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Corticosteroid Pregnancy: UK SPC §4.6, verbatim: 'The ability of corticosteroids to cross the placenta varies between individual drugs, however, methylprednisolone does cross 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.' 'Hypoadrenalism may, in theory, occur in the neonate following pre-natal exposure to corticosteroids but usually resolves spontaneously following birth and is rarely clinically important. Infants born to mothers, who have received substantial doses of corticosteroids during pregnancy must be carefully observed and evaluated for signs of adrenal insufficiency.' '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. Cataracts have been observed in infants born to mothers undergoing long-term treatment with corticosteroids during pregnancy.' Breast-feeding: 'Corticosteroids are excreted in small amounts in breast milk, however, 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... In women treatment with corticosteroids can lead to menstrual irregularities.'

Methylprednisolone (IV Pulse)

Brand names: Solu-Medrone, Depo-Medrone

Intravenous pulse methylprednisolone is a high-dose glucocorticoid regimen given as short infusions for severe or organ-threatening inflammatory and autoimmune disease, including systemic vasculitis, lupus flares and other rheumatological emergencies.

Adult dose

Dose: SPC §4.2, IV pulse therapy, 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.' The general adult range that frames it: 'Dosage should be varied according to the severity of the condition, initial dosage will vary from 10 to 500 mg.'
Route: Intravenous infusion. §4.2: '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.' The same product may be given intramuscularly, but pulse therapy is an infusion. §4.2: 'This medicine is not recommended for intrathecal or epidural use.'
Frequency: Once daily, 'for a few days (usually ≤ 5 days)' (§4.2)
MAXDOSE IS DELIBERATELY EMPTY: §4.2 states '250 mg/day or above' for these indications and gives NO numeric ceiling for them. The only explicit '1 g/day' ceiling in the SPC belongs to graft rejection after transplantation ('a dose of up to 1 g/day may be required'), a different indication, so it must not be presented as the ceiling for a rheumatic pulse. ADMINISTRATION (safety-critical): infuse high doses over at least 30 minutes; 'For intravenous infusion the initially prepared solution may be diluted with 5% dextrose in water, isotonic saline solution, or 5% dextrose in isotonic saline solution. To avoid compatibility problems with other drugs methylprednisolone should be administered separately, only in the solutions mentioned.' TITRATION AND WITHDRAWAL: 'Dosage requirements are variable and must be individualized on the basis of the disease under treatment, its severity and the response of the patient'; 'The proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage, which will maintain an adequate clinical response, is reached'; 'If after long-term therapy the drug is to be stopped, it needs to be withdrawn gradually rather than abruptly.' STEP-DOWN: 'Following the initial emergency period, consideration should be given to employing a longer acting injectable preparation or an oral preparation.' 'Corticosteroid therapy is an adjunct to, and not replacement for, conventional therapy.'

Paediatric dose

Route: Intravenous or intramuscular
NO PAEDIATRIC IV-PULSE REGIMEN FOR RHEUMATIC DISEASE EXISTS IN THE FETCHED LABEL, so dosePerKg is null and the weight calculator is deliberately left unset. SPC §4.2 'Paediatric population', verbatim and in full: 'In the treatment of 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. In the treatment of status asthmaticus, a dosage of 1 to 4 mg/kg/day for 1-3 days is recommended.' Both of those are different indications from this page's, and their figures differ roughly ten-fold from each other, so neither may be carried onto a rheumatology pulse page. Verify any paediatric pulse dose against a children's formulary and specialist paediatric rheumatology advice.

Dose adjustments

Renal

No renal dose adjustment is stated in the fetched SPC — §4.2 'Special populations' covers only the paediatric population and the elderly, and neither §4.2 nor §4.3 mentions renal impairment. §4.8 does list 'Sodium retention; Fluid retention' among undesirable effects, which is the relevant practical caution.

Hepatic

No hepatic dose adjustment is stated in the fetched SPC — §4.2 'Special populations' covers only the paediatric population and the elderly, and neither §4.2 nor §4.3 mentions hepatic impairment.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Systemic fungal infections 'unless specific anti-infective therapy is employed' (UK SPC §4.3)
  • Cerebral oedema in malaria (UK SPC §4.3)
  • Known hypersensitivity to methylprednisolone or to any of the excipients listed in section 6.1 (UK SPC §4.3)
  • Live or live, attenuated vaccines — 'Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids' (UK SPC §4.3); §4.4 adds 'Live vaccines should not be given to individuals with impaired immune responsiveness. The antibody response to other vaccines may be diminished.'
  • Intrathecal / epidural administration — not a formal §4.3 contraindication, but §4.2 states 'This medicine is not recommended for intrathecal or epidural use', and §4.8 lists 'Arachnoiditis, functional gastrointestinal disorder/bladder dysfunction, headache, meningitis, paraparesis/paraplegia, seizure and sensory disturbances' as reactions reported with the intrathecal/epidural route
  • Not a 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

