Methylprednisolone

General

• Type: Corticosteroid
• Dosage Forms: IM; IV
• Common Trade Names: Medrol, Solu-Medrol

Adult Dosing

Anaphylaxis

• 125mg IV

Pediatric Dosing

Anaphylaxis

• 2mg/kg

Special Populations

• Pregnancy Rating: C(US)
• Lactation: Oral maternal doses to 8mg daily is safe. Recommend waiting 2-8 hours after infusion of 1 gm.
• Renal Dosing
  • Adult: not available
  • Pediatric: not available
• Hepatic Dosing
  • Adult: not available
  • Pediatric: not available

Controversial Use in Spinal Cord Injury

• Steroid use for spinal cord injury was a controversial treatment during the 1990s and 2000s, with the NASCIS II and III studies reporting positive outcomes in a subgroup analysis of patients who received methylpredisolone within 8 hours of injury. Multiple cochrane reviews performed by the author of the NASCIS trials concluded neurological improvement after injury, but a review of all individual studies demonstrate negative outcomes for both the retrospective and the prospective trials. Most recent guidelines from the Congress of Neurological Surgeons and American Association of Neurological Surgeons discourage against the use of steroids in spinal cord injury, citing harmful side effects including death.

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life: 0.25 hours (IV)
• Metabolism: Hepatic
• Excretion: Urine excretion
• Mechanism of Action: Potent anti-inflammatory properties with minimal mineralocorticoid activity

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Acute allergic reaction	125mg	Corticosteroid	IV/IM	Adult
Acute asthma exacerbation	1 mg/kg IV q4-6h	Corticosteroid (if unable to tolerate PO)	IV	Adult
Acute respiratory distress syndrome	1mg/kg load, then 1mg/kg/day (d1-14), taper over d15-28	Pulse-dose steroids for early established severe ARDS (Meduri protocol)	IV	Adult
Angioedema	125 mg IV	Corticosteroid (allergic angioedema)	IV	Adult
COPD exacerbation	125 mg IV daily (1-2 mg/kg)	Corticosteroid (IV option)	IV	Adult
Chloramine	125mg IV (adults); 2mg/kg IV (children)	Airway inflammation	IV	Adult
Crohn's disease	20mg IV q6hr	Severe/fulminant flare (inpatient)	IV	Adult
Giant cell arteritis	500-1000mg IV daily x 3 days (pulse dose)	Visual symptoms or suspected GCA with vision loss	IV	Adult
Immune thrombocytopenic purpura	1g	Severe bleeding with high-dose steroids	IV	Adult
Immune thrombocytopenic purpura	30mg/kg	Severe bleeding with high-dose steroids	IV	Pediatric
Orbital compartment syndrome	250mg IV	Adjunctive to lateral canthotomy	IV	Adult
Peritonsillar abscess	125 mg	Adjunct steroid (pain/inflammation)	IV	Adult
Retrobulbar hemorrhage	250mg IV	Adjunctive to cantholysis	IV	Adult
Systemic lupus erythematosus	1-2mg/kg IV	Acute SLE flare management	IV	Adult
Thrombotic thrombocytopenic purpura	125 mg IV (or prednisone 1 mg/kg PO)	Glucocorticoid (adjunct to plasmapheresis)	IV/PO	Adult