Methylprednisolone

Emergency-relevant points from SPC section 4.2. Administration rate: high intravenous doses should be given over a period of at least 30 minutes; doses up to 250 mg should be given intravenously over at least five minutes. ANAPHYLAXIS: adrenaline or noradrenaline must be administered FIRST for immediate haemodynamic effect, followed by intravenous methylprednisolone sodium succinate with other accepted procedures - the SPC notes evidence that corticosteroids, through their prolonged haemodynamic effect, are of value in preventing recurrent attacks of acute anaphylactic reactions. In sensitivity reactions methylprednisolone is capable of providing relief within one half to two hours. STATUS ASTHMATICUS: 40 mg intravenously, repeated as dictated by patient response; in some asthmatic patients it may be advantageous to administer by slow intravenous drip over a period of hours. ACUTE MULTIPLE SCLEROSIS EXACERBATION: 500 mg/day or 1 g daily for 3 days as an intravenous infusion over at least 30 minutes (SPC also describes pulses of 500 or 1000 mg/day for 3 or 5 days over 30 minutes in MS unresponsive to standard therapy). IV pulses of 250 mg/day or above for a few days (usually 5 days or fewer) may be suitable during exacerbations or conditions unresponsive to standard therapy such as rheumatic disorders, systemic lupus erythematosus and oedematous states (glomerulonephritis, lupus nephritis). GRAFT REJECTION: up to 1 g/day to suppress rejection crises, continued only until the patient's condition has stabilised, usually not beyond 48-72 hours, as prolonged high-dose corticosteroid therapy can cause serious corticosteroid-induced side effects. CEREBRAL OEDEMA due to brain tumour: corticosteroids reduce or prevent oedema; taper the dose to avoid a rebound rise in intracranial pressure, and if brain swelling occurs as the dose is reduced (intracranial bleeding having been ruled out) restart larger and more frequent parenteral doses. Following the initial emergency period, consider a longer-acting injectable or an oral preparation. Dosage must be individualised, with a risk/benefit decision in each case; after long-term therapy withdraw gradually rather than abruptly. Elderly: primarily used in acute short-term conditions with no information to suggest a dosage change is warranted, but plan treatment bearing in mind the more serious consequences of common corticosteroid side effects in old age, with close clinical supervision. For intravenous infusion the initially prepared solution may be diluted with 5% dextrose in water, isotonic saline, or 5% dextrose in isotonic saline; administer separately from other drugs to avoid compatibility problems.

SPC section 4.2 paediatric population gives indication-specific per-kg regimens rather than a single dose: status asthmaticus 1 to 4 mg/kg/day for 1-3 days; graft rejection reactions following transplantation 10 to 20 mg/kg/day for up to 3 days, to a maximum of 1 g/day. No single per-kg value applies across indications, so dosePerKg is left null deliberately. Verify against a children's formulary before prescribing.