Plain-language summary, compiled from the cited regulatory records
Methylprednisolone is a corticosteroid medication [1]. It belongs to the drug class of Corticosteroids, Weak (Group I) [1].
Methylprednisolone is approved for use in several conditions, including endocrine disorders such as primary or secondary adrenocortical insufficiency, congenital adrenal hyperplasia, nonsuppurative thyroiditis, and hypercalcemia associated with cancer [1]. It is also indicated for certain rheumatic disorders [1].
In the past 12 months, there have been 11,608 adverse event reports associated with this active ingredient [2]. The most frequent reactions reported include off-label use, drug ineffectiveness, condition aggravation, pain, and headache [2].
This is not medical advice. Consult a qualified healthcare professional.
GBOfficial regulatory label· revised May 22, 2026[1]
Depo-Medrone may be used locally or systemically, particularly where oral therapy is not feasible. Depo-Medrone may be used by any of the following routes: intramuscular, intra-articular, periarticular, intrabursal, intralesional or into the tendon sheath.
CAOfficial regulatory label· revised March 9, 2026[2]
Intravenous administration of Methylprednisolone Sodium Succinate for Injection, USP (methylprednisolone sodium succinate) is indicated in situations in which a rapid and intense hormonal effect is required. Methylprednisolone Sodium Succinate for Injection, USP is indicated for: • Hypersensitivity and dermatologic conditions - Status asthmaticus - Anaphylactic reactions - Drug reactions - Contact dermatitis - Urticaria - Generalized neurodermatitis - Reactions to insect bites - Pemphigus foliaceous and vulgaris - Exfoliative dermatitis - Erythema multiforme • In anaphylactic reactions epinephrine or norepinephrine should be administered first for an immediate hemodynamic effect followed by intravenous injection of Methylprednisolone Sodium Succinate for Injection, USP and other accepted procedures.
There is evidence that the corticoids through their prolonged hemodynamic effect are of value in preventing recurrent attacks of acute anaphylactic reactions. • In sensitivity reactions such as in serum sickness, allergic dermatosis (urticaria) and reactions to insect bites, Methylprednisolone Sodium Succinate for Injection, USP is capable of providing relief within 1/2 to 2 hours.
USUnited States· FDA
5 products
Uses
USOfficial regulatory label· revised February 13, 2026[3]
INDICATIONS AND USAGE
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use of Methylprednisolone Sodium Succinate for Injection is indicated as follows: Allergic states Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions.
Dermatologic diseases Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine disorders Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis.
Drug interactions
Known interactions involving Methylprednisolone. Select one for details. This list is informational and not a complete interaction checker.
Showing 240 of 600. Type above to find a specific drug.
Interaction data compiled from DDInter (academic, CC-BY). Severity classification only - this is not a complete interaction checker and not medical advice.
[2]Health Canada (DPD) · 02565595 · revised March 9, 2026
[3]FDA DailyMed · 05d95a56-b03a-4d… · revised February 13, 2026 [PDF]
[4]OpenFDA adverse-event reports (US), 12 months ending June 4, 2026.
Information on this page is compiled from public regulatory records. Drugvu is not affiliated with any regulator or pharmaceutical manufacturer. This is not medical advice. Always consult a qualified healthcare professional.
How to take
GBOfficial regulatory label· revised May 22, 2026[1]
Depo-Medrone should not be mixed with any other suspending agent or solution. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever suspension and container permit.
Depo-Medrone may be used by any of the following routes: intramuscular, intra-articular, periarticular, intrabursal, intralesional and into the tendon sheath. 8). 4). Depo-Medrone vials are intended for single dose use only.
Intramuscular – for sustained systemic effect:
Allergic conditions (asthma, drug reactions), 80 – 120 mg (2 – 3 ml). Dermatological conditions, 40 – 120 mg (1 – 3 ml). Rheumatic disorders and collagen diseases (rheumatoid arthritis, SLE), 40 – 120 mg (1 – 3 ml) per week. Dosage must be individualized and depends on the condition being treated and its severity.
The frequency of intramuscular injections should be determined by the duration of clinical response. On average the effect of a single 2 ml (80 mg) injection may be expected to last approximately two weeks.
Intra-articular:
Rheumatoid arthritis, osteo-arthritis. The dose of Depo-Medrone depends upon the size of the joint and the severity of the condition. Repeated injections, if needed, may be given at intervals of one to five or more weeks depending upon the degree of relief obtained from the initial injection.
25 ml).
Intrabursal:
Subdeltoid bursitis, prepatellar bursitis, olecranon bursitis. 75 ml). In most cases, repeat injections are not needed.
Intralesional:
Keloids, localised lichen planus, localized lichen simplex, granuloma annulare, alopecia areata, and discoid lupus erythematosus. 5 ml). 5 – 1 ml). One to four injections are usually employed. Care should be taken to avoid injection of sufficient material to cause blanching, since this may be followed by a small slough.
Peri-articular:
Epicondylitis. 75 ml) into the affected area.
Into the tendon sheath:
Tenosynovitis, epicondylitis. 75 ml). In recurrent or chronic conditions, repeat injections may be necessary. Special precautions should be observed when administering Depo-Medrone. Intramuscular injections should be made deeply into the gluteal muscles.
The usual technique of aspirating prior to injection should be employed to avoid intravascular administration. Doses recommended for intramuscular injection must not be administered superficially or subcutaneously. Intra-articular injections should be made using precise, anatomical localisation into the synovial space of the joint involved.
The injection site for each joint is determined by that location where the synovial cavity is most superficial and most free of large vessels and nerves. Suitable sites for intra-articular injection are the knee, ankle, wrist, elbow, shoulder, phalangeal and hip joints.
The spinal joints, unstable joints and those devoid of synovial space are not suitable. Treatment failures are most frequently the result of failure to enter the joint space. Intra-articular injections should be made with care as follows: ensure correct positioning of the needle into the synovial space and aspirate a few drops of joint fluid.
