Methylprednisolone
Solu-Medrol / Medrol (oral)
corticosteroid systemicIV · IM · oralOnset: 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
Clinical Pearls
- IV methylprednisolone preferred for inpatient asthma/COPD exacerbation over oral prednisone
- Equivalent dose: 4 mg methylprednisolone = 5 mg prednisone = 20 mg cortisol
- Short courses (<7–14 days) typically do not require tapering
- Hyperglycemia is common and requires sliding scale or insulin adjustment
- Does NOT cause immediate bronchodilation — adjunct to bronchodilators
Mnemonic
💡 Solu-Medrol = SOLUtion for Medrol (IV route): hospital-grade steroids
NBRC High-Yield
- IV corticosteroid for acute asthma and COPD exacerbation
- Onset 1–4 hours — not for immediate bronchodilation
- Monitor glucose, K+, and blood pressure
- Short courses do not need tapering
- 4 mg methylprednisolone = 5 mg prednisone (steroid equivalence)