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As adjunctive therapy in life threatening conditions the recommended dose of Methylprednisolone is 30 mg/kg of body weight administered intravenously over a period of at least 30 minutes. This dose may be repeated every 4 hours for up to 48 hours.
Pulse dosing for corticosteroid responsive diseases in exacerbation and/or unresponsive to standard therapy (lupus nephritis, rheumatoid arthritis)-
Suggested schedules:
- Rheumatic disorders: 1 gm/day for one, two, three or four days IV or 1 gm/month for six month IV.
- Systemic lupus erythematosus: 1 gm/day for three days IV.
- Multiple sclerosis: 1 gm/day for three days IV or 1 gm/day for five days IV.
- Oedematous states e.g. glomerulonephritis, lupus nephritis: 30 mg/kg every other day for four days IV or 1 gm/day for three, five or seven days IV. The regimen should be administered over at least 30 minutes, and may be repeated if improvement has not occurred within a week after therapy or as patient’s condition dictates.
Terminal Cancer-Quality of life:
Prospective controlled studies have shown that Methylprednisolone 125 mg administered intravenously daily for up to eight weeks, significantly improves quality of life in patients with terminal cancer.
Prevention of nausea and vomiting associated with cancer chemotherapy-
Mild to moderately emetogenic chemotherapy:
Administer Methylprednisolone 250 mg IV over at least five minutes one hour before chemotherapy, at the initiation of chemotherapy, and at the time of discharge. A chlorinated phenothiazine may also be used with the first dose of Methylprednisolone for increased effect.
Severely emetogenic chemotherapy:
Administer Methylprednisolone 250 mg IV over at least five minutes with appropriate doses of metoclopramide or a butyrophenone one hour before chemotherapy, then Methylprednisolone 250 mg IV at the initiation of chemotherapy and at time of discharge.
Acute spinal cord injury:
Treatment should begin within 8 hours of injury.
- For patients initiated on treatment within 3 hours of injury: Administer 30 mg/kg as an IV bolus over a 15-minute period, followed by a 45-minute pause and then a continuous IV infusion of 5.4 mg/kg/h for 23 hours.
- For patients initiated on treatment within 3 to 8 hours of injury: Administer 30 mg/kg as an IV bolus over a 15 minute period, followed by a 45-minute pause, and then a continuous IV infusion of 5.4 mg/kg/h for 47 hours.
In other indications: Initial dosage will vary from 1000 mg depending on the clinical problem being treated. Larger doses may be required for short term management of severe, acute conditions. The initials dose up to 250 mg should be given intravenously over a period of at least five minutes and if greater than 250 mg, should be given over at least 30 minutes. It should not be less than 0.5 mg per kg every 24 hours. Subsequent doses may be given intravenously or intra-muscularly at intervals dictated by the patient’s response and clinical condition. Corticosteroid therapy is an adjunct to, and not a replacement for conventional therapy.
Dosage may be reduced for infants and children but should be governed more by the severity of the condition and response of the patient than by age or size. It should not be less than 0.5 mg per kg every 24 hours. Methylprednisolone (methylprednisolone sodium succinate) may be administered by intravenous or intra-muscular injection, or by intravenous infusion, the preferred method for initial emergency use being intravenous injection. To administer by intravenous (or intramuscular) injection, prepare solution with the diluents provided.
Use in children: Use in children may cause growth retardation in infancy, childhood and adolescence.
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