The aspirating syringe should then be replaced by another containing Depo-Medrone. To ensure position of the needle, synovial fluid should be aspirated and the injection made. After injection the joint is moved slightly to aid mixing of the synovial fluid and the suspension.
Subsequent to therapy care should be taken for the patient not to overuse the joint in which benefit has been obtained. Negligence in this matter may permit an increase in joint deterioration that will more than offset the beneficial effects of the steroid.
Intrabursal injections should be made as follows: the area around the injection site is prepared in a sterile way and a wheal at the site made with 1 per cent procaine hydrochloride solution. A 20-24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated.
The needle is left in place and the aspirating syringe changed for a small syringe containing the desired dose. After injection, the needle is withdrawn and a small dressing applied. In the treatment of tenosynovitis care should be taken to inject Depo-Medrone into the tendon sheath rather than into the substance of the tendon.
Due to the absence of a true tendon sheath, the Achilles tendon should not be injected with Depo-Medrone. The usual sterile precautions should be observed, with each injection.
Paediatric population:
Dosage may be reduced for infants and children but should be governed more by the severity of the condition and response of the patient, than by age or size.
Elderly:
When used according to instructions, there is no information to suggest that a change in dosage is warranted in the elderly. However, treatment of elderly patients, particularly if long-term, should be planned bearing in mind the more serious consequences of the common side-effects of corticosteroids in old age and close clinical supervision is required (see Special warnings and special precautions for use).
This is not medical advice. Consult a qualified healthcare professional.
Side effects & warnings
GBOfficial regulatory label· Adverse reactions· revised May 22, 2026[1]
4). MedDRA System Organ Class Frequency Undesirable Effects Infections and infestations Not Known Infection (including increased susceptibility and severity of infections with suppression of clinical symptoms and signs); Opportunistic infection; Injection site infection; Peritonitis; Recurrence of dormant tuberculosis Blood and lymphatic system disorders Not Known Leukocytosis Immune system disorders Not Known Drug hypersensitivity, Anaphylactic reaction, Anaphylactoid reaction MedDRA System Organ Class Frequency Undesirable Effects Endocrine disorders Not Known Cushingoid; Hypothalamic pituitary adrenal axis suppression; Withdrawal symptoms - Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death.
4). A 'withdrawal syndrome' may also occur including, fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and loss of weight. Metabolism and nutrition disorders Not Known Metabolic acidosis; Glucose tolerance impaired; Sodium retention; Fluid retention; Increased requirements for insulin (or oral hypoglycemic agents in diabetics)*; Alkalosis hypokalaemic; Dyslipidaemia, Increased appetite (which may result in Weight increased); Lipomatosis Psychiatric disorders Not Known Affective disorder (including Depressed mood, Euphoric mood, Affect lability, Drug dependence, Suicidal ideation).
4); Chorioretinopathy; rare instances of blindness associated with intralesional therapy around the face and head*; Increased intra- ocular pressure, with possible damage to the optic nerve; Corneal or scleral thinning; Exacerbation of ophthalmic viral or fungal disease Ear and labyrinth disorders Not Known Vertigo Cardiac disorders Not Known Cardiac failure congestive (in susceptible patients) Vascular disorders Not Known Hypertension; Hypotension; Embolism arterial, Thrombotic events, Flushing Respiratory, thoracic and mediastinal disorders Not Known Pulmonary embolism, Hiccups MedDRA System Organ Class Frequency Undesirable Effects Gastrointestinal disorders Not Known Peptic ulcer (with possible Peptic ulcer perforation and Peptic ulcer haemorrhage); Gastric haemorrhage; Intestinal perforation; Pancreatitis; Oesophagitis ulcerative; Oesophagitis; Abdominal pain; Abdominal distension; Diarrhoea; Dyspepsia; Nausea Hepatobiliary disorders Not known Hepatitis, Increase of liver enzymes Skin and subcutaneous tissue disorders Not Known Angioedema; Hirsutism; Petechiae; Ecchymosis; Skin atrophy; Erythema; Hyperhidrosis; Skin striae; Skin hyperpigmentation; Rash; Pruritus; Urticaria; Acne; Skin hypopigmentation; Panniculitis@ Musculoskeletal and connective tissue disorders Not Known Growth retardation; Osteoporosis; Muscular weakness; Osteonecrosis; Pathological fracture; Muscle atrophy; Myopathy; Rhabdomyolysis; Neuropathic arthropathy; Arthralgia; Myalgia; Post injection pain flare (following intra-articular, periarticular, and tendon sheath injections)* Reproductive system and breast disorders Not Known Menstruation irregular General disorders and administration site conditions Not Known Abscess sterile; Impaired healing; Oedema peripheral; Fatigue; Malaise; Injection site reaction Investigations Not Known Blood potassium decreased; Alanine aminotransferase increased; Aspartate aminotransferase increased; Blood alkaline phosphatase increased; Carbohydrate tolerance decreased; Urine calcium increased; suppression of reactions to skin tests*; Blood urea increased Injury, poisoning and procedural complications Not Known Tendon rupture (particularly of the Achilles tendon); Spinal compression fracture.
Systemic corticosteroids are not indicated for, and therefore should not be used to treat, traumatic brain injury. † Common (≥1/100 to <1/10); Uncommon (≥1/1,000 to <1/100); Rare (≥1/10,000 to <1/1,000); Not known (frequency cannot be estimated from the available data).
* Not a MedDRA PT. 4). @ Panniculitis may occur following dose reduction or discontinuation of methylprednisolone and has been more frequently reported in the paediatric population. CERTAIN SIDE EFFECTS REPORTED WITH SOME CONTRAINDICATED AND NON-RECOMMENDED ROUTES OF ADMINISTRATION.
Permanent/temporary blindness, rhinitis. Ophthalmic: (Subconjunctival) - Redness and itching, abscess, slough at injection site, residue at injection site, increased intra-ocular pressure, decreased vision - blindness, infection.
