Indications for: SOLU-MEDROL
Steroid-responsive disorders where oral therapy not feasible.
See full labeling. Individualize. Initially 10–40mg IV; subsequent doses IV or IM. For high-dose therapy: give 30mg/kg IV over 30mins; may repeat every 4–6hrs for 48hrs.
See full labeling. Individualize. Initially 0.11–1.6mg/kg/day in 3–4 divided doses IV or IM.
Systemic fungal infections. Live vaccines. Depo-Medrol, Solu-Medrol: also premature infants (benzyl alcohol content), intrathecal administration, idiopathic thrombocytopenic purpura (IM preparations). Allergy to cow's milk or other dairy products (Solu-Medrol 40mg).
Not for epidural use; serious neurologic events may occur. Cerebral malaria, optic neuritis: not recommended. Latent or active amebiasis. Strongyloides infestation. Ocular herpes simplex. Cirrhosis. Tuberculosis. If exposed to chickenpox or measles, consider prophylactic passive immune therapy. Ulcerative colitis if perforation pending. Peptic ulcer. Diverticulitis. Intestinal anastomoses. Myasthenia gravis. Systemic sclerosis. Recent MI. CHF. Hypertension. Renal insufficiency. Osteoporosis. Diabetes. Hypothyroidism. Kaposi's sarcoma. Supplement with additional steroids in physiologic stress. May increase risk and mask signs of infection. May cause electrolyte imbalances, adrenocortical insufficiency, psychotic derangements. Alternate, intermittent, or single-daily doses at 8 AM minimize adrenal suppression. Monitor weight, growth, fluid and electrolyte balance. IV: drug-induced liver injury; discontinue if toxic hepatitis occurs. Intrasynovial: avoid previously infected or unstable joints. Solu-Medrol 40mg: consider allergy to cow's milk if new or worsening allergic symptoms occur; use alternatives. Avoid abrupt cessation. Use lowest effective dose. Pregnancy (Cat.C). Nursing mothers: not recommended.
Potentiated by CYP3A4 inhibitors (eg, ketoconazole, macrolides), cyclosporine, estrogens. Antagonized by CYP3A4 inducers (eg, barbiturates, phenytoin, carbamazepine, rifampin), cholestyramine. May potentiate cyclosporine (seizure risk). May antagonize oral anticoagulants (monitor), isoniazid. Increased risk of arrhythmias with digitalis. May need to adjust dose of antidiabetic agents. Monitor for hypokalemia with potassium-depleting drugs (eg, amphotericin B, diuretics). Concomitant neuromuscular blocking agents; increased risk of myopathy. Withdraw anticholinesterase agents at least 24hrs before initiating corticosteroid therapy. Aminoglutethimide may lead to loss of corticosteroid-induced adrenal suppression. Increased GI effects with aspirin, other NSAIDs. Caution with aspirin in hypoprothrombinemia. May suppress reactions to skin tests.
HPA axis suppression, increased susceptibility to infection, glaucoma, cataracts, secondary infections, hypokalemia, hypocalcemia, hypernatremia, hypertension, CHF, psychic disorders, myopathy, osteoporosis, peptic ulcer, dermal atrophy, increased intracranial pressure, carbohydrate intolerance. Parenteral: atrophy, flare at site; intrasynovial: septic arthritis.
Generic Drug Availability:
Tabs, dosepak (YES); Depo-medrol: 20mg/mL (NO); 40mg/mL, 80mg/mL (YES); Solu-medrol: 40mg, 125mg, 500mg, 1g (YES); 2g (NO)
Tabs 2mg—100; 4mg—100, 500; 8mg, 32mg—25; 16mg—50; Dosepak—21; Depo-Medrol multi-dose vial (20mg/mL)—1; (40mg/mL, 80mg/mL)—1, 25; Single-dose vial (40mg/mL, 80mg/mL)—1; Solu-Medrol single-dose vial (500mg, 1g)—1; (40mg, 125mg)—25; Multi-dose vial (500mg, 1g)—1; Vial with diluent (2g)—1