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Glomerulonephritis / Vasculitis Pregnancy: §4.6: methylprednisolone crosses the placenta. 'There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate in man, however, when administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of intra-uterine growth retardation.' 'Since adequate human reproductive studies have not been done with methylprednisolone sodium succinate, this medicinal product should be used during pregnancy only after a careful assessment of the benefit-risk ratio to the mother and fetus. In humans, the risk of low birth weight appears to be dose related and may be minimized by administering lower corticosteroid doses.' Infants born to mothers who received substantial doses during pregnancy 'must be carefully observed and evaluated for signs of adrenal insufficiency'. Cataracts have been observed in infants of mothers on long-term treatment. Breast-feeding: 'doses of up to 40 mg daily of methylprednisolone are unlikely to cause systemic effects in the infant' — note that a pulse dose greatly exceeds this, so the benefit-risk assessment the SPC requires applies. Fertility: corticosteroids impair fertility in animal studies and can cause menstrual irregularities in women.

Methylprednisolone IV Pulse (Nephrology)

Brand names: Solu-Medrone

Intravenous pulse methylprednisolone is a high-potency glucocorticoid regimen used in nephrology to induce rapid immunosuppression in severe glomerular and immune-mediated renal disease, such as crescentic glomerulonephritis and vasculitis.

Adult dose

Dose: Glomerulonephritis / lupus nephritis, IV pulse: 250 mg/day or above for a few days (usually ≤ 5 days). §4.2 verbatim: 'Methylprednisolone IV pulses, consisting of administration of 250 mg/day or above for a few days (usually ≤ 5 days) may be suitable during exacerbation episodes or conditions unresponsive to standard therapy, such as: rheumatic disorders, systemic lupus erythematosus, edematous states, such as glomerulonephritis or lupus nephritis.'
Route: Intravenous infusion. §4.2 verbatim: 'When administering methylprednisolone in high doses intravenously it should be given over a period of at least 30 minutes. Doses up to 250 mg should be given intravenously over a period of at least five minutes.' §4.2 also states: 'This medicine is not recommended for intrathecal or epidural use.' For infusion, 'the initially prepared solution may be diluted with 5% dextrose in water, isotonic saline solution, or 5% dextrose in isotonic saline solution' and 'methylprednisolone should be administered separately, only in the solutions mentioned'.
Frequency: Once daily, 'for a few days (usually ≤ 5 days)' (§4.2)
SCOPE — this is the SPC's IV-PULSE regimen for oedematous states including glomerulonephritis and lupus nephritis, which is this page's primary indication (nephrology specialty file; page name 'Methylprednisolone IV Pulse (Nephrology)'). ⚠️ VASCULITIS IS NOT SEPARATELY NAMED: the page's category reads 'Glomerulonephritis / Vasculitis', but the SPC's pulse list names only 'rheumatic disorders, systemic lupus erythematosus, edematous states, such as glomerulonephritis or lupus nephritis'. ANCA-associated or systemic vasculitis is not named anywhere in the retrieved §4.2, so the dose above is published for the glomerulonephritis / lupus nephritis half of the page only. ⚠️ MAXDOSE IS DELIBERATELY EMPTY: §4.2 states '250 mg/day or above' for these indications and gives NO numeric ceiling for them. The SPC's other explicit ceilings belong to OTHER indications and must not be imported here — 'up to 1 g/day' and '500 mg to 1 g most commonly used' are for GRAFT REJECTION after transplantation, and '500 or 1000 mg/day for 3 or 5 days' is for MULTIPLE SCLEROSIS unresponsive to standard therapy. The general framing sentence is 'Dosage should be varied according to the severity of the condition, initial dosage will vary from 10 to 500 mg.' The label says 'at least 30 minutes' and sets no upper bound. GENERAL §4.2 PRINCIPLES: 'Dosage requirements are variable and must be individualized on the basis of the disease under treatment, its severity and the response of the patient over the entire duration of treatment'; 'Undesirable effects may be minimised by using the lowest effective dose for the minimum period'; 'If after long-term therapy the drug is to be stopped, it needs to be withdrawn gradually rather than abruptly'; 'Corticosteroid therapy is an adjunct to, and not replacement for, conventional therapy.' §4.5 was not retrieved (§4.4 truncated before it), so no interactions array is published.

Paediatric dose

Route: Intravenous infusion
Frequency: Not applicable — no paediatric figure for this page's indication
Max: Not applicable
NO PAEDIATRIC DOSE IS PUBLISHED FOR THIS PAGE'S INDICATION. §4.2's paediatric paragraph gives figures for two OTHER indications only, and neither is glomerulonephritis, lupus nephritis or vasculitis. Quoted here for the editor and explicitly NOT the dose for this page: graft rejection following transplantation — 'a dosage of 10 to 20 mg/kg/day for up to 3 days, to a maximum of 1 g/day, is recommended'; status asthmaticus — 'a dosage of 1 to 4 mg/kg/day for 1-3 days is recommended'. Note that both are PER-DAY rates (mg/kg/DAY), not per-dose values. A paediatric glomerulonephritis / lupus nephritis pulse dose must be taken from a paediatric nephrology source or a children's formulary — it is not derivable from this SPC and has not been scaled here.

Dose adjustments

Renal

No renal dose adjustment is stated in the retrieved sections of this SPC. §4.2's only special-population adjustments are the paediatric and elderly paragraphs; neither addresses renal impairment.