Miscellaneous injection sites:
Scalp, tonsillar […]
GBOfficial regulatory label· Warnings and precautions· revised May 22, 2026[1]
Warnings and Precautions:
Undesirable effects may be minimised by using the lowest effective dose for the minimum period. 2). Depo-Medrone vials are intended for single dose use only. Any multidose use of the product may lead to contamination. 8). Appropriate measures must be taken to avoid intravascular injection.
Due to the absence of a true tendon sheath, the Achilles tendon should not be injected with Depo-Medrone. While crystals of adrenal steroids in the dermis suppress inflammatory reactions, their presence may cause disintegration of the cellular elements and physiochemical changes in the ground substance of the connective tissue.
The resultant infrequently occurring dermal and/or subdermal changes may form depressions in the skin at the injection site. The degree to which this reaction occurs will vary with the amount of adrenal steroid injected. Regeneration is usually complete within a few months or after all crystals of the adrenal steroid have been absorbed.
In order to minimize the incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections. Multiple small injections into the area of the lesion should be made whenever possible. The technique of intra-articular and intramuscular injection should include precautions against injection or leakage into the dermis.
Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy. Intralesional doses should not be placed too superficially, particularly in easily visible sites in patients with deeply pigmented skins, since there have been rare reports of subcutaneous atrophy and depigmentation.
Systemic absorption of methylprednisolone occurs following intra-articular injection of Depo-Medrone. Systemic as well as local effects can therefore be expected. Adrenal cortical atrophy develops during prolonged therapy and may persist for months after stopping treatment.
In patients who have received more than physiological doses of systemic corticosteroids (approximately 6 mg methylprednisolone) for greater than 3 weeks, withdrawal should not be abrupt. How dose reduction should be carried out depends largely on whether the disease is likely to relapse as the dose of systemic corticosteroids is reduced.
This is not medical advice. Consult a qualified healthcare professional.
Who should not take it
GBOfficial regulatory label· Contraindications· revised May 22, 2026[1]
8) • for use by the intravenous route Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids.
This is not medical advice. Consult a qualified healthcare professional.
In some asthmatic patients it may be advantageous to administer Methylprednisolone Sodium Succinate for Injection, USP by slow intravenous drip over a period of hours. • As Adjunctive therapy in - Acute systemic lupus erythematosus - Acute rheumatic fever - Acute gout In these conditions Methylprednisolone Sodium Succinate for Injection, USP may be given by slow intravenous administration over a period of several minutes.
Thereafter, the patient should be placed on intramuscular or oral therapy as required for continued relief of symptoms. In these conditions, other accepted measures of therapy should also be instituted. • Ulcerative colitis Colonic instillation of Methylprednisolone Sodium Succinate in retention enemas or by continuous drip, have been shown to be a useful adjunct in the treatment of patients with ulcerative colitis.
Methylprednisolone Sodium Succinate for Injection, USP Page 5 of 42 • Shock In severe hemorrhagic or traumatic shock, adjunctive use of intravenous Methylprednisolone Sodium Succinate for Injection, USP may aid in achieving hemodynamic restoration.
Corticoid therapy should not replace standard methods of combating shock, but present evidence indicates that concurrent use of large doses of corticoids with other measures may improve survival rates. • Organ transplants Corticosteroids, both parenterally and orally, in high doses have been used following organ transplantation as part of multi-faceted attempts to reduce the rejection phenomenon.
Methylprednisolone Sodium Succinate for Injection, USP is suitable for such indications. • Cerebral oedema of non traumatic origin Administration of Methylprednisolone Sodium Succinate immediately prior to intracranial surgery and in the immediate post-operative period has reduced the duration of post-operative complications related to cerebral oedema.
1 Pediatrics Methylprednisolone Sodium Succinate for Injection, USP is contraindicated for use in premature infants (see
How to take
CAOfficial regulatory label· revised March 9, 2026[2]
1 Dosing Considerations • Because complications of treatment with glucocorticoids are dependent on the size of the dose and the duration of treatment, a 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.
• The lowest possible dose of corticosteroid should be used to control the condition under treatment. • Patients should be advised to inform subsequent health professionals of the prior use of Methylprednisolone Sodium Succinate for Injection, USP.
• The existence of diabetes, osteoporosis, renal insufficiency, chronic psychosis, cardiovascular disease, myasthenia gravis or predisposition to thrombophlebitis requires that Methylprednisolone Sodium Succinate for Injection, USP be administered with extreme caution.
• Dosage adjustments may be required based on the following: - during remission - exacerbation of the disease process - the patient’s individual response to therapy - upon exposure of the patient to emotional or physical stress such as serious infection, surgery or injury.
Methylprednisolone Sodium Succinate for Injection, USP dosage may need to be increased during and after the stressful situation. • Geriatrics: In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
• Caution is recommended with prolonged corticosteroid treatment in the elderly due to a potential increased risk for osteoporosis, as well as increased risk for fluid retention with possible resultant hypertension. 3 Pediatrics). 2 Recommended Dose and Dosage Adjustment • Corticosteroid therapy is an adjunct to, and not replacement for, conventional therapy.
, shock states), the recommended dose of Methylprednisolone Sodium Succinate for Injection, USP is 30 mg per kg, given intravenously over Methylprednisolone Sodium Succinate for Injection, USP Page 7 of 42 a period of at least 30 minutes.
This large dose may be repeated every 4- 6 hours for up to 48 hours. • In other indications, initial dosage will vary from 10 to 500 mg depending on the clinical problem being treated. Larger doses may be required for short-term management of severe, acute conditions.
, doses greater than 250 mg). Subsequent doses may be given intravenously or intramuscularly at intervals dictated by the patient's response and clinical condition. • Methylprednisolone Sodium Succinate in doses of 40 to 120 mg administered as retention enemas or by continuous drip three to seven times weekly for periods of two or more weeks have been shown to be a useful adjunct in the treatment of some patients with ulcerative colitis.
