of methylprednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.vildagliptinMinor (1)methylprednisolone decreases effects of vildagliptin by pharmacodynamic antagonism. Minor/Significance Unknown.vincristine liposomalMinor (1)methylprednisolone will decrease the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.voriconazoleMonitor Closely (1)voriconazole will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.warfarinMonitor Closely (1)methylprednisolone increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.willow barkMinor (1)methylprednisolone decreases levels of willow bark by increasing renal clearance. Minor/Significance Unknown.xipamideMonitor Closely (1)xipamide, methylprednisolone. pharmacodynamic synergism. Use Caution/Monitor. Risk of hypokalemia.yellow fever vaccineSerious - Use Alternative (1)methylprednisolone decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.zafirlukastMonitor Closely (1)zafirlukast will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ziprasidoneMinor (1)methylprednisolone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zonisamideMinor (1)methylprednisolone will decrease the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zoster vaccine liveSerious - Use Alternative (1)methylprednisolone decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.zoster vaccine recombinantMonitor Closely (1)methylprednisolone decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant. Frequency Not Defined Acne Adrenal suppression Amenorrhea Delayed wound healing Delirium Diabetes mellitus Edema Emotional instability Erythema Fluid retention GI perforation Glucose intolerance Growth suppression (children) Hallucinations Headache Hepatomegaly Hepatitis Hypokalemic alkalosis Increased transaminases Insomnia Leukocytosis Menstrual irregularity Myopathy Neuritis Osteoporosis Peptic ulcer Perianal pruritus Pituitary adrenal axis suppression Protein catabolism Pseudotumor cerebri (on withdrawal) Psychosis Sodium and water retention Seizure Tachycardia Ulcerative esophagitis Urticaria Vasculitis Vertigo Weight gain Contraindications Untreated serious infections Documented hypersensitivity to drug or components (eg, lactose monohydrate from cow milk) Intrathecal administration Systemic fungal infection (except intra-articular injection in localized joint conditions) IM route is contraindicated in idiopathic thrombocytopenic purpura Premature infants (formulations containing benzyl alcohol only) Traumatic brain injury (high doses) Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids Cautions Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, history of seizure disorders, multiple sclerosis, thromboembolic disorders, myocardial infarction Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing Minimal mineralocorticoid activity Use in septic shock or sepsis syndrome not proven effective and may increase mortality in some patients including patients with elevated serum creatinine and patients who develop secondary infections Clearance of corticosteroids may increase in hyperthyroid patients and decrease in hypothyroid ones; dose adjustments may be necessary Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy May cause hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, or hyperglycemia Prolonged corticosteroid use may result in elevated IOP, glaucoma, or cataracts Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease) Injection may result in dermal and/or subdermal changes forming depressions in the skin at injection site; to minimize incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections; avoid injection into deltoid muscle due to high incidence of subcutaneous atrophy Increased dosage of rapidly acting corticosteroids indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation Not for use in the treatment of traumatic brain injury Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in situation of stress occurring during that period, hormone therapy should be reinstituted Rarely, high doses of cyclically pulsed intravenous methylprednisolone (usually for the treatment of exacerbations of multiple sclerosis at doses of 1 g/day) can induce a toxic form of acute hepatitis; discontinue therapy if it occurs; since recurrence has occurred after re-challenge, avoid use in patients with a history of toxic hepatitis caused by methylprednisolone With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases; corticosteroids may also mask some signs of current infection; corticosteroids may exacerbate systemic fungal infections and should not be used in presence of such infections unless needed to control drug reactions; latent amebiasis or active amebiasis should be ruled out before initiating corticosteroid therapy patients who have spent time in tropics or patients with unexplained diarrhea Lowest possible dose should be used to control condition under treatment; when reduction in dosage possible, reduction should be gradual Risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used Kaposi’s sarcoma reported in patients receiving corticosteroid therapy, most often for chronic conditions; discontinuation of therapy may result in clinical improvement Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not affect the ultimate outcome or natural history of the disease Psychic derangements may appear when corticosteroids used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids Give consideration to potential for hypersensitivity reactions to cow’s milk ingredients in Solumedrol; if appropriate, stop administration of injection solution Solumedrol and treat patient’s condition accordingly; alternative treatments, including use of corticosteroid formulations that do not contain ingredients produced from cow’s milk, should be considered for acute allergy management Increased incidence of scleroderma reported in patients with systemic sclerosis; use caution Pediatric patients As in adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis Pediatric patients treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in growth velocity; this negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (ie, cosyntropin stimulation and basal cortisol plasma levels) Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function The linear growth of pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives; in order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose Hypertrophic cardiomyopathy was reported after administration of hydrocortisone to prematurely born infants, therefore appropriate diagnostic evaluation and monitoring of cardiac function and structure should be performed Epidural injection Serious neurologic events, some resulting in death, have been reported with epidural injection Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke These serious neurologic events have been reported with and without use of fluoroscopy Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use Methylprednisolone preserved with benzyl alcohol Methylprednisolone preserved with benzyl alcohol should not be administered to neonates, infants, pregnant women, or breastfeeding women Benzyl alcohol is associated with serious adverse events and death, particularly in pediatric patients (gasping syndrome, characterized by CNS depression, metabolic acidosis, and gasping respirations) Pregnancy category: C Lactation: Drug enters milk; use with cautionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Potent glucocorticoid with minimal to no mineralocorticoid activity Modulates carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis Controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level Absorption Onset: PO: 1-2 hr; IV (Succinate): within 1 hr; Intra-articular (acetate): 1 week; IM (succinate): Rapid absorption Duration (intra-articular): Slow absorption from intra-articular site; may continue 1 week Peak plasma time: PO: 2.1 ± 0.7 hr; IV (succinate): 0.8 hr Distribution Vd: IV (succinate): 24 L ± 6 L Metabolism Extensively metabolized in liver Elimination Half-life (adults): Oral: 2.5 ± 1.2 hr; IV (succinate): 0.25 ± 0.1 hr Dialyzable: Hemodialysis, slightly Excretion: Urine (mainly, as metabolites), feces (minimally) IV Compatibilities Solution: D5/0.5 NS, D5/NS, D5W, LR, NS Additive: Chloramphenicol sodium succinate, cimetidine, clindamycin, dopamine, granisetron, heparin, norepinephrine, penicillin G potassium, ranitidine, theophylline, verapamil Syringe: Diatrizoate meglumine, diatrizoate meglumin/diatrizoate sodium, granisetron, iohexol, iopamidol, iothalamate meglumine, ioxalate meglumine/ioxalate sodium, metoclopramide Y-site (partial list): Acyclovir, amifostine, amiodarone, cisplatin, dopamine, enalaprilat, famotidine, heparin, inamrinone, linezolid, meperidine, metronidazole, midazolam, morphine, sodium bicarbonate IV Incompatibilities Additive: Aminophylline(?), calcium gluconate, cytarabine(?), glycopyrrolate, metaraminol, nafcillin, penicillin G sodium Syringe: Doxapram Y-site: Allopurinol, amsacrine, ciprofloxacin, cisatracurium(?), diltiazem(?), etoposide phosphate, fenoldopam, filgrastim, gemcitabine, heparin/hydrocortisone(?), ondansetron, paclitaxel, potassium chloride(?), propofol, sargramostim, vinorelbine, vitamins B and C(?) IV/IM Preparation Reconstitute for IM/IV injection with BWI containing 0.9% benzyl alcohol IV Administration Inject directly into vein or into tubing of running IV Injection: Administer over at least 1 minute Infusion: Further dilute reconstituted mixture with D5W, NS, D5/NS, or other compatible solution Push: Administer over 10-20 minutes BRAND FORM. UNIT PRICE PILL IMAGE Medrol (Pak) oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 32 mg tabletmethylprednisolone oral- 16 mg tabletmethylprednisolone oral- 8 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 32 mg tabletmethylprednisolone oral- 16 mg tabletmethylprednisolone oral- 8 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 32 mg tabletmethylprednisolone oral- 16 mg tabletmethylprednisolone oral- 8 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletmethylprednisolone oral- 4 mg tabletMedrol oral- 4 mg tabletMedrol oral- 32 mg tabletMedrol oral- 32 mg tabletMedrol oral- 16 mg tabletMedrol oral- 8 mg tabletMedrol oral- 8 mg tabletMedrol oral- 2 mg tabletMethylpred DP oral- 4 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationmethylprednisolone oral METHYLPREDNISOLONE - ORAL (METH-il-pred-NIS-oh-lone) COMMON BRAND NAME(S): Medrol USES: Methylprednisolone is used to treat conditions such as arthritis, blood disorders, severe allergic reactions, certain cancers, eye conditions, skin/kidney/intestinal/lung diseases, and immune system disorders. It decreases your immune system's response to various diseases to reduce symptoms such as swelling, pain, and allergic-type reactions. This medication is a corticosteroid hormone.Methylprednisolone may also be used with other medications in hormone disorders. HOW TO USE: Take this medication by mouth as directed by your doctor, usually with food or milk. Follow your dosing instructions carefully. The dosage and length of treatment are based on your medical condition and response to treatment. Different dosing schedules exist for this medication. If you are not taking the same dose each day or if you take this medication every other day, it may help to mark your calendar with a reminder. Consult your doctor or pharmacist if you have any