Intra-articular corticosteroid + LA Pregnancy: eMC §4.6: adequate human reproductive studies have not been done with methylprednisolone acetate with lidocaine, so this product should be used during pregnancy only after careful assessment of the benefit-risk ratio to the mother and foetus. Methylprednisolone crosses the placenta; the risk of low birth weight appears dose-related, and corticosteroids given for long periods or repeatedly in pregnancy may increase the risk of intra-uterine growth retardation. Neonatal hypoadrenalism may in theory follow prenatal exposure but is rare and usually resolves spontaneously; infants exposed to substantial doses must be observed for adrenal insufficiency. Cataracts have been observed in infants born to mothers on long-term corticosteroids. Lidocaine readily crosses the placenta and use of local anaesthetics during labour and delivery may be associated with adverse effects on mother and foetus. The product contains benzyl alcohol as a preservative, which can cross the placenta. Breast-feeding: corticosteroids are distributed in small amounts in breast milk and may suppress growth and interfere with endogenous glucocorticoid production in nursing infants, although doses of up to 40 mg daily of methylprednisolone are unlikely to cause systemic effects in the infant. Fertility: corticosteroids have been shown to impair fertility in animal studies.

Methylprednisolone with lidocaine

Brand names: Depo-Medrone with Lidocaine

Methylprednisolone acetate combined with lidocaine is a depot corticosteroid preparation given by local injection, typically intra-articular or soft-tissue, where the lidocaine provides immediate local anaesthesia alongside the longer-acting anti-inflammatory steroid.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Intra-articular (rheumatoid arthritis, osteoarthritis), by joint size: large joint (knee, ankle, shoulder) 0.5-2 mL (20-80 mg of steroid); medium joint (elbow, wrist) 0.25-1 mL (10-40 mg of steroid); small joint (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular) 0.1-0.25 mL (4-10 mg of steroid)

Route: Intra-articular, periarticular, intrabursal, or into the tendon sheath ONLY. It must NOT be used by the intrathecal, intravascular (e.g. intravenous) or intramuscular routes.

Frequency: Single injection; repeated injections, if needed, may be given at intervals of one to five or more weeks depending on the degree of relief obtained from the initial injection

eMC SPC (Depo-Medrone with Lidocaine Suspension for Injection) §4.2. The dose depends on the size of the joint and the severity of the condition. OTHER ROUTES/INDICATIONS: periarticular for epicondylitis — infiltrate 0.1-0.75 mL (4-30 mg of steroid) into the affected area; intrabursal for subdeltoid, prepatellar or olecranon bursitis — 0.1-0.75 mL (4-30 mg of steroid) directly into the bursa (in most acute cases repeat injections are not needed); into the tendon sheath for tendinitis, tenosynovitis or epicondylitis — 0.1-0.75 mL (4-30 mg of steroid), with repeat injections sometimes necessary in recurrent or chronic conditions. ADMINISTRATION: do not mix with any other preparation (flocculation may occur); inspect visually for particulate matter and discoloration before use; vials are for single-dose use only. Intra-articular injections should be made using precise anatomical localisation into the synovial space — confirm needle position by aspirating a few drops of joint fluid, then change the aspirating syringe for one containing the product, and move the joint slightly after injection to aid mixing. Suitable joints are knee, ankle, wrist, elbow, shoulder, phalangeal and hip; spinal joints, unstable joints and those devoid of synovial space are NOT suitable. Advise the patient not to overuse the joint afterwards. In tenosynovitis and tendinitis, inject into the tendon sheath rather than into the substance of the tendon; the Achilles tendon must NOT be injected because it has no true tendon sheath. Use the lowest effective dose for the minimum period, and do not exceed recommended doses — multiple small injections into the area of the lesion should be made whenever possible, with precautions against injection or leakage into the dermis, to minimise dermal/subdermal atrophy and depigmentation. Systemic absorption occurs after intra-articular injection, so systemic as well as local effects can be expected; after more than physiological doses (approximately 6 mg methylprednisolone) for more than 3 weeks, withdrawal should not be abrupt. Facilities for resuscitation should be available (lidocaine component). PAEDIATRIC (no numeric per-kg dose is stated, hence paedDose is null): 'For infants and children, the recommended dosage should be reduced, but dosage should be governed by the severity of the condition rather than by strict adherence to the ratio indicated by age or body weight.' Verify any paediatric dose against a children's formulary and local protocol. ELDERLY: no information suggests a change in dosage is warranted, but treatment (particularly long-term) should be planned bearing in mind the more serious consequences of common corticosteroid side-effects in old age, with close clinical supervision. SOURCE NOTE: the openFDA fallback fetched for this id (Dyural 40 Kit) describes BUPIVACAINE hydrochloride, a different local anaesthetic and a different product — none of its dosing, contraindications or interactions have been used here. eMC §4.4, §4.6 and §4.8 were truncated at the source-fetch limit; §4.5 (interactions) was not fetched at all — clinician to verify against the full current SPC.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to the active substances or to any of the excipients (eMC §4.3)
Known hypersensitivity to other local anaesthetics of the amide type (eMC §4.3)
Systemic infection, unless specific anti-infective therapy is employed (eMC §4.3)
Use by the intrathecal route, due to its potential for neurotoxicity (eMC §4.3)
Use by the intravascular (e.g. intravenous) route (eMC §4.3)
Use by the intramuscular route (eMC §4.3)
Administration of live or live-attenuated vaccines in patients receiving immunosuppressive doses of corticosteroids (eMC §4.3)