Many patients can be controlled with 40 mg of Methylprednisolone Sodium Succinate for Injection, USP administered in from 1 to 10 fluid ounces of water depending on the degree of involvement of the inflamed colonic mucosa. Other accepted therapeutic measures should, of course, be instituted.
3 Reconstitution Parenteral Products: DIRECTIONS FOR RECONSTITUTION USING THE FLIP-OFF VIALS 1. Remove the protective plastic flip-off seal. 2. Swab the rubber stopper with an antiseptic solution and introduce the required quantity of the diluent by means of a syringe into the vial.
3. Shake the vial thoroughly to dissolve the powder content. 4. Withdraw the dose in the usual manner with the help of a syringe Reconstitute with Sterile Water for Injection, or, if required, sterile Bacteriostatic Water for Injection as follows: Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration, whenever solution and container permit.
5 mg/mL Compatibility The compatibility and stability of Methylprednisolone Sodium Succinate for Injection, USP , in solutions and with other drugs in intravenous admixtures is dependent on admixture pH, concentration, time, temperature, and the ability of methylprednisolone to solubilize itself.
V. V. V. "piggy-back" solution. 9% sodium chloride. The resulting solutions are physically and chemically stable for 48 hours. 4 Administration Methylprednisolone Sodium Succinate for Injection, USP may be administered by intravenous or intramuscular injection or by intravenous infusion, the preferred method for initial emergency use being intravenous injection.
To administer Methylprednisolone Sodium Succinate for Injection, USP, reconstitute the vial as per instructions. Store reconstituted solution at room temperature (between 15 and 30°C). Use reconstituted solution within 48 hours. Methylprednisolone Sodium Succinate for Injection, USP vials are single dose vials.
Discard unused portion. Reconstituted Methylprednisolone Sodium Succinate for Injection, USP products can be used directly […]
This is not medical advice. Consult a qualified healthcare professional.
Side effects & warnings
CAOfficial regulatory label· Adverse reactions· revised March 9, 2026[2]
1 Adverse Reaction Overview The following Adverse Reactions have been reported with the systemic use of Methylprednisolone Sodium Succinate and other corticosteroid preparations. Methylprednisolone Sodium Succinate for Injection, USP Page 18 of 42 MedDRA (v15) System Organ Class Undesirable Effect Blood and lymphatic system disorders Leukocytosis Infections and infestations Infection; opportunistic infection; injection site infections following non-sterile administration; decreased resistance to infection Immune system disorders Drug hypersensitivity; (anaphylactoid reaction; anaphylactic reaction (with or without circulatory collapse)) Endocrine disorders Cushingoid; hypothalamic pituitary adrenal axis suppression; steroid withdrawal syndrome; moon face; abnormal fat deposits; glycosuria; hypertrichosis; secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery or illness) A steroid “withdrawal syndrome,” seemingly unrelated to adrenocortical insufficiency, may also occur following abrupt discontinuance of glucocorticoids.
This syndrome includes symptoms such as: anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, desquamation, myalgia, weight loss, and/or hypotension. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels.
Metabolism and nutrition disorders Lipomatosis; sodium retention; sodium excretion; fluid retention; alkalosis hypokalemic; dyslipidaemia; metabolic acidosis; glucose tolerance impaired; increased requirement for insulin (or oral hypoglycemic agents in diabetics); nitrogen balance negative (due to protein catabolism); blood urea increased; increased appetite (which may result in weight increased); diuresis Psychiatric disorders Affective disorder (including affect lability, depressed mood, euphoric mood, drug dependence, suicidal ideation); psychotic disorder (including mania, delusion, hallucination, schizophrenia [aggravation of]); mental disorder; insomnia; mood swings; personality change; confusional state; abnormal behavior; anxiety; irritability; emotional instability Nervous system disorders Epidural lipomatosis; intracranial pressure increased (with papilledema [idiopathic intracranial hypertension] usually following discontinuation of treatment); convulsion; amnesia; cognitive disorder; dizziness; headache; seizures; neuritis; neuropathy; paresthesia Eye disorders Central serous chorioretinopathy; cataract; glaucoma; exophthalmos; rare instances of blindness associated with periocular injections.
Ear and labyrinth disorders Vertigo Cardiac disorders Cardiac failure congestive (in susceptible patients); arrhythmia; cardiac arrest; bradycardia; tachycardia; cardiac enlargement; circulatory collapse; hypertrophic cardiomyopathy in premature infants; myocardial rupture following recent myocardial infarction; pulmonary oedema; syncope Methylprednisolone Sodium Succinate for Injection, USP Page 19 of 42 MedDRA (v15) System Organ Class Undesirable Effect Vascular disorders Hypertension; hypotension; flushing; thromboembolism; thrombophlebitis, thrombosis, vasculitis Respiratory, thoracic and mediastinal disorders Hiccups; bronchospasm, pulmonary embolism Gastrointestinal disorders Peptic ulcer (with possible peptic ulcer perforation and peptic ulcer haemorrhage); intestinal perforation; gastric haemorrhage; pancreatitis; esophagitis ulcerative; oesophagitis; abdominal distension; abdominal pain; diarrhoea; dyspepsia; nausea; vomiting; dysgeusia; peritonitis (peritonitis may be the primary presenting sign or symptom of a gastrointestinal disorder such as perforation, obstruction or pancreatitis) Hepatic disorders Hepatomegaly, hepatitis, drug-induced liver injury, liver failure Skin and subcutaneous disorders Angioedema; hirsutism; petechiae; ecchymoses; skin atrophy; erythema; hyperhidrosis; skin striae; rash; pruritus; urticaria; acne; panniculitis; skin hypopigmentation; skin hyperpigmentation; allergic dermatitis; burning or tingling (especially in the perineal area after intravenous injection); cutaneous and subcutaneous atrophy; dry scaly skin; sterile abscess; thinning scalp hair; Kaposi’s sarcoma Musculoskeletal and connective tissue disorders Muscular weakness; myalgia; myopathy; rhabdomyolysis; muscle atrophy; osteoporosis; osteonecrosis; pathological; post-injection flare (following intra-articular use); fracture; neuropathic arthropathy; arthralgia; growth retardation Reproductive system and breast disorders Menstruation irregular; increased or decreased motility and number of spermatozoa.
