methylprednisolone sodium succinate: clinical use

Prescribing considerations

• Use as an adjunct, not a replacement, for condition-specific emergency or anti-infective treatment.
• Review infection history and exposure to chickenpox, shingles or measles.
• Assess diabetes, hypertension, heart failure, gastrointestinal ulceration, psychiatric history, glaucoma, osteoporosis, epilepsy and myasthenia gravis.
• Consider adrenal suppression and steroid safety documentation after clinically significant systemic exposure.
• Avoid intrathecal and epidural administration.

Contraindications and cautions

• Hypersensitivity to methylprednisolone or an excipient
• Untreated systemic fungal infection
• Cerebral oedema associated with malaria
• Live or live-attenuated vaccination during immunosuppressive corticosteroid exposure

Monitoring

• New, worsening or reactivated infection
• Blood glucose, blood pressure, fluid balance and electrolytes where clinically relevant
• Mental state, sleep and behavioural changes
• Gastrointestinal bleeding or pancreatitis symptoms
• Vision or intraocular pressure when indicated
• Adrenal suppression after sustained or repeated systemic exposure
• Growth and development in children receiving prolonged treatment
• Cardiac function and structure in premature infants receiving treatment

Clinical pharmacology

A systemic glucocorticoid with strong anti-inflammatory activity and relatively limited mineralocorticoid activity. It is metabolised mainly through CYP3A4 in the liver and excreted as urinary metabolites.

Formulation and product differences

• Both selected products are powders requiring reconstitution before intravenous or intramuscular use.
• The larger selected vial has clinically relevant sodium content; the smaller selected vial is described as essentially sodium-free.
• Reconstituted solution should be used immediately and any remainder discarded.

Injection

Route: Parenteral

Strengths: 40 mg, 125 mg, 500 mg, 1 g