or a wound that won't heal
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Signs of adrenal gland problems: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat
Signs of pancreatitis: severe abdominal pain, severe back pain, or severe nausea and vomiting
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision
Skin changes: acne, stretch marks, slow healing, or excessive hair growth
Purple, red, blue, brown, or black skin lesions or mouth sores
Chest pain or pressure
Abnormal heartbeat (fast, slow, or irregular)
Changes in menstrual periods
Bone or joint pain
Vision changes
New or worsening mental, mood, or behavioral changes
Seizures
Abnormal sensations (burning, numbness, or tingling)
Unexplained bruising or bleeding
Severe abdominal pain
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
New or worsening muscle weakness
Fluid retention, swelling, weight gain, or breathing difficulties

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you're concerned about any of the following side effects or if they persist, contact your doctor:

Nausea or vomiting
Insomnia
Restlessness
Excessive sweating
* Headache

This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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Seek Immediate Medical Attention If You Experience:

  • Signs of infection (fever, chills, body aches, sore throat, cough, painful urination)
  • Severe stomach pain, black/tarry stools, or vomiting blood
  • Unusual swelling, rapid weight gain, or shortness of breath
  • Severe mood changes (depression, euphoria, confusion)
  • Blurred vision or eye pain
  • Increased thirst or urination (signs of high blood sugar)
  • Muscle weakness or severe fatigue
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

To ensure safe treatment, inform your doctor of the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reactions you've experienced.
If you have any type of infection, including bacterial, viral, or fungal infections, as well as conditions like amoeba infection (e.g., traveler's diarrhea), herpes infection of the eye, cerebral malaria, threadworm infestation, or any other infectious disease.
If you have nerve problems affecting your eyes.

Additional Considerations for Injection Administration (Intramuscular):

If you have idiopathic thrombocytopenic purpura (ITP), a condition affecting platelet count.

It is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health issues, to your doctor and pharmacist. This information will help determine if it is safe to take this medication with your other treatments. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
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Precautions & Cautions

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

If you are taking this medication for an extended period, your doctor may recommend regular blood tests, weight checks, and other laboratory tests to monitor your health. You may also need to have your eye pressure and bone density checked.

Be aware that medications like this one can cause high blood pressure. Your doctor will likely monitor your blood pressure regularly.

This medication may interfere with allergy skin tests, so it is crucial to inform your doctor and laboratory personnel that you are taking it.

Long-term use of this medication may increase the risk of developing cataracts or glaucoma. Discuss this potential risk with your doctor.

Prolonged use of this medication can also lead to weak bones (osteoporosis). Talk to your doctor to determine if you are at a higher risk of developing osteoporosis or if you have any concerns.

Your doctor may advise you to reduce your salt intake and increase your potassium consumption. Follow their recommendations and discuss any questions or concerns you may have.

If you have diabetes, it is essential to closely monitor your blood sugar levels while taking this medication.

Before consuming alcohol, consult with your doctor to discuss any potential risks or interactions.

Before receiving any vaccines, inform your doctor that you are taking this medication, as some vaccines may not be effective or may increase the risk of infection when used with this medication.

If you have not had chickenpox or measles before, avoid exposure to these illnesses, as they can be severe or even life-threatening in people taking steroid medications like this one. If you have been exposed to chickenpox or measles, inform your doctor immediately.

Steroid medications, including this one, can increase the risk of infection, which can be mild or severe. They can also make it more challenging to recognize the signs of infection. To minimize the risk of infection, wash your hands frequently, avoid people with infections, colds, or flu, and inform your doctor if you experience any symptoms of infection.

In some cases, medications like this one can reactivate latent infections, such as tuberculosis or hepatitis B. Inform your doctor if you have a history of these infections.

This medication can suppress your body's natural production of steroids. If you experience fever, infection, surgery, or injury, inform your doctor, as your body's response to these stresses may be affected. You may require additional doses of steroids in these situations.

Do not stop taking this medication abruptly without consulting your doctor, as this can increase the risk of side effects. If you need to discontinue this medication, your doctor will likely recommend a gradual tapering schedule.