General disorders and administration site conditions Impaired healing; fatigue; malaise; injection site reaction; oedema peripheral Investigations Urine calcium increased; blood potassium decreased; Carbohydrate tolerance decreased; intraocular pressure increased; aminotransferase increased; aspartate aminotransferase increased; blood alkaline phosphatase increased; suppression of reactions to skin tests; blood urea increased Injury, poisoning and procedural complications Spinal compression fracture; tendon rupture (particularly of the Achilles tendon)
CAOfficial regulatory label· Warnings and precautions· revised March 9, 2026[2]
3 Pediatrics). 2 Geriatrics Evidence from clinical studies and experience suggests that use in the geriatric population is associated with differences in safety or effectiveness. 2 CONTRAINDICATIONS Methylprednisolone Sodium Succinate for Injection, USP is contraindicated: • in patients with known hypersensitivity to the ingredients.
• for systemic fungal infections • in patients administered with live or live, attenuated vaccines while receiving immunosuppressive doses of corticosteroids. • for intrathecal or epidural administration. Reports of serious medical events have been associated with these routes of administration.
• for use in premature infants, if the sterile Bacteriostatic Water for Injection is used for reconstituting Methylprednisolone Sodium Succinate for Injection, USP products (as sterile Bacteriostatic Water for Injection contains benzyl alcohol).
3 Pediatrics. • for intramuscular administration in idiopathic thrombocytopenic purpura. 1 Dosing Considerations • Because complications of treatment with glucocorticoids are dependent on the size of the dose and the duration of treatment, a 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.
• The lowest possible dose of corticosteroid should be used to control the condition under treatment. • Patients should be advised to inform subsequent health professionals of the prior use of Methylprednisolone Sodium Succinate for Injection, USP.
• The existence of diabetes, osteoporosis, renal insufficiency, chronic psychosis, cardiovascular disease, myasthenia gravis or predisposition to thrombophlebitis requires that Methylprednisolone Sodium Succinate for Injection, USP be administered with extreme caution.
• Dosage adjustments may be required based on the following: - during remission - exacerbation of the disease process - the patient’s individual response to therapy - upon exposure of the patient to emotional or physical stress such as serious infection, surgery or injury.
Methylprednisolone Sodium Succinate for Injection, USP dosage may need to be increased during and after the stressful situation. • Geriatrics: In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
This is not medical advice. Consult a qualified healthcare professional.
Who should not take it
CAOfficial regulatory label· Contraindications· revised March 9, 2026[2]
3 Pediatrics). 2 Geriatrics Evidence from clinical studies and experience suggests that use in the geriatric population is associated with differences in safety or effectiveness. 2 CONTRAINDICATIONS Methylprednisolone Sodium Succinate for Injection, USP is contraindicated: • in patients with known hypersensitivity to the ingredients.
• for systemic fungal infections • in patients administered with live or live, attenuated vaccines while receiving immunosuppressive doses of corticosteroids. • for intrathecal or epidural administration. Reports of serious medical events have been associated with these routes of administration.
• for use in premature infants, if the sterile Bacteriostatic Water for Injection is used for reconstituting Methylprednisolone Sodium Succinate for Injection, USP products (as sterile Bacteriostatic Water for Injection contains benzyl alcohol).
3 Pediatrics. • for intramuscular administration in idiopathic thrombocytopenic purpura. Except for short-term emergency therapy, Methylprednisolone Sodium Succinate for Injection, USP is contraindicated in patients with: • arrested tuberculosis • herpes simplex keratitis • acute psychoses • Cushing's syndrome • peptic ulcer Methylprednisolone Sodium Succinate for Injection, USP Page 6 of 42 • markedly elevated serum creatinine • vaccinia and varicella
This is not medical advice. Consult a qualified healthcare professional.
Gastrointestinal diseases To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hematologic disorders Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular administration is contraindicated), pure red cell aplasia, selected cases of secondary thrombocytopenia.
Miscellaneous Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic diseases For the palliative management of leukemias and lymphomas.
Nervous System Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, or craniotomy. Ophthalmic diseases Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids.
Renal diseases To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis.
Rheumatic disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy).
For the treatment of dermatomyositis, temporal arteritis, polymyositis, and systemic lupus erythematosus.
How to take
USOfficial regulatory label· revised February 13, 2026[3]
DOSAGE AND ADMINISTRATION
Note:
Methylprednisolone sodium succinate injection when reconstituted with bacteriostatic water for injection contains benzyl alcohol (see DESCRIPTION , WARNINGS and PRECAUTIONS , Pediatric Use) Because of possible physical incompatibilities, methylprednisolone sodium succinate should not be diluted or mixed with other solutions.
Use only Water for Injection or Bacteriostatic Water For Injection with Benzyl Alcohol when reconstituting methylprednisolone sodium succinate (see DESCRIPTION ). Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
This preparation may be administered by intravenous injection, by intravenous infusion, or by intramuscular injection, the preferred method for initial emergency use being intravenous injection. Following the initial emergency period, consideration should be given to employing a longer acting injectable preparation or an oral preparation.
5 gram administered over a period of less than 10 minutes ). Bradycardia has been reported during or after the administration of large doses of methylprednisolone sodium succinate and may be unrelated to the speed or duration of infusion.
When high dose therapy is desired, the recommended dose of methylprednisolone sodium succinate sterile powder is 30 mg/kg administered intravenously over at least 30 minutes . This dose may be repeated every 4 to 6 hours for 48 hours.
In general, high dose corticosteroid therapy should be continued only until the patient's condition has stabilized; usually not beyond 48 to 72 hours. In other indications, initial dosage will vary from 10 to 40 mg of methylprednisolone depending on the specific disease entity being treated.