Hepatic

Not stated in the product information we used — check the full SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • §4.3 verbatim: 'in patients who have systemic fungal infections unless specific anti-infective therapy is employed and in cerebral oedema in malaria'
  • §4.3 verbatim: 'in patients with known hypersensitivity to methylprednisolone or to any of the excipients listed in section 6.1'
  • §4.3 verbatim: 'Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids.'
  • Not a §4.3 contraindication but a §4.2 route restriction: 'This medicine is not recommended for intrathecal or epidural use.'
  • Not a §4.3 contraindication but a §4.4 restriction: 'The use of corticosteroids in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculous regimen.'

Side effects

  • Infections (§4.8, frequency not known): infection including increased susceptibility and severity with suppression of clinical symptoms and signs; opportunistic infection; recurrence of dormant tuberculosis; peritonitis
  • Endocrine (§4.8): Cushingoid appearance; hypothalamic-pituitary-adrenal axis suppression; steroid withdrawal syndrome (fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules, loss of weight)
  • Metabolic (§4.8): metabolic acidosis; sodium retention; fluid retention; impaired glucose tolerance; hypokalaemic alkalosis; dyslipidaemia; increased insulin or oral hypoglycaemic requirements in diabetics; lipomatosis and epidural lipomatosis; increased appetite with weight gain
  • Psychiatric (§4.8): 'A wide range of psychiatric reactions including affective disorders (such as irritable, euphoric, depressed and labile mood, drug dependence and suicidal thoughts), psychotic reactions (including mania, delusions, hallucinations and schizophrenia), behavioural disturbances, irritability, anxiety, sleep disturbances, and cognitive dysfunction including confusion and amnesia have been reported for all corticosteroids. Reactions may occur in both adults and children. In adults, the frequency of severe reactions was estimated to be 5%-6%.'
  • Nervous system (§4.8): raised intracranial pressure with papilloedema (benign intracranial hypertension); seizure; amnesia; cognitive disorder; dizziness; headache
  • Eye (§4.8): blurred vision (rare); posterior subcapsular cataracts, exophthalmos, glaucoma, papilloedema with possible optic nerve damage, corneal or scleral thinning, exacerbation of ophthalmic viral or fungal disease, chorioretinopathy (frequency not known)
  • Immune / blood (§4.8): drug hypersensitivity including anaphylactic and anaphylactoid reaction; leukocytosis
  • Neoplasms (§4.8): 'Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy. Discontinuation of corticosteroids may result in clinical remission.'
  • Route-specific (§4.8): intrathecal/epidural administration — arachnoiditis, functional gastrointestinal/bladder dysfunction, headache, meningitis, paraparesis/paraplegia, seizure and sensory disturbances (this product is not recommended by those routes)
  • ⚠️ INCOMPLETE — the fetched §4.8 is truncated at the source-fetch limit immediately after the Eye disorders row; cardiac, vascular, gastrointestinal, musculoskeletal and skin reactions listed beyond that point were not retrieved.

Monitoring

  • Monitor for the development of infection and consider withdrawal or dose reduction as needed — corticosteroids may mask signs of infection and the clinical presentation 'may reach an advanced stage before being recognised' (§4.4).
  • Chickenpox and measles exposure: patients (or parents of children) without a definite history of chickenpox should avoid close personal contact with chickenpox or herpes zoster and seek urgent medical attention if exposed. Passive immunisation with varicella/zoster immunoglobulin is needed by exposed non-immune patients receiving systemic corticosteroids or who have used them within the previous 3 months, given within 10 days of exposure (§4.4).
  • Do not give live vaccines to individuals with impaired immune responsiveness; the antibody response to other vaccines may be diminished (§4.4).
  • Screen for and observe latent tuberculosis and tuberculin reactivity — reactivation may occur, and chemoprophylaxis should be given during prolonged therapy (§4.4).
  • Use caution in known or suspected Strongyloides (threadworm) infestation — risk of hyperinfection, widespread larval migration, severe enterocolitis and potentially fatal gram-negative septicaemia (§4.4).
  • Withdraw gradually rather than abruptly after long-term therapy (§4.2).
  • ⚠️ The fetched §4.4 is truncated at the source-fetch limit — cardiac, ophthalmic, gastrointestinal, musculoskeletal and endocrine precautions beyond the Kaposi's sarcoma sentence were not retrieved. Read the full SPC at https://www.medicines.org.uk/emc/product/3066/smpc before prescribing a pulse course.

Clinical monograph

How it works

As a synthetic corticosteroid, it binds glucocorticoid receptors to broadly suppress inflammatory and immune responses, reducing cytokine production and inflammatory cell activity.

Prescribing in practice

  • High-dose pulses can cause serious acute effects including hyperglycaemia, hypertension, fluid retention, infection risk and, rarely, arrhythmia, so patients require close monitoring during and after infusion.
  • Screen for and manage active infection before pulsing, and consider gastroprotection and bone protection as appropriate.
  • It is given intravenously, usually over consecutive days, under specialist supervision.

Monitoring

Monitor blood pressure, blood glucose, fluid balance, electrolytes and for signs of infection during and following pulse therapy.

Counselling the patient

  • You may notice flushing, a metallic taste, raised blood sugars or sleep disturbance around the infusions.
  • Report fever or other signs of infection promptly, as steroids increase infection risk.
  • Do not stop any prescribed continuing steroid abruptly without medical advice.

Evidence & guidelines

Pulsed methylprednisolone is a standard component of induction immunosuppression for severe ANCA-associated vasculitis and rapidly progressive glomerulonephritis.

Reference: KDIGO Vasculitis 2021; KDIGO Lupus Nephritis 2021; NICE NG232; SPC Solu-Medrone; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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