corticosteroid systemic

Methylprednisolone

Solu-Medrol / Medrol (oral)

Route: IV · IM · oral
Onset: 1–4 hours (anti-inflammatory effect)
Duration: 18–36 hours

Mechanism of action

Synthetic glucocorticoid. Binds cytoplasmic glucocorticoid receptors → nuclear translocation → modifies transcription. Anti-inflammatory: reduces cytokine production, leukocyte migration, vascular permeability. Relative potency: 5× cortisol.

Dosing

Adult: Acute asthma/COPD: 60–125 mg IV q6–8h × 3–5 days. Less severe: 40–60 mg IV daily. Pulse dosing (severe): 1–2 g/day
Pediatric: 1–2 mg/kg IV q6–8h (asthma exacerbation); max 60 mg/day

Indications

Acute asthma exacerbation (IV in hospitalized patients)
COPD exacerbation
Allergic reactions
Inflammatory conditions
Post-extubation stridor (if planned — controversial)

Contraindications

Systemic fungal infections (without antifungal coverage)
Live virus vaccines
IM injection in ITP

Side effects

Hyperglycemia
Hypertension
Hypokalemia
Fluid retention
GI ulceration
Insomnia/mood changes
Adrenal suppression (prolonged use)
Immunosuppression
Wound healing impairment
Avascular necrosis of femoral head (long-term)

Monitoring parameters

Blood glucose (q4–6h in diabetics; at least daily in non-diabetics)
Blood pressure
Serum potassium
Signs of infection
GI symptoms

Drug interactions

NSAIDs (additive GI ulceration)
Warfarin (variable — may increase or decrease INR)
Oral hypoglycemics/insulin (hyperglycemia counteraction needed)
Live vaccines (immunosuppression contraindication)
CYP3A4 inducers/inhibitors

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