Methylprednisolone (Respiratory)

Dosage requirements are variable and must be individualised on the basis of the disease being treated, its severity and the patient's response over the entire duration of treatment, with a risk/benefit decision made in each case on an ongoing basis. Determine the maintenance dose by decreasing the initial dosage in small decrements at appropriate intervals until the lowest dose maintaining an adequate clinical response is reached. After long-term therapy the drug must be withdrawn gradually rather than abruptly. Following the initial emergency period, consider a longer-acting injectable or an oral preparation. Other stated adult regimens: intravenous pulses of 250 mg/day or above for a few days (usually <=5 days) may be suitable during exacerbations or conditions unresponsive to standard therapy (rheumatic disorders, systemic lupus erythematosus, oedematous states such as glomerulonephritis or lupus nephritis); acute exacerbations of multiple sclerosis — 500 mg/day or 1 g daily for 3 days (or pulses of 500 or 1000 mg/day for 3 or 5 days), given as an intravenous infusion over at least 30 minutes; graft rejection following transplantation — up to 1 g/day, with 500 mg to 1 g most commonly used for acute rejection, limited to 48-72 hours until the patient stabilises; anaphylactic reactions — give adrenaline or noradrenaline first for immediate haemodynamic effect, followed by intravenous methylprednisolone with other accepted procedures; cerebral oedema due to brain tumour — see the SPC's Schedule A and Schedule B tapering tables (Schedule A: pre-operative 20 mg IM every 3-6 h, during surgery 20-40 mg IV hourly, then post-operatively 20 mg IM 3-hourly for 24 h, then 16, 12, 8 and 4 mg IM 3-hourly for 24 h each, then 4 mg IM 6-hourly then 12-hourly for 24 h each; Schedule B: pre-operative 40 mg IM 6-hourly for 2-3 days, post-operative 40 mg IM 6-hourly for 3-5 days, then 20 mg orally 6-hourly for 1 day, 12 mg 6-hourly for 1 day, 8 mg 8-hourly for 1 day, 4 mg 12-hourly for 1 day and 4 mg for 1 day, aiming to discontinue after a total of 10 days). Elderly: methylprednisolone is primarily used in acute short-term conditions and there is no information to suggest a change in dosage is warranted, but plan treatment bearing in mind the more serious consequences of common corticosteroid side effects in old age, with close clinical supervision. Use the lowest effective dose for the minimum period. 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 and only in the solutions mentioned. Corticosteroid therapy is an adjunct to, not a replacement for, conventional therapy. NOTE ON INTERACTIONS: section 4.5 was not fetched from this SPC, and the openFDA record in this bundle is for 'Dyural 40 Kit' — a kit whose interactions section describes bupivacaine and epinephrine, not methylprednisolone — so it has deliberately NOT been used and no interaction list is given here.

The SPC states a RANGE, not a single per-kilogram value, so dosePerKg is left null rather than fabricating a single number. Status asthmaticus: 'a dosage of 1 to 4 mg/kg/day for 1-3 days is recommended'. Graft rejection reactions 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'. Verify against a children's formulary before prescribing.