Methylprednisolone (IV Pulse)

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.