METHYLPREDNISOLONE SODIUM SUCCINATE
Classifications: hormone; adrenal corticosteroid; antiinflammatory; Therapeutic: adrenal corticosteroid; antiinflammatory
Pregnancy Category: C
Methylprednisolone: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg tablets
Methylprednisolone Acetate: 20 mg/mL, 40 mg/mL, 80 mg/mL injection
Methylprednisolone Sodium Succinate: 40 mg, 125 mg, 500 mg, 1 g, 2 g powder for injection
Intermediate-acting synthetic adrenal corticosteroid with similar glucocorticoid activity and has considerably fewer sodium
and water retention effects than hydrocortisone. It inhibits phagocytosis, and release of allergic substances. It also modifies
the immune response of the body to various stimuli. Sodium succinate form is characterized by rapid onset of action and
is used for emergency therapy of short duration.
Has antiinflammatory and immunosuppressive properties.
An antiinflammatory agent in the management of acute and chronic inflammatory diseases, for palliative management of neoplastic
diseases, and for control of severe acute and chronic allergic processes. High-dose, short-term therapy: management of acute
bronchial asthma, prevention of fat embolism in patient with long-bone fracture. Short term management of rheumatic disorders.
Acetate form used as a long-acting contraceptive and for spinal cord injury, lupus nephritis, multiple sclerosis.
Systemic fungal infections; pregnacy (category C), lactation.
Cushing's syndrome; GI disease, GI ulceration; hepatic disease; renal disease; hypertension; varicella, vaccinia; CHF; diabetes
mellitus; glaucoma; coagulopathy; emotional instability or psychotic tendencies.
Route & Dosage
Adult: PO 260 mg/d in 1 or more divided doses IM (Acetate) 1080 mg/wk weekly or every other week; (Succinate) 1080 mg daily IV 1040 mg prn or 30 mg/kg q46h x 48 h
Child: PO/IM/IV 0.51.7 mg/kg/d divided q612h
Adult/Child: IV 2 mg/kg then 15 mg/kg qh
Acute Spinal Cord Injury
Adult/Child: IV 30 mg/kg over 15 min, followed in 45 min by 5.4 mg/kg/h x 23 h
Dose on IBW or ABW, whichever is lower.
- Crush tablet before and give with fluid of patient's choice.
- Note: Preparation less irritating if given with food.
- Use alternate day therapy when given over long period.
- Give injection deep into large muscle (not deltoid).
- Note: Do NOT use methylprednisolone acetate for IV.
PREPARE: Direct/Intermittent: Available in ACT-O-Vial from which the desired dose may be withdrawn after initial dilution with supplied diluent. May be
further diluted according to physician's orders.
ADMINISTER: Direct: Give each 500 mg or fraction thereof over 23 min. Intermittent: Give over 1530 min.
INCOMPATIBILITIES Solution/additive: Dextrose 5%/sodium chloride 0.45%, aminophylline, calcium gluconate, glycopyrrolate, metaraminol, nafcillin, penicillin G sodium. Y-site: Allopurinol, amsacrine, ciprofloxacin, cisatracurium (≥2 mg/mL concentration), diltiazem, docetaxel, etoposide, filgrastim, fenoldopam, gemcitabine, ondansetron, paclitaxel, potassium chloride, propofol, sargramostim, vinorelbine.
- Store at 15°30° C (59°86° F). Do not freeze.
Adverse Effects (≥1%)CNS:
Euphoria, headache, insomnia
, confusion, psychosis. CV:
CHF, edema. GI:
Nausea, vomiting, peptic ulcer
Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine:
Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses:
InteractionsDrug: Amphotericin B, furosemide, thiazide diuretics
increase potassium loss; with attenuated virus vaccines
, may enhance virus
replication or increase vaccine
adverse effects; isoniazid, phenytoin, phenobarbital, rifampin
decrease effectiveness of methylprednisolone because they increase metabolism
Readily absorbed from GI tract. Peak:
12 h PO; 48 d IM. Duration:
1.251.5 d PO; 15 wk IM. Metabolism:
In liver. Half-Life:
>3.5 h; HPA suppression: 1836 h.
Assessment & Drug Effects
- Lab tests: Monitor periodically kidney and liver function, thyroid function, CBC, serum electrolytes, weight, and total
- Monitor diabetics for loss of glycemic control.
- Monitor serum potassium and report S&S of hypokalemia (see Appendix F).
- Monitor for and report S&S of Cushing's syndrome (see Appendix F).
Patient & Family Education
- Consult physician for any of the following: slow wound healing, significant insomnia or confusion, or unexplained bone pain.
- Do not alter established dosage regimen (i.e., not to increase, decrease, or omit doses or change dose intervals). Withdrawal
symptoms (rebound inflammation, fever) can be induced with sudden discontinuation of therapy.
- Report onset of signs of hypocorticism adrenal insufficiency immediately: Fatigue, nausea, anorexia, joint pain, muscular
weakness, dizziness, fever.