Methylprednisolone

About Methylprednisolone

Methylprednisolone is a synthetic glucocorticoid, a class the label says is used mainly for its strong anti-inflammatory effects. The Medrol label lists endocrine disorders; short-term add-on treatment of arthritis flares; lupus and related diseases; severe skin disease; severe allergic conditions not controlled by usual treatment, including asthma, allergic rhinitis, contact and atopic dermatitis and drug reactions; eye inflammation; sarcoidosis and some other lung diseases; blood disorders; palliative care of leukemias and lymphomas; nephrotic syndrome; ulcerative colitis and regional enteritis; acute flares of multiple sclerosis; and certain cases of tuberculous meningitis and trichinosis. Doses start at 4 to 48 mg a day, by condition, and are lowered in small steps to the lowest dose that works. The label equates 4 mg of methylprednisolone with 5 mg of prednisolone and gives the multiple sclerosis regimen as 200 mg of prednisolone a day for a week, then 80 mg every other day for a month.

Methylprednisolone has no boxed warning. It must not be used with a systemic fungal infection or by anyone allergic to the product, and live or live attenuated vaccines are contraindicated at doses that suppress the immune system. The label warns that it can raise the risk of infection and mask its signs; that chickenpox and measles can be serious or fatal in people who are not immune; that latent tuberculosis and hepatitis B can reactivate; that prolonged use can cause cataracts, glaucoma and eye infections; that large doses can raise blood pressure, cause salt and water retention and deplete potassium; and that it can cause osteoporosis, muscle weakness, higher blood sugar, slowed growth in children and psychiatric effects. People under unusual stress, such as surgery, may need more corticosteroid, and adrenal insufficiency after withdrawal can last for months.

The 4 mg Dosepak holds 21 tablets taken over six days: six tablets on the first day, then one fewer each day, to one on the sixth. Unless the prescriber directs otherwise, all six Day 1 tablets are taken on the day the pack is received, at once or split into two or three doses before bedtime. Generic packs also hold 21 tablets of 4 mg, the same tablets sold in bottles, in a different package. Alternate-day therapy, twice the daily dose every other morning, is an option in long-term treatment. The label asks that benefits be weighed against possible hazards in pregnancy and breastfeeding, and that babies born to mothers given substantial doses be watched for low adrenal function. Depo-Medrol and Solu-Medrol are separate products.

Taking Methylprednisolone

How to take it

Exactly as directed, with food or milk to lessen stomach upset. Follow the day-by-day schedule printed on a dose pack. Do not stop long-term treatment on your own; the dose is lowered gradually.

If you miss a dose

MedlinePlus says to ask the prescriber, when you start, what to do about a missed dose and to write it down. If you take it once a day, take a missed dose as soon as you remember, unless the next is nearly due; then skip it. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from heat and moisture (not in the bathroom), out of reach of children. Use a take-back program rather than flushing.

Interactions to know about

Ketoconazole and troleandomycin can raise its levels, and phenobarbital, phenytoin and rifampin lower them. Cyclosporine and methylprednisolone slow each other’s breakdown, and convulsions have been reported with the two together. It can speed the clearance of high-dose aspirin and change the effect of oral blood thinners. Live vaccines are avoided at immune-suppressing doses.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Methylprednisolone differs from pharmacy to pharmacy

Generic tablets are rated equivalent to Medrol in the 4, 8, 16 and 32 mg strengths, so quotes differ mainly by each pharmacy’s fee and markup, while the 2 mg tablet has no rated generic. A prescription that names Medrol and blocks substitution is priced as a brand.

A dose pack is a packaged product of 21 tablets, while loose tablets are counted out, so the two are quoted separately.

Ways to pay less for Methylprednisolone without insurance

• Ask for a generic dose pack or tablets, and check that the prescription does not name Medrol only.
• Ask the prescriber whether 21 loose 4 mg tablets with written instructions would suit you instead of a dose pack, and compare quotes for both.
• Ask the prescriber whether generic prednisone would suit you, particularly if you take a 2 mg dose.
• A dose pack is one short course, so compare more than one pharmacy before it is filled.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Methylprednisolone

1. 1.How do I follow my dose pack, and what if I miss a dose?
2. 2.Should I take it with food or milk, and at what time of day?
3. 3.Will it raise my blood sugar or blood pressure, or affect a vaccine I need?
4. 4.Is it safe with my aspirin, blood thinner, seizure medicine or cyclosporine?

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