methylprednisolone acetate: clinical use

Prescribing considerations

• Confirm that the intended route is licensed; avoid intravascular placement and do not use intravenously, intrathecally or epidurally.
• Recognise that systemic absorption and systemic adverse effects can follow local injection.
• Exclude infection before injecting a joint, bursa or tendon sheath and maintain strict aseptic technique.
• Do not inject unstable joints, previously infected joints or the Achilles tendon; place tendon-sheath injections around, not into, the tendon.
• Use each vial once and discard the remainder; do not mix the suspension with another fluid.
• Consider the patient’s total corticosteroid exposure and whether a Steroid Treatment Card is required.

Contraindications and cautions

• Hypersensitivity to methylprednisolone acetate or an excipient
• Systemic infection without appropriate anti-infective treatment
• Intravenous administration
• Intrathecal administration
• Live or live-attenuated vaccination during immunosuppressive corticosteroid exposure

Monitoring

• Clinical response and evidence of systemic corticosteroid toxicity
• New, worsening or masked infection, including relevant exposure to chickenpox, shingles or measles
• Blood glucose in people with diabetes or at risk of hyperglycaemia
• Blood pressure, fluid status and potassium where systemic exposure is clinically important
• Mood, behaviour, sleep and cognition; act promptly on suicidal thinking or psychosis
• Visual symptoms and intraocular complications when indicated
• Adrenal suppression where exposure is prolonged, repeated or substantial
• Growth and development in children receiving prolonged systemic treatment
• Renal function and blood pressure in systemic sclerosis
• Clotting results when used with vitamin K antagonists

Clinical pharmacology

Methylprednisolone acetate is a synthetic glucocorticoid with anti-inflammatory and immunosuppressive activity. The acetate suspension is less soluble than methylprednisolone, producing slower absorption from the injection depot. Absorbed methylprednisolone is widely distributed and is metabolised mainly in the liver through CYP3A4.

Formulation and product differences

• The selected product is a white aqueous depot suspension rather than a solution.
• It supports local injection and deep intramuscular administration but is unsuitable for intravenous or intrathecal use.
• Each vial is single use, must not be mixed with another fluid and is essentially sodium-free.
• The depot formulation permits slower release than soluble methylprednisolone formulations.

Injection

Route: Parenteral

Strengths: 40 mg/mL