Using medications like this one via epidural injection (into the spine) has been associated with severe health problems, including paralysis, loss of vision, stroke, and death. This medication is not approved for epidural use, and you should discuss any concerns with your doctor.

Some formulations of this medication contain benzyl alcohol, which can be harmful to newborns and infants. If possible, avoid products containing benzyl alcohol in these age groups, and consult with your doctor to determine if this product contains benzyl alcohol.

If you miss a dose or recently stopped taking this medication and experience fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, inform your doctor.

Long-term use of medications like this one has been associated with an increased risk of Kaposi's sarcoma, a type of cancer. Discuss this potential risk with your doctor. Additionally, patients with cancer may be at a higher risk of developing tumor lysis syndrome (TLS), a potentially life-threatening condition.

If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.

This medication may affect growth in children and adolescents. Regular growth checks may be necessary, and you should discuss any concerns with your doctor.

This medication may lower sperm counts in some individuals. If you have questions or concerns, consult with your doctor.

If you are pregnant or become pregnant while taking this medication, inform your doctor immediately, as it may harm the unborn baby.

If you are breastfeeding, discuss the potential risks to your baby with your doctor.

If you took this medication during pregnancy, inform your baby's doctor to ensure they are aware of any potential risks.
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Overdose Information

Overdose Symptoms:

  • Fluid retention (swelling)
  • High blood pressure
  • High blood sugar
  • Mood changes (agitation, depression)
  • Muscle weakness

What to Do:

Seek emergency medical attention or call Poison Control at 1-800-222-1222. Treatment is generally supportive and symptomatic.

Drug Interactions

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Contraindicated Interactions

  • Live or live attenuated vaccines (in patients receiving immunosuppressive doses of corticosteroids)
  • Systemic fungal infections
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Major Interactions

  • CYP3A4 inducers (e.g., rifampin, phenytoin, barbiturates) - may decrease methylprednisolone levels
  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, clarithromycin) - may increase methylprednisolone levels
  • NSAIDs (e.g., ibuprofen, naproxen) - increased risk of GI ulceration/bleeding
  • Anticoagulants (e.g., warfarin) - may alter anticoagulant effect (monitor INR)
  • Diuretics (e.g., thiazides, loop diuretics) - increased risk of hypokalemia
  • Digoxin - increased risk of digoxin toxicity due to hypokalemia
  • Antidiabetic agents (e.g., insulin, metformin) - corticosteroids can increase blood glucose, requiring dose adjustment of antidiabetics
  • Neuromuscular blocking agents (e.g., pancuronium) - prolonged neuromuscular blockade
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Moderate Interactions

  • Cholestyramine - may decrease absorption of methylprednisolone
  • Cyclosporine - increased risk of seizures and other CNS effects for both drugs
  • Oral contraceptives - may increase methylprednisolone levels
  • Vaccines (non-live) - diminished antibody response
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Minor Interactions

  • Not available

Monitoring

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Baseline Monitoring

Blood pressure

Rationale: Corticosteroids can cause hypertension.

Timing: Prior to initiation

Serum electrolytes (Na, K, Cl)

Rationale: Risk of fluid retention, hypokalemia.

Timing: Prior to initiation

Blood glucose

Rationale: Risk of hyperglycemia, especially in diabetics.

Timing: Prior to initiation

Bone mineral density (DEXA scan)

Rationale: For long-term therapy, risk of osteoporosis.

Timing: Prior to initiation (if long-term therapy anticipated)

Ophthalmologic exam (intraocular pressure)

Rationale: For long-term therapy, risk of glaucoma/cataracts.