Side effects

Lidocaine systemic toxicity (rare; usually from accidental intravascular injection, excessive dose or rapid absorption) — neurological: dizziness or light-headedness, nervousness, tremor, circumoral paraesthesia, tongue numbness, drowsiness, convulsions, coma; cardiovascular: hypotension, bradycardia, myocardial depression, cardiac arrhythmias, and possibly cardiac arrest or circulatory collapse; blurred vision, diplopia and transient amaurosis may be signs of lidocaine toxicity
Infections — opportunistic infection, infection with suppression of clinical signs and symptoms, injection site infection, recurrence of dormant tuberculosis
Endocrine — Cushingoid appearance, hypothalamic-pituitary-adrenal axis suppression, and a withdrawal syndrome (fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules, weight loss); too rapid a reduction after prolonged treatment can lead to acute adrenal insufficiency, hypotension and death
Metabolic — sodium and fluid retention, hypokalaemic alkalosis, dyslipidaemia, impaired glucose tolerance and increased insulin (or oral hypoglycaemic) requirements in diabetics, increased appetite with weight gain
Psychiatric — affective disorder including depressed mood, euphoria and suicidal ideation; psychotic disorder including mania, delusion and hallucination; confusional state, anxiety, insomnia, irritability, personality change
Immune — drug hypersensitivity, anaphylactic and anaphylactoid reactions; blood — leukocytosis
Injection-site dermal and/or subdermal changes — skin depressions and depigmentation from steroid crystals in the dermis (usually regenerating within a few months)

Interactions

Live or live-attenuated vaccines: contraindicated in patients receiving immunosuppressive doses of corticosteroids (eMC §4.3)
No eMC §4.5 interactions text was present in the fetched bundle, and the openFDA fallback describes a different active substance (bupivacaine) so was not used — clinician to source §4.5 from the current SPC

Clinical monograph

How it works

Methylprednisolone acetate is a depot glucocorticoid that suppresses local inflammatory mediators within the injected tissue, while lidocaine is an amide local anaesthetic that reversibly blocks neuronal sodium channels to provide short-term pain relief.

Prescribing in practice

Do not inject into or through infected tissue or a potentially septic joint, as introducing depot steroid into infection can have serious consequences, and exclude lidocaine hypersensitivity.
Use strict aseptic technique and avoid repeated frequent injections into the same site because of the risk of tissue and cartilage atrophy and local depigmentation.
Account for the systemic effects of absorbed steroid in patients with diabetes, hypertension or on other corticosteroids, and be aware lidocaine adds a small systemic local-anaesthetic load.

Monitoring

Observe the patient briefly after injection for local reaction or local-anaesthetic effects, and review the joint or soft tissue for response and any signs of post-injection infection.

Counselling the patient

Expect short-lived numbness from the anaesthetic, then a possible brief flare before benefit.
Rest the injected area for a day or two and seek help if it becomes hot, swollen or increasingly painful.
Tell the clinician if you have diabetes, as blood glucose may rise transiently.

Evidence & guidelines

Depot corticosteroid with local anaesthetic injections are standard practice for inflammatory joint and soft-tissue conditions, supported by rheumatology and musculoskeletal guidance in the UK.

Reference: BSR; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways