Methylprednisolone

Glucocorticoid·Endocrinology - Systemic Corticosteroids

Acute exacerbations of Multiple Sclerosis, severe SLE, optic neuritis, acute spinal cord injury

STEROIDSolu-Medrol, Depo-Medrol (LA IM)1000 mgS4TGA

Max Dose

1 g/day (Pulse)

Half-life

2-3 h

Psychosis

HIGH RISK

Anti-inflam

POTENT

Rapid Summary

Overview

Highly potent IV glucocorticoid. Has zero mineralocorticoid (salt-retaining) activity. Used for massive 'pulse' therapy to rapidly crush severe autoimmune flares.

Maximum Dose

Max 1 g/day (1000 mg) for 3-5 days strictly for pulse therapy.

Clinical Focus

Massive 1g IV doses frequently cause severe, acute steroid-induced psychosis and massive blood sugar spikes.

Bottom Line

Methylprednisolone is a potent IV corticosteroid for acute MS relapses and severe inflammatory conditions, but high-dose pulse therapy carries cardiac arrhythmia risk and requires slow infusion.

Formulation & Access

Brand Names

Solu-Medrol, Depo-Medrol (LA IM)

Parenteral

Vials (40, 125, 500, 1000 mg powder) for IV infusion.

Prescribing & PBS

Hospital/Specialist supply.

Indications & Use

Primary

TGA

Acute exacerbations of Multiple Sclerosis, severe SLE, optic neuritis, acute spinal cord injury.

Clinical Place

The ultimate 'nuke' for an autoimmune crisis. Avoids the lethal fluid overload that 1g of Hydrocortisone would cause.

Quick reference

Class & Role

Glucocorticoid — Highly potent IV glucocorticoid.

Route / Formulation

Vials (40, 125, 500, 1000 mg powder) for IV infusion. (Solu-Medrol, Depo-Medrol (LA IM))

Usual Dose & Max

IV 1000 mg (1 g) OD infused over 1 hour, for 3 to 5 days. Max 1 g/day (1000 mg) for 3-5 days strictly for pulse therapy.

Key Indication Doses

MS Flare / Optic Neuritis: IV 1000 mg (1 g) OD infused over 1 hour, for 3 to 5 days. Severe Lupus / Vasculitis: IV 500-1000 mg/day for 3 days. Spinal Cord Injury (Controversial): IV 30 mg/kg bolus followed by 5.4 mg/kg/hr (Specialist trauma only).

Best Uses

Methylprednisolone is a potent IV corticosteroid for acute MS relapses and severe inflammatory conditions, but high-dose pulse therapy carries cardiac arrhythmia risk and requires slow infusion.

Avoid / Cautions

Systemic fungal infections, active untreated tuberculosis. Pregnancy Category A, but high doses risk fetal growth restriction.

Key Risks

Neurological: Steroid psychosis, mania, severe insomnia, delirium. (Occurs in ~5-10% of patients receiving 1g pulses). Metabolic: Extreme hyperglycemia (often requiring temporary insulin infusions even in non-diabetics). Cardiovascular: Arrhythmias if infused too rapidly (Must infuse 1g over at least 60 mins).

Key Interactions

Macrolides (Clarithromycin) and Azoles inhibit CYP3A4, blocking methylprednisolone clearance and worsening toxicity.

Monitoring

Strict QID BSL monitoring. Inform the patient and family about the risk of acute mood changes or hallucinations. Monitor U&E (potassium can still drop despite low mineralocorticoid activity).

Clinical Pearl

If you give a patient 1g of Methylprednisolone for 3 days, you do NOT need to taper them down. The HPA axis does not permanently suppress after only 3 days. You can stop the drug cold-turkey without causing an adrenal crisis.

Access

Solu-Medrol, Depo-Medrol (LA IM)

Brand: Solu-Medrol, Depo-Medrol (LA IM)

Methylprednisolone

Glucocorticoid·Endocrinology - Systemic Corticosteroids

Acute exacerbations of Multiple Sclerosis, severe SLE, optic neuritis, acute spinal cord injury

STEROIDSolu-Medrol, Depo-Medrol (LA IM)1000 mgS4TGA

Max Dose

1 g/day (Pulse)

Half-life

2-3 h

Psychosis

HIGH RISK

Anti-inflam

POTENT

Rapid Summary

Overview

Highly potent IV glucocorticoid. Has zero mineralocorticoid (salt-retaining) activity. Used for massive 'pulse' therapy to rapidly crush severe autoimmune flares.

Maximum Dose

Max 1 g/day (1000 mg) for 3-5 days strictly for pulse therapy.

Clinical Focus

Massive 1g IV doses frequently cause severe, acute steroid-induced psychosis and massive blood sugar spikes.

Bottom Line

Methylprednisolone is a potent IV corticosteroid for acute MS relapses and severe inflammatory conditions, but high-dose pulse therapy carries cardiac arrhythmia risk and requires slow infusion.

Formulation & Access

Brand Names

Solu-Medrol, Depo-Medrol (LA IM)

Parenteral

Vials (40, 125, 500, 1000 mg powder) for IV infusion.

Prescribing & PBS

Hospital/Specialist supply.

Indications & Use

Primary

TGA

Acute exacerbations of Multiple Sclerosis, severe SLE, optic neuritis, acute spinal cord injury.

Clinical Place

The ultimate 'nuke' for an autoimmune crisis. Avoids the lethal fluid overload that 1g of Hydrocortisone would cause.

Quick reference

Class & Role

Glucocorticoid — Highly potent IV glucocorticoid.

Route / Formulation

Vials (40, 125, 500, 1000 mg powder) for IV infusion. (Solu-Medrol, Depo-Medrol (LA IM))

Usual Dose & Max

IV 1000 mg (1 g) OD infused over 1 hour, for 3 to 5 days. Max 1 g/day (1000 mg) for 3-5 days strictly for pulse therapy.

Key Indication Doses

Best Uses

Methylprednisolone is a potent IV corticosteroid for acute MS relapses and severe inflammatory conditions, but high-dose pulse therapy carries cardiac arrhythmia risk and requires slow infusion.

Avoid / Cautions

Systemic fungal infections, active untreated tuberculosis. Pregnancy Category A, but high doses risk fetal growth restriction.

Key Risks

Key Interactions

Macrolides (Clarithromycin) and Azoles inhibit CYP3A4, blocking methylprednisolone clearance and worsening toxicity.

Monitoring

Strict QID BSL monitoring. Inform the patient and family about the risk of acute mood changes or hallucinations. Monitor U&E (potassium can still drop despite low mineralocorticoid activity).

Clinical Pearl

Access

Solu-Medrol, Depo-Medrol (LA IM)

Brand: Solu-Medrol, Depo-Medrol (LA IM)