Timing: Prior to initiation (if long-term therapy anticipated)

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Routine Monitoring

Blood pressure

Frequency: Daily to weekly (acute phase), then periodically

Target: Individualized, within normal limits

Action Threshold: Significant elevation requiring intervention

Serum electrolytes (Na, K)

Frequency: Weekly (acute phase), then periodically

Target: Na: 135-145 mEq/L, K: 3.5-5.0 mEq/L

Action Threshold: Hypokalemia (<3.5 mEq/L) or significant fluid retention

Blood glucose

Frequency: Daily (acute phase), then periodically

Target: Fasting: <100 mg/dL, Postprandial: <140 mg/dL

Action Threshold: Persistent hyperglycemia (>180 mg/dL) requiring intervention

Signs of infection

Frequency: Continuously

Target: Absence of fever, localized pain, redness, swelling

Action Threshold: Any signs of new infection

Growth and development (pediatric patients)

Frequency: Periodically (e.g., every 3-6 months)

Target: Normal growth velocity

Action Threshold: Growth retardation

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Symptom Monitoring

  • Signs of infection (fever, sore throat, malaise, localized pain/redness)
  • Adrenal insufficiency (fatigue, weakness, nausea, vomiting, hypotension, hypoglycemia) upon withdrawal
  • Hyperglycemia (increased thirst, urination, hunger)
  • Gastrointestinal upset (stomach pain, heartburn, black/tarry stools)
  • Mood changes (irritability, anxiety, depression, euphoria)
  • Fluid retention (swelling in ankles/feet, weight gain)
  • Muscle weakness or pain
  • Vision changes

Special Patient Groups

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Pregnancy

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown teratogenic effects. Human data are limited but suggest a possible association with cleft palate in first trimester exposure, though this is not definitively established.

Trimester-Specific Risks:

First Trimester: Possible increased risk of cleft palate, though data are conflicting and not conclusive.
Second Trimester: Risk of fetal growth restriction, adrenal suppression (rarely), and premature delivery.
Third Trimester: Risk of fetal growth restriction, adrenal suppression (rarely), and premature delivery. Neonates exposed in utero should be observed for signs of hypoadrenalism.
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Lactation

L3 (Moderately Safe). Methylprednisolone is excreted into breast milk in small amounts. Low doses are generally considered compatible with breastfeeding. High doses or prolonged use may cause adverse effects in the infant (e.g., growth suppression, adrenal suppression). Monitor infant for adverse effects.

Infant Risk: Low risk with typical doses; potential for growth suppression or adrenal suppression with high or prolonged maternal doses. Monitor infant for signs of adrenal insufficiency (e.g., poor feeding, lethargy).
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Pediatric Use

Corticosteroids can cause growth retardation in children. Monitor growth and development carefully. Long-term use should be avoided if possible. Adrenal suppression is a risk, especially with abrupt discontinuation. Increased susceptibility to infections.

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Geriatric Use

Elderly patients may be at increased risk for adverse effects, including osteoporosis, fluid retention, hypertension, and diabetes. Use with caution and monitor closely.

Clinical Information

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Clinical Pearls

  • Methylprednisolone IV is often used for acute exacerbations requiring rapid anti-inflammatory or immunosuppressive effects.
  • Always taper the dose gradually after prolonged therapy to prevent adrenal insufficiency.
  • Patients on long-term corticosteroids should be monitored for bone density, blood glucose, blood pressure, and signs of infection.
  • Consider prophylactic measures for GI protection (e.g., PPIs) if there is a history of GI ulcers or concurrent NSAID use.
  • Educate patients about the importance of not stopping the medication abruptly and recognizing signs of adrenal insufficiency.
  • Immunosuppressive doses of corticosteroids can mask signs of infection; maintain a high index of suspicion.
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Alternative Therapies

  • Dexamethasone (longer acting, higher potency)
  • Prednisone/Prednisolone (oral, common for tapering)
  • Hydrocortisone (shorter acting, less potent)
  • Other immunosuppressants or anti-inflammatory agents depending on the specific condition being treated (e.g., NSAIDs, DMARDs, biologics)
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Cost & Coverage

Average Cost: Varies widely by dose and formulation (e.g., $10-$100+ per vial) per 1 vial
Generic Available: Yes
Insurance Coverage: Tier 1 or Tier 2 (generic), Tier 3 (brand)
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for advice. Additionally, you may want to inquire about potential drug take-back programs in your area. Some medications may come with a separate patient information leaflet, so be sure to check with your pharmacist. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred to ensure prompt and effective treatment.