  • §4.8 preamble: 'Under normal circumstances methylprednisolone therapy would be considered as short-term. However, the possibility of side-effects attributable to corticosteroid therapy should be recognised, particularly when high-dose therapy is being used.' All frequencies below are 'Not Known' unless stated
  • Infections — 'Infection (including increased susceptibility and severity of infections with suppression of clinical symptoms and signs); Opportunistic infection; Recurrence of dormant tuberculosis; Peritonitis'
  • Endocrine — 'Cushingoid; Hypothalamic pituitary adrenal axis suppression; Steroid withdrawal syndrome (including, fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and loss of weight)'
  • Metabolism and nutrition — 'Metabolic acidosis; Sodium retention; Fluid retention; Glucose tolerance impaired; Alkalosis hypokalaemic; Dyslipidemia; Increased insulin requirements (or oral hypoglycemic agents in diabetics); Lipomatosis; Increased appetite (which may result in weight increase); Epidural lipomatosis'
  • Psychiatric — '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 — 'Increased intracranial pressure with Papilloedema [Benign intracranial hypertension]; Seizure; Amnesia; Cognitive disorder; Dizziness; Headache'
  • Eye — Rare: 'Vision blurred'; Not known: 'Posterior subcapsular cataracts; Exophthalmos; Glaucoma; Papilloedema with possible damage to the optic nerve; Corneal or scleral thinning; Exacerbation of ophthalmic viral or fungal disease; Chorioretinopathy'
  • Immune — 'Drug hypersensitivity (Anaphylactic reaction; Anaphylactoid reaction)'
  • Blood and lymphatic — 'Leukocytosis'
  • Neoplasms — "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 has been associated with 'Arachnoiditis, functional gastrointestinal disorder/bladder dysfunction, headache, meningitis, paraparesis/paraplegia, seizure and sensory disturbances'
  • NOTE: the fetched §4.8 table is truncated after 'Eye disorders', so the musculoskeletal, cardiac, gastrointestinal, skin and general-disorder rows of the SPC table were not retrieved — this list is not complete

Monitoring

  • Infection (§4.4): 'Monitor for the development of infection and consider withdrawal of corticosteroids or dosage reduction as needed.' Corticosteroids 'may mask some signs of infection' and 'The clinical presentation may often be atypical and may reach an advanced stage before being recognised.'
  • Chickenpox / measles exposure (§4.4): patients or parents of children 'without a definite history of chickenpox should be advised to avoid close personal contact with chickenpox or herpes zoster and if exposed they should seek urgent medical attention'. 'Passive immunization with varicella/zoster immunoglobin (VZIG) is needed by exposed non-immune patients who are receiving systemic corticosteroids or who have used them within the previous 3 months; this should be given within 10 days of exposure to chickenpox.' If chickenpox is confirmed, 'Corticosteroids should not be stopped and the dose may need to be increased.'
  • Tuberculosis (§4.4): 'If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.'
  • Parasitic infection (§4.4): great care in 'known or suspected parasitic infections such as Strongyloides (threadworm) infestation, which may lead to Strongyloides hyperinfection and dissemination'
  • Dose review and withdrawal (§4.2): 'The proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage, which will maintain an adequate clinical response, is reached. If after long-term therapy the drug is to be stopped, it needs to be withdrawn gradually rather than abruptly.'
  • Elderly (§4.2): 'treatment of elderly patients should be planned bearing in mind the more serious consequences of the common side-effects of corticosteroids in old age and close clinical supervision is required'
  • Before administration (§4.2): 'Parenteral drug products should wherever possible be visually inspected for particulate matter and discoloration prior to administration.'
  • This list may be incomplete — check the full SPC.

Clinical monograph

How it works

Methylprednisolone is a synthetic glucocorticoid that binds intracellular corticosteroid receptors to suppress pro-inflammatory gene transcription and broadly dampen cellular and humoral immune responses.

Prescribing in practice

  • Rapid administration of large doses has been associated with cardiac arrhythmia and rare sudden cardiovascular collapse, so infuse over an adequate period with monitoring rather than as a bolus.
  • Pulse dosing markedly raises infection risk and can precipitate hyperglycaemia, fluid retention, hypertension and mood or sleep disturbance, so screen for active infection beforehand.
  • Never stop chronic corticosteroid cover abruptly and consider adrenal suppression and gastroprotection in patients on continued oral steroids.

Monitoring

Monitor blood pressure, blood glucose, electrolytes and signs of infection during and after each pulse, with closer observation in patients who have cardiac or renal comorbidity.

Counselling the patient

  • Report symptoms of infection, palpitations or marked mood change promptly.
  • Carry a steroid alert card if on ongoing steroid therapy.
  • Expect possible flushing, altered sleep or raised blood sugar around infusion days.

Evidence & guidelines

Pulsed intravenous corticosteroids are long-established in UK practice for induction of remission in severe autoimmune and vasculitic disease, reflected in NICE and specialist society guidance.

Reference: BSR guidelines; EUROLUPUS trial; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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