However, in certain overwhelming, acute, life-threatening situations, administrations in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages. It Should Be Emphasized that Dosage Requirements are Variable and Must Be Individualized on the Basis of the Disease Under Treatment and the Response of the Patient.
After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached.
Situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness, and the effect of patient exposure to stressful situations not directly related to the disease entity under treatment.
In this latter situation, it may be necessary to increase the dosage of the corticosteroid for a period of time consistent with the patient's condition. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.
Methylprednisolone sodium succinate for injection may be administered by intravenous or intramuscular injection or by intravenous infusion, the preferred method for initial emergency use being intravenous injection. To administer by intravenous (or intramuscular) injection, prepare solution as directed.
The desired dose may be administered intravenously over a period of several minutes. If desired, the medication may be administered in diluted solutions by adding Water for Injection or other suitable diluent, withdrawing the indicated dose.
To prepare solutions for intravenous infusion, first prepare the solution for injection as directed. This solution may then be added to indicated amounts of 5% dextrose in water, isotonic saline solution, or 5% dextrose in isotonic saline solution.
From a microbiological point of view, unless the method of opening/reconstitution/dilution precludes the risk of microbial contamination, the product should be used immediately. If not used immediately, in-use storage times and conditions are the responsibility of the user.
Chemical and physical stability of the further diluted product has been demonstrated within 4 hours of preparation if stored below 25°C or within 24 hours of preparation if stored at 2°C to 8°C. In pediatric patients, the initial dose of methylprednisolone may vary depending on the specific disease entity being treated.
2 to 48 mg/m 2 bsa/day). The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone, or methylprednisolone in pediatric patients whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses.
It is further recommended that short course, or "burst" therapy, be continued until the patient achieves a peak expiratory flow rate of 80% of his or her personal best or until symptoms resolve. This usually requires 3 to 10 days of treatment, although it can take longer.
There is no evidence that tapering the dose after improvement will prevent a relapse. Dosage may be reduced for infants and children but should be governed more by the severity of the condition and response of the patient than by age or size.
5 mg per kg every 24 hours. Dosage must be decreased or discontinued gradually when the drug has been administered for more than a few days. If a period of spontaneous remission occurs in a chronic condition, treatment should be discontinued.
Routine laboratory studies, such as urinalysis, two-hour postprandial blood sugar, determination of blood pressure and body weight, and a chest X-ray should be made at regular intervals during prolonged therapy. Upper GI X-rays are desirable in patients with an ulcer history or significant dyspepsia.
In treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of methylprednisolone for a week followed by 64 mg every other day for 1 month have been shown to be effective (see PRECAUTIONS, Neurologic-psychiatric ).
75 Methylprednisolone, 4 These dose relationships apply only to oral or intravenous administration of these compounds. When these substances or their derivatives are injected intramuscularly or into joint spaces, their relative properties may be greatly altered.
This is not medical advice. Consult a qualified healthcare professional.
Most-reported reactions to the US regulator (12 mo to June 4, 2026): 11,608 reports total. [4]
Off Label Use 3,058
Drug Ineffective 1,612
Condition Aggravated 849
Pain 763
Headache 717
Nausea 694
Rash 669
Fatigue 659
Hypertension 636
Pneumonia 636
Infusion Related Reaction 586
Dyspnoea 560
Side effects & warnings
USOfficial regulatory label· Adverse reactions· revised February 13, 2026[3]
ADVERSE REACTIONS
The following adverse reactions have been reported with methylprednisolone sodium succinate or other corticosteroids: Allergic reactions: Allergic or hypersensitivity reactions, anaphylactoid reaction, anaphylaxis, angioedema.
Acne, allergic dermatitis, burning or tingling (especially in the perineal area after intravenous injection), cutaneous and subcutaneous atrophy, dry scaly skin, ecchymoses and petechiae, edema, erythema, hyperpigmentation, hypopigmentation, impaired wound healing, increased sweating, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.
Endocrine:
Decreased carbohydrate and glucose tolerance, development of cushingoid state, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients.
Abdominal distention, bowel/bladder dysfunction (after intrathecal administration), elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis.
Hepatobiliary:
Hepatitis (see WARNINGS , Drug-Induced Liver Injury ).
Metabolic:
Negative nitrogen balance due to protein catabolism.
Musculoskeletal:
Aseptic necrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, postinjection flare (following intra-articular use), steroid myopathy, tendon rupture, vertebral compression fractures.
Neurologic/Psychiatric:
Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo.
Arachnoiditis, meningitis, paraparesis/paraplegia, and sensory disturbances have occurred after intrathecal administration (see WARNINGS, Neurologic ).
Ophthalmic:
Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, rare instances of blindness associated with periocular injections.
Vascular:
Flushing.
Other:
Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, injection site infections following non-sterile administration (see WARNINGS ), malaise, moon face, weight gain.
To report SUSPECTED ADVERSE REACTIONS, contact Hikma Pharmaceuticals USA Inc. gov/medwatch.
USOfficial regulatory label· Warnings and precautions· revised February 13, 2026[3]
WARNINGS
Serious Neurologic Adverse Reactions with Epidural Administration Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. 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. The safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use.
General Reconstituted methylprednisolone sodium succinate sterile powder contains benzyl alcohol, which is potentially toxic when administered locally to neural tissue . Exposure to excessive amounts of benzyl alcohol has been associated with toxicity (hypotension, metabolic acidosis), particularly in neonates, and an increased incidence of kernicterus, particularly in small preterm infants.
There have been rare reports of deaths, primarily in preterm infants, associated with exposure to excessive amounts of benzyl alcohol. The amount of benzyl alcohol from medications is usually considered negligible compared to that received in flush solutions containing benzyl alcohol.
