Methylprednisolone

How it works

It binds the intracellular glucocorticoid receptor and modulates transcription of genes involved in inflammation and immunity, suppressing leucocyte function and the production of inflammatory mediators.

Prescribing in practice

• Do not stop prolonged or high-dose therapy abruptly because of the risk of adrenal suppression and Addisonian crisis; the dose must be tapered, and a steroid emergency card and sick-day guidance provided.
• Has minimal mineralocorticoid activity compared with hydrocortisone, so it is less likely to cause fluid retention but is not a first choice for primary adrenal replacement.
• Long-term use increases the risk of osteoporosis, hyperglycaemia, infection, peptic ulceration, mood disturbance and adrenal suppression, so use the lowest effective dose for the shortest time.

Monitoring

Monitor weight, blood pressure, blood glucose, signs of infection and, in prolonged therapy, bone health and growth in children.

Counselling the patient

• Carry a steroid treatment card and never stop the medicine suddenly.
• Seek urgent advice if unwell, feverish or vomiting, as the dose may need to be increased.
• Report symptoms of infection promptly, as steroids can mask them.

Evidence & guidelines

Glucocorticoids are long-established anti-inflammatory and immunosuppressive agents, and MHRA advice highlights the need for steroid emergency cards and structured withdrawal to prevent adrenal crisis.