Intravenous methylpredinosone

1. Respiratory Distress syndrome 
2. Anaphylaxis shock (severe allergic reaction)
3. Urticaria (rashes)
4. Asthma, Chronic obstructive pulmonary disease
5. Gout
6. Automotive hemolytic anaemia
7. Inflammatory bowel disorder
8. Multiple Sclerosis
9. Nausea and vomiting
10. Covid-19

Mode of action

It shows its effect by reducing inflammation and by changing the immune response, caused by a particular condition. The onset of action of methylprednisolone is within one hour.

Administration of Intravenous methylprednisolone

Intravenous methylprednisolone is administered by healthcare professionals in a hospital.

1. An intravenous line is placed in a vein of the hand or arm. Through a flexible tube, medication is infused over 1 to 3 hours under the guidance of doctors.
2. The dose and time of infusion are decided by the doctor. If any side effects are experienced at the time of infusion then a slower infusion of drugs is required.  Cardiac arrest or arrhythmia may happen if the dose of methylprednisolone is above 250mg. 

Precautions before receiving intravenous methylprednisolone

1. Inform the healthcare provider if you are allergic to methylprednisolone injection.
2. Inform the healthcare provider regarding the prescription and non-prescription drugs you are using at present to avoid side effects or drug interactions.
3. If you are having surgery inform the doctor that you are using a methylprednisolone injection for a particular condition. While using methylprednisolone injection do not take any other vaccines without informing the doctor.

Precautions while using intravenous methylprednisolone

In some patients allergic reactions may occur after the administration of intravenous methylprednisolone in such cases precautions must be taken before the administration of the drug. Prolonged usage of corticosteroids may result in adrenal insufficiency (which occurs when adrenal glands fail to make enough hormone cortisol and aldosterone) leading to serious outcomes.

1. If methylprednisolone is used in patients with diabetes mellitus frequent monitoring of the patient is necessary because methylprednisolone can increase the blood glucose levels.
2. Frequent monitoring is necessary if methylprednisolone is used in patients with seizure disorders.
3. Monitoring of patients is necessary because there is a chance of development of psychiatric disturbances within a few days or weeks after administration of methylprednisolone.
4. Few reports suggest evidence of cardiac arrest or arrhythmias within a few minutes of administration of large doses of methylprednisolone. 
5. In patients with hypertension usage of methylprednisolone may cause thromboembolism so precaution is necessary while prescribing methylprednisolone.
6. Frequent monitoring is necessary for patients with myasthenia gravis or osteoporosis.

Dosage of intravenous methylprednisolone

For adults in the case of :

1. COVID 19- is a respiratory disorder caused by the SARS-CoV-2 virus. Dose- 32 mg IV once a day for up to 10 days.
2. Pneumocystis- infection caused by fungus. Symptoms include difficulty in breathing, cough, pain in the chest, tiredness and fever. Dose- 30 mg IV every 12 hours for 5 days, then 30 mg IV every 24 hours for 5 days, then 15 mg IV every 24 hours for 11 days.
3. Acute spinal cord injury- it’s the injury to the neck or spine caused by accidents, sports injury, falls, violence, or birth injuries. Dose- 1st hour: 30mg/kg IV over 15 minutes, Next twenty-three hours: 5.4 mg/kg/hr IV by continuous infusion.
4. Allergic conditions- in case of anaphylaxis cannot be used as a primary treatment option, methylprednisolone can be used to prevent late phase allergic reaction in which redness of tissues and inflammation occurs. Dose- 40 to 125 mg as a single dose IV
5. Lupus nephritis- symptoms include inflammation in kidneys, blood and protein in the urine, and high blood pressure. Dose- 0.5-1g IV over 1 hour once daily for 3 days.

Overdose

Overdose of methylprednisolone is not life-threatening but long term use can cause acne, increased facial hair, changes in the menstrual cycle, impotence, and bruising of the skin.

Side effects of methylprednisolone

1. Pain, redness and inflammation at the site of injection.
2. Nausea, vomiting, headache, fatigue, acne, sweating, disturbance in sleep.
3. Increase in blood sugar levels, inability to fight infections.
4. Weight gain, changes in the menstrual cycle, joint pains, bruising, and psychological changes such as mood swings, anxiety, and depression.
5. Unusual hair growth, vision disturbances, black stools, stomach pain, intestinal bleeding, puffy face, and changes in a heartbeat.
6. Very serious side effects include seizures in such cases inform the healthcare provider immediately.
7. Serious allergic reactions are rare; it includes rash, itching, and inflammation of the face, throat and tongue.
8. Avoid consumption of alcohol along with methylprednisolone because the combination of both may lead to weight gain, and more prone to infections.

Withdrawal effects of intravenous methylprednisolone

Sudden withdrawal from methylprednisolone may cause symptoms such as dizziness, nausea, headache, and weight loss therefore consult a doctor before withdrawing. To prevent withdrawal effects, doctors may reduce the dose of methylprednisolone slowly.

Contraindications

Methylprednisolone must be avoided in patients with glaucoma, diabetes, hypertension, heart failure, and tuberculosis.

Monitoring of patients 

1. Blood pressure, blood glucose levels, electrolytes, and weight must be monitored.
2.  In children growth and development must be monitored.
3. Patients should be carefully monitored for high sugar levels, high blood pressure, high potassium levels and oedema.

Management of toxicity

Toxicity caused by methylprednisolone can be managed by adjusting the dose after attaining therapeutic response, by alternate day therapy.

Methylprednisolone in pregnancy and lactation

1. If the benefits exceed the risks then methylprednisolone can be used in pregnancy.
2. If methylprednisolone is used during pregnancy it must be used with causation as the drug enters the breast milk.
3. Methylprednisolone rarely harms the unborn baby during pregnancy but long term use must be avoided.

Drug interactions of methylprednisolone with foods

1. Avoid eating grapefruit or drinking grapefruit juice while administering methylprednisolone. To prevent drug-drug interactions, provide the list of drugs you are using to the healthcare professionals.
2. Drugs such as mifepristone, ibuprofen, warfarin, and aspirin may interact with methylprednisolone.
3. Methylprednisolone may interact with certain lab tests like skin tests and cause false results.
4. Few medications may cause the removal of methylprednisolone from the body; it includes antifungals such as ketoconazole, and antibiotics such as erythromycin, estrogens, and cyclosporine.

Brand names

The following are the brand names of methylprednisolone

1. Medrol
2. Medrol Dosepak
3. Depo-Medrol and
4. SoluMedrol

Conclusion

Methylprednisolone is the anti-inflammatory agent used to treat conditions related to the skin, gastrointestinal system, endocrine system, nervous system, kidneys, lungs, arthritis, and thyroid diseases.