Administration of high dosages of medications containing this preservative must take into account the total amount of benzyl alcohol administered. The amount of benzyl alcohol at which toxicity may occur is not known. If the patient requires more than the recommended dosages or other medications containing this preservative, the practitioner must consider the daily metabolic load of benzyl alcohol from these combined sources (see PRECAUTIONS, Pediatric Use ).
Injection of methylprednisolone sodium succinate may result in dermal and/or subdermal changes forming depressions in the skin at the injection site. In order to minimize the incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections.
Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy. Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy (see ADVERSE REACTIONS ). In patients receiving the 40 mg presentation of methylprednisolone sodium succinate for injection during the treatment for acute allergic conditions and where these symptoms worsen or any new allergic symptoms occur, consideration should be given to the potential for hypersensitivity reactions to cow’s milk ingredients (see CONTRAINDICATIONS ).
This is not medical advice. Consult a qualified healthcare professional.
Who should not take it
USOfficial regulatory label· Contraindications· revised February 13, 2026[3]
CONTRAINDICATIONS
Methylprednisolone Sodium Succinate Sterile Powder is contraindicated: in systemic fungal infections and patients with known hypersensitivity to the product and its constituents; The methylprednisolone sodium succinate for injection 40 mg presentation includes lactose monohydrate produced from cow’s milk.
This presentation is therefore contraindicated in patients with a known or suspected hypersensitivity to cow’s milk or its components or other dairy products because it may contain trace amounts of milk ingredients. for intrathecal administration.
Reports of severe medical events have been associated with this route of administration. Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura. Additional contraindication for the use of Methylprednisolone Sodium Succinate Sterile Powder preserved with benzyl alcohol: Formulations preserved with benzyl alcohol are contraindicated for use in premature infants (see WARNINGS and PRECAUTIONS, Pediatric Use ).
This is not medical advice. Consult a qualified healthcare professional.
Clinical assessment of disease activity may be needed during withdrawal. If the disease is unlikely to relapse on withdrawal of systemic corticosteroids, but there is uncertainty about HPA suppression, the dose of systemic corticosteroid may be reduced rapidly to physiological doses.
Once a daily dose of 6 mg methylprednisolone is reached, dose reduction should be slower to allow the HPA-axis to recover.
The following precautions apply for parenteral corticosteroids:
Following intra-articular injection, the occurrence of a marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis. If this complication occurs and the diagnosis of sepsis is confirmed, appropriate antimicrobial therapy should be instituted.
Local injection of a steroid into a previously infected joint is to be avoided. Intra-articular corticosteroids are associated with a substantially increased risk of inflammatory response in the joint, particularly bacterial infection introduced with the injection.
Charcot-like arthropathies have been reported particularly after repeated injections. Appropriate examination of any joint fluid present is necessary to exclude any bacterial infection, prior to injection. Corticosteroids should not be injected into unstable joints.
Sterile technique is necessary to prevent infections or contamination. The slower rate of absorption by intramuscular administration should be recognised. Immunosuppressant Effects/Increased Susceptibility to Infections Corticosteroids may increase susceptibility to infection, may mask some signs of infection, exacerbate existing infections, increase the risk of reactivation or exacerbation of latent infections and new infections may appear during their use.
Suppression of the inflammatory response and immune function increases the susceptibility to fungal, viral and bacterial infections and their severity. The clinical presentation may often be atypical and may reach an advanced stage before being recognised.
With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Do not use intra-synovially, intrabursally or intratendinous administration for local effect in the presence of acute infection.
Monitor for the development of infection and consider withdrawal of corticosteroids or dosage reduction as needed. Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals.
Chickenpox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. Chickenpox is of serious concern since this normally minor illness may be fatal in immunosuppressed patients.
Patients (or parents of children) without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and if exposed they should seek urgent medical attention. Passive immunization with varicella/zoster immunoglobin (VZIG) is needed by exposed non-immune patients who are receiving systemic corticosteroids or who have used them within the previous 3 months; this should be given within 10 days of exposure to chickenpox.
If a diagnosis of chickenpox is confirmed, the illness warrants specialist care and urgent treatment. Corticosteroids should not be stopped and the dose may need to be increased. Live vaccines should not be given to individuals with […]
• Caution is recommended with prolonged corticosteroid treatment in the elderly due to a potential increased risk for osteoporosis, as well as increased risk for fluid retention with possible resultant hypertension. 3 Pediatrics). 2 Recommended Dose and Dosage Adjustment • Corticosteroid therapy is an adjunct to, and not replacement for, conventional therapy.
, shock states), the recommended dose of Methylprednisolone Sodium Succinate for Injection, USP is 30 mg per kg, given intravenously over Methylprednisolone Sodium Succinate for Injection, USP Page 7 of 42 a period of at least 30 minutes.
This large dose may be repeated every 4- 6 hours for up to 48 hours. • In other indications, initial dosage will vary from 10 to 500 mg depending on the clinical problem being treated. Larger doses may be required for short-term management of severe, acute conditions.
, doses greater than 250 mg). Subsequent doses may be given intravenously or intramuscularly at intervals dictated by the patient's response and clinical condition. • Methylprednisolone Sodium Succinate in doses of 40 to 120 mg administered as retention enemas or by continuous drip three to seven times weekly for periods of two or more weeks have been shown to be a useful adjunct in the treatment of some patients with ulcerative colitis.
Many patients can be controlled with 40 mg of Methylprednisolone Sodium Succinate for Injection, USP administered in from 1 to 10 fluid ounces of water depending on the degree of involvement of the inflamed colonic mucosa. Other accepted therapeutic measures should, of course, be instituted.
3 Reconstitution Parenteral Products: DIRECTIONS FOR RECONSTITUTION USING THE FLIP-OFF VIALS 1. Remove the protective plastic flip-off seal. 2. Swab the rubber stopper with an antiseptic solution and introduce the required quantity of the diluent by means of a syringe into the vial.
3. Shake the vial thoroughly to dissolve the powder content. 4. Withdraw the dose in the usual manner with the help of a syringe Reconstitute with Sterile Water for Injection, or, if required, sterile Bacteriostatic Water for Injection as follows: Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration, whenever solution and container permit.
5 mg/mL Compatibility The compatibility and stability of Methylprednisolone Sodium Succinate for Injection, USP , in solutions and with other drugs in intravenous […]
If appropriate, administration of methylprednisolone sodium succinate for injection should be stopped, and the patient’s condition should be treated accordingly. Alternative treatments, including the use of corticosteroid formulations that do not contain ingredients produced from cow’s milk, should be considered for acute allergy management, where appropriate.
Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy who are subjected to any unusual stress before, during, and after the stressful situation. Results from one multicenter, randomized, placebo-controlled study with methylprednisolone hemisuccinate, an intravenous corticosteroid, showed an increase in early (at 2 weeks) and late (at 6 months) mortality in patients with cranial trauma who were determined not to have other clear indications for corticosteroid treatment.
High doses of systemic corticosteroids, including methylprednisolone sodium succinate, should not be used for the treatment of traumatic brain injury. Cardio-renal Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.
These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium excretion. Literature reports suggest an apparent association between the use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction; therefore, therapy with corticosteroids should be used with great caution in these patients.
There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure (see CONTRAINDICATIONS and PRECAUTIONS , Drug Interactions , Amphotericin B injection and potassium-depleting agents ).
Endocrine Hypothalamic-pituitary adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia. Monitor patients for these conditions with chronic use. Corticosteroids can produce reversible HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment.
Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted.
Immunosuppression and Increased Risk of Infection Corticosteroids, including Methylprednisolone Sodium Succinate, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens.
Corticosteroids can:
Reduce resistance to new infection Exacerbate existing infections Increase the risk of disseminated infections Increase the risk of reactivation or exacerbation of latent infections Mask some signs of infection Corticosteroid-associated infections can be mild but can be severe and at times fatal.
The rate of infectious complications increases with increasing corticosteroid dosages. A study has failed to establish the efficacy of methylprednisolone sodium succinate in the treatment of sepsis syndrome and septic shock. , patients with elevated serum creatinine levels or patients who develop secondary infections after methylprednisolone sodium succinate).
Monitor for the development of infection and consider methylprednisolone sodium succinate withdrawal or dosage reduction as needed. Tuberculosis If methylprednisolone sodium succinate is used to treat a condition in patients with latent tuberculosis or tuberculin reactivity, reactivation of the disease may occur.
Closely monitor such patients for reactivation. During prolonged methylprednisolone sodium succinate therapy, patients with latent tuberculosis or tuberculin reactivity should receive chemoprophylaxis. Varicella Zoster and Measles Viral Infections Varicella and measles can have a serious or even fatal course in non-immune patients taking corticosteroids, including methylprednisolone sodium succinate.
In corticosteroid-treated patients who have not had these diseases or are non-immune, particular care should be taken to avoid exposure to varicella and measles: If a methylprednisolone sodium succinate treated patient is exposed to varicella, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated.
If varicella develops, treatment with antiviral agents may be considered. If a methylprednisolone sodium succinate treated patient is exposed to measles, prophylaxis with immunoglobulin (IG) may be indicated. Hepatitis B Virus Reactivation Hepatitis B virus reactivation can occur in patients who are hepatitis B carriers treated with immunosuppressive dosages of corticosteroids, including methylprednisolone sodium succinate.
Reactivation can also occur infrequently in corticosteroid-treated patients who appear to have resolved hepatitis B infection. , prolonged) treatment with methylprednisolone sodium succinate. For patients who show evidence of hepatitis B infection, recommend consultation with physicians with expertise in managing hepatitis B regarding monitoring and consideration for hepatitis B antiviral therapy.
Fungal Infections Corticosteroids, including methylprednisolone sodium succinate, may exacerbate systemic fungal infections; therefore, avoid methylprednisolone sodium succinate use in the presence of such infections unless methylprednisolone sodium succinate is needed to control drug reactions.
For patients on chronic methylprednisolone sodium succinate therapy who develop systemic fungal infections, methylprednisolone sodium succinate withdrawal or dosage reduction is recommended. Amebiasis Corticosteroids, including methylprednisolone sodium succinate, may activate latent amebiasis.
Therefore, it is recommended that latent amebiasis or active amebiasis be ruled out before initiating methylprednisolone sodium succinate in patients who have spent time in the tropics or patients with unexplained diarrhea. Strongyloides Infestation Corticosteroids, including methylprednisolone sodium succinate, should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation.
In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.
Cerebral Malaria Avoid corticosteroids, including methylprednisolone sodium succinate, in patients with cerebral malaria. Drug-Induced Liver Injury Rarely, high doses of cyclically pulsed intravenous methylprednisolone (usually for the treatment of exacerbations of multiple sclerosis at doses of 1 gram/day) can induce a toxic form of acute hepatitis.
The time to onset of this form of steroid-induced liver injury can be several weeks or longer. Resolution has been observed after discontinuation of treatment. However, serious liver injury can occur, sometimes resulting in acute liver failure and death.
Discontinue intravenous methylprednisolone if toxic hepatitis occurs. Since recurrence has occurred after re-challenge, avoid use of high dose intravenous methylprednisolone in patients with a history of toxic hepatitis caused by methylprednisolone.
Vaccination Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines can not be predicted.
, for Addison’s disease. Neurologic Reports of severe medical events have been associated with the intrathecal route of administration (see ADVERSE REACTIONS , Gastrointestinal and Neurologic/Psychiatric ). Ophthalmic Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.
The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should be used cautiously in patients with ocular herpes simplex because of corneal perforation.
Corticosteroids should not be used in active ocular herpes simplex. Kaposi's Sarcoma Kaposi’s sarcoma has been reported to occur in patients receiving corticosteroid therapy, most often for chronic conditions. Discontinuation of corticosteroids may result in clinical improvement of Kaposi’s sarcoma.