Pro-Medrol

Indications

Methyl Prednisolone Sodium Succinate is an injectable form of the steroid Methylprednisolone. It is used when a strong, fast anti-inflammatory effect is needed, for example:

• Severe allergic reactions and severe asthma attacks (alongside emergency treatment)
• Flare-ups of multiple sclerosis
• Severe flare-ups of lupus, rheumatoid arthritis, vasculitis and other inflammatory diseases
• Severe skin conditions
• Rejection of a transplanted organ
• Other serious conditions where tablets cannot be taken or a high dose is needed quickly

How It Works

Methylprednisolone is a corticosteroid, similar to the natural hormone cortisol but much stronger. It calms the immune system and reduces swelling, redness and inflammation in the body.

Dosage and Administration

It is given by a doctor or nurse as an injection or a slow drip into a vein, or as an injection into a muscle. The dose depends on the condition and is given as prescribed. Very high doses (sometimes called pulse therapy) are given as a slow drip over at least 30 minutes, often once a day for a few days. Doses for children are based on body weight, as prescribed. After a long course, steroids must be reduced slowly rather than stopped suddenly.

Interactions

• Aspirin and NSAID painkillers (such as Ibuprofen) increase the risk of stomach ulcers and bleeding.
• Water tablets (such as Furosemide) and Amphotericin B can lower potassium further.
• It raises blood sugar, so diabetes medicines may need adjusting.
• Ketoconazole, Clarithromycin, Ritonavir and some other medicines can increase its effect; Rifampicin, Phenytoin and Carbamazepine can reduce it.
• It can change the effect of Warfarin.
• Live vaccines should not be given while on high doses.
• With quinolone antibiotics (such as Ciprofloxacin) there is a higher risk of tendon damage.

Contraindications

• Allergy to Methylprednisolone or any ingredient. Some strengths contain lactose made from cow's milk and must not be given to people allergic to cow's milk protein.
• Fungal infections affecting the whole body, unless they are being treated
• Live vaccines in people receiving high, immune-suppressing doses
• It must not be injected into the spine (intrathecal or epidural use)

Side Effects

Short courses may cause high blood sugar, mood changes, trouble sleeping, increased appetite, raised blood pressure, fluid retention, stomach upset, a metallic taste and flushing. Longer use can cause weight gain, a round face, thin skin and easy bruising, weak bones, muscle weakness, cataracts, glaucoma, a higher chance of infections and reduced natural steroid production.

Get urgent medical help if there is:

• Chest pain, an irregular or very fast heartbeat, or fainting (especially with fast high-dose infusions)
• Swelling of the face or throat, difficulty breathing or a widespread rash
• Black stools, vomiting blood or severe stomach pain
• Fever, chills or other signs of infection
• Severe mood changes, confusion or seeing or hearing things that are not there
• Sudden changes in vision

Pregnancy and Lactation

It is used in pregnancy only when the doctor feels the benefit outweighs the risk; long or high-dose use may affect the baby's growth. Small amounts pass into breast milk; short courses are usually compatible with breastfeeding, but the doctor should advise, especially with high doses.

Precautions and Warnings

• Use with care in people with diabetes, high blood pressure, heart failure, recent heart attack, stomach ulcers, osteoporosis, glaucoma, epilepsy, liver or kidney disease, or a history of mental illness.
• Tell the doctor about any past tuberculosis or recent infections, including chickenpox or measles contact.
• Blood sugar, blood pressure and potassium may be monitored.
• It is not used to treat head injury.
• After long use, do not stop suddenly; the dose must be tapered.

Overdose

A single large dose rarely causes serious harm, but repeated high doses can cause high blood sugar, salt and water retention, low potassium and other steroid effects. Treatment is supportive and given in hospital.

Therapeutic Class

Corticosteroid (glucocorticoid).

Storage

Store the unopened vials below 30°C, away from light and out of the reach of children. Once mixed with liquid, use promptly as stated in the product leaflet.