Corticosteroid — IV Pregnancy: Use with caution; prednisolone preferred in pregnancy (less placental transfer)

Methylprednisolone

Brand names: Solu-Medrone

Adult dose

Dose: 1-2 g IV (spinal cord injury); 500 mg-1 g IV (severe asthma/exacerbation); 125 mg IV (anaphylaxis adjunct)

Route: Intravenous

Frequency: Once daily for defined course; anaphylaxis: single dose

Max: 2 g/day

Acute spinal cord injury: 30 mg/kg IV bolus over 15 min, then 5.4 mg/kg/hr for 23 hours (NASCIS II protocol — use remains controversial; specialist decision). Severe asthma: 125-500 mg IV once daily. Anaphylaxis: 200 mg IV after adrenaline

Paediatric dose

Dose: 1-2 mg/kg IV (severe asthma); 30 mg/kg (spinal cord injury, specialist only) mg/kg

Route: IV

Frequency: Once daily or single dose

Max: 1 g/day (asthma)

Severe asthma: 1-2 mg/kg IV once daily (max 60 mg). Spinal injury: seek specialist opinion. Anaphylaxis: 2 mg/kg IV

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Severe asthma: 1-2 mg/kg IV once daily (max 60 mg). Spinal injury: seek specialist opinion. Anaphylaxis: 2 mg/kg IV

Clinical pearls

4x more potent than prednisolone and 5x more potent than hydrocortisone on an mg basis — dose conversions are critical
NASCIS spinal cord injury protocol remains controversial — benefit limited to specific timing windows (within 8 hours); not universally recommended; NICE and AOSPINE do not routinely endorse
Hyperglycaemia is a predictable effect with high-dose IV steroids — monitor glucose 4-hourly; insulin sliding scale may be needed
In life-threatening asthma: IV methylprednisolone not superior to oral prednisolone in published evidence when oral route is possible — IV reserved for patients unable to swallow
Sodium succinate formulation (Solu-Medrone): requires reconstitution; some formulations contain benzyl alcohol — avoid in neonates

Contraindications

Systemic infections (without antimicrobial cover)
Live vaccines

Side effects

Hyperglycaemia (rapid onset with IV)
Hypertension
Fluid retention
GI bleeding (with NSAIDs)
Psychiatric effects (mania, psychosis)
Immunosuppression
Hypothalamic-pituitary-adrenal suppression (prolonged use)

Interactions

NSAIDs (additive GI bleeding risk)
Ciclosporin (mutual interaction — both levels affected)
Antidiabetics (raise blood glucose)
Warfarin (variable effect — monitor INR)

Monitoring

Blood glucose
Blood pressure
Electrolytes (sodium, potassium)
Signs of infection

Reference: BNFc; BNF 90; NASCIS II Protocol; BTS/SIGN Asthma Guidelines; NICE NG80; WAO Anaphylaxis Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways