Methylprednisolone

Details About Generic Salt ::  Methylprednisolone 

Main Medicine Class:: #N/A   Sub Medicine Class ::  #N/A

8H. CORTICOSTEROIDS in 8. ENDOCRINE/STEROID HORMONES & METABOLIC SYSTEM
METHYLPREDNISOLONE
CORTICOSTEROID, SYSTEMIC | ANTI-ASTHMA, ANTI-INFLAMMATORY, IMMUNOSUPPRESSANT
also comes under 14A. Immunuosuppressants in 14. Immunology & Allergy
PK: A: Rapid (IM & IV) D: 0.7-1.5 L/kg (Vd) M: Hepatic E: Urine

Indications & Dose: ALLERGIC CONDITIONS Short-term therapy PO Adult Initially 24mg (6 tablets) for the first day, then tapered by 4mg/day until 21 tablets have been administered. Day 1: 8mg (2 tablets) BID before breakfast & at HS & 4mg (1 tablet) BID after lunch & dinner, Day 2: 4mg (1 tablet) TID before breakfast, after lunch & dinner & 8mg (2 tablets) at HS, Day 3: 4mg (1 tablet) QID before breakfast, after lunch & dinner & at HS, Day 4: 4mg (1 tablet) TID before breakfast, after lunch & at HS, Day 5: 4mg (1 tablet) BID before breakfast & at HS, Day 6: 4mg (1 tablet) before breakfast Child 1 month-18 yr: 0.5–1.7mg/kg/day in 2–4 divided doses depending on condition & response | ASTHMA EXACERBATIONS/ STATUS ASTHMATICUS PO/IV Adult 40-80mg/day in 1-2 divided doses until PEF is 70% of predicted or personal best Child <12 yr: 1-2mg/kg/day in 2 divided doses, max 60mg/day until PEF is 70% of predicted or personal best | DERMATOMYOSITIS/POLYMYOSITIS IV Adult 1g/day for 3-5 days for severe muscle weakness, followed by conversion to oral prednisone (sodium succinate) | ERYTHEMA MULTIFORME Severe IV Child 1 month-18 yr: 10-30mg/kg/day, max 1g/day or q48h for up to 3 doses | IMMUNOSUPPRESSIVE PO Adult Initially 2-60mg/day in 1-4 divided doses followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate clinical response Child 0.5-1.7mg/kg/day or 5-25mg/m2/day in divided doses q6-12h (sodium succinate) | IV Adult 10-40mg over several min & repeated IV/IM at intervals depending on clinical response; when high dosages are needed 30mg/kg over >30 min, may be repeated q4-6h for 48h (sodium succinate) Child 0.5-1.7mg/kg/day or 5-25mg/m2/day in divided doses q6-12h or “Pulse” therapy: 15-30mg/kg/dose over >30min OD 3 days (as sodium succinate) | IM Adult 10-80mg/day (sodium succinate) Child Same as oral dose | INFLAMMATORY DISORDERS PO Adult Initially 2-60mg/day in 1-4 divided doses followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate clinical response Child 0.5-1.7mg/kg/day or 5-25mg/m2/day in divided doses q6-12h (sodium succinate) | IV Adult 10-40mg over several min & repeated IV/IM at intervals depending on clinical response; when high dosages are needed 30mg/kg over >30 min, may be repeated q4-6ho for 48h (sodium succinate) Child 0.5-1.7mg/kg/day or 5-25mg/m2/day in divided doses q6-12h or “Pulse” therapy: 15-30mg/kg/dose over >30min OD 3 days (as sodium succinate) | IM Adult 10-80mg/day (sodium succinate) Child Same as oral dose | LUPUS NEPHRITIS IV Adult High-dose “pulse” therapy : 0.5-1g/day for 3 days (sodium succinate) Child 30mg/kg over >30min q48h 6 doses (sodium succinate) | PNEUMOCYSTIS PNEUMONIA IN HIV PATIENTS IV Adult 30mg BID 5 days, then 30mg OD 5 days, then 15mg OD 11 days in AIDS patients

Contra: Hypersensitivity, systemic fungal infect, administration of live virus vaccines, formulations containing benzyl alcohol preservative in premature infants, IM route in idiopathic thrombocytopenia purpura, intrathecal administration

Precautions: HF, DM, GI diseases, head injury, hepatic/renal impairment, myasthenia gravis, acute MI, cataracts/glaucoma, osteoporosis, history of seizure disorder, thyroid disease, elderly, pediatrics, during drug withdrawal

ADR: Serious: Disturbances of electrolyte balance, osteoporosis, increased susceptibility to infect, increased severity of varicella & measles, Churg-Strauss syndrome, ocular changes, hypersensitivity reactions, cardiovascular collapse, thromboembolic complications, avascular necrosis of bone, acute pancreatitis, benign intracranial HTN, Others: Cushingoid symptoms, growth retardation in children, adrenal atrophy, menstrual irregularities, mental & neurological disturbances, muscle wasting & nitrogen depletion, hyperglycemia, increased appetite, impaired tissue repair & immune function

DDI: Serious Phenobarbital decreases therapeutic effects of drug, Carbamazepine increases drug clearance, Diltiazem/Aprepitant increases drug level, Hormonal Contraceptives increases drug levels, Itraconazole increases levels/effects of inhaled drug, Erythromycin/Clarithromycin inhibits drug metabolism & decreases volume of distribution, Nefazodone inhibits drug metabolism & prolongs its effects on cortisol suppression, Rifampicin/Phenytoin markedly reduces therapeutic effects of drug, Ketoconazole reduces drug metabolism & clearance

Diet: With food

Monitor: BP, blood glucose, electrolytes, growth in children

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