Steroid-responsive disorders where oral therapy not feasible.
Initially 10–40mg IV; subsequent doses IV or IM.
Infants: not recommended. Others: 0.5mg/kg per day or more IV or IM.
Systemic fungal infections. Live vaccines. Depo-Medrol: also premature infants, intrathecal administration. Solu-Medrol: also premature infants.
Tuberculosis. Latent amebiasis. Strongyloides infestation. Hypothyroidism. Ocular herpes simplex. Cirrhosis. Renal insufficiency. If exposed to chickenpox or measles, consider prophylactic passive immune therapy. Ulcerative colitis if perforation pending. Peptic ulcer. Diverticulitis. Intestinal anastomoses. Myasthenia gravis. Hypertension. Osteoporosis. Diabetes. Kaposi's sarcoma. Supplement with additional steroids in physiologic stress. Avoid abrupt cessation. May increase risk and mask signs of infection. May cause electrolyte imbalances, adrenocortical insufficiency, psychotic derangements. Alternate, intermittent, or single-daily doses at 8AM minimize adrenal suppression. Use lowest effective dose. Monitor weight, growth, fluid and electrolyte balance. Intrasynovial: avoid previously infected or unstable joints. Pregnancy. Nursing mothers.
Potentiated by CYP3A4 inhibitors (eg, troleandomycin, ketoconazole). Antagonized by CYP3A4 inducers (eg, barbiturates, phenytoin, rifampin). Avoid cyclosporine and aspirin in hypoprothrombinemia. May antagonize anticoagulants (monitor). May need to adjust dose of antidiabetic agents.
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.
Tabs 2mg—100; 8mg, 32mg—25; 16mg—50; Dosepak—21; Depo-Medrol 20mg/mL (5mL)—1; 40mg/mL (5mL, 10mL)—1, 25; 80mg/mL (5mL)—1, 25; Solu-Medrol single-dose vial 40mg (1mL)—1, 25; 125mg (2mL)—25; 500mg (4mL), 1g (8mL)—1; Multi-dose vial 500mg (8mL), 1g (16mL)—1