Medrol is a drug from the group of glucocorticosteroids with anti-inflammatory, immunosuppressive and antiallergic action.
Release form and composition
Medrol's dosage form - tablets: elliptical, white, two notches on one side (crosswise), on the other - extruded inscription:
- "UPJOHN" - 10 pcs. in blisters, in a cardboard bundle of 1, 3 or 10 blisters; 30 pieces each in dark glass bottles, in a cardboard bundle one bottle;
- UPJOHN 73 - 10 pcs. in blisters, in a carton bundle 5 packs; on 14 pieces in blisters, in a carton box 1 pack; 50 each in dark glass bottles, in a cardboard bundle one bottle;
- UPJOHN 176 - 20 or 50 each. in dark glass bottles, in a cardboard bundle one bottle.
The active ingredient of the drug is methylprednisolone. Its content in 1 tablet, depending on the inscription:
- UPJOHN - 4 mg;
- UPJOHN 73 - 16 mg;
- UPJOHN 176 –32 mg.
Auxiliary components: corn starch and dried corn starch, calcium stearate, sucrose and lactose.
Indications for use
Systemic diseases of the connective tissue (mainly - in periods of exacerbation, in some cases - as maintenance therapy):
- Rheumatic polymyalgia;
- Systemic dermatomyositis (polymyositis);
- Giant cell arteritis.
- Severe psoriasis;
- Systemic lupus erythematosus;
- Skin diseases:
- Acute rheumatic heart disease;
- Exfoliative dermatitis;
- Severe erythema multiforme (Stevens-Johnson syndrome);
- Dermatitis herpetiformis;
- Mushroom mycosis;
- Severe seborrheic dermatitis.
Diseases of the musculoskeletal system, including rheumatic diseases (Medrol is used for a short time, in addition to the main therapy, for removal from an acute condition or during exacerbation):
- Acute and subacute bursitis;
- Psoriatic arthritis;
- Acute gouty arthritis;
- Ankylosing spondylitis;
- Post-traumatic osteoarthritis;
- Acute non-specific tendosynovit;
- Sinovitis in osteoarthritis;
- Rheumatoid arthritis, incl. juvenile (with this disease in some cases it may be necessary to conduct maintenance therapy with low doses).
- Congenital adrenal hyperplasia;
- Primary and secondary adrenal insufficiency;
- Subacute and chronic thyroiditis;
- Hypercalcemia in malignant tumors.
Allergic reactions (severe or disabling conditions in which conventional therapy is ineffective):
- Atopic dermatitis;
- Contact dermatitis;
- Seasonal or perennial allergic rhinitis;
- Bronchial asthma;
- Serum sickness;
- Reactions hypersensitivity to drugs.
- Symptomatic sarcoidosis;
- Aspiration pneumonitis;
- Fulminant or disseminated pulmonary tuberculosis (in combination with appropriate anti-tuberculosis chemotherapy);
- Leffler syndrome, which is not amenable to treatment with other drugs.
- Idiopathic thrombocytopenic purpura in adults;
- Secondary thrombocytopenia in adults;
- Autoimmune (acquired) hemolytic anemia;
- Erythroblastopenia (erythrocyte) anemia;
- Erythroid (congenital) hypoplastic anemia.
Diseases of the gastrointestinal tract (for removing a patient from a critical condition):
- Regional enteritis;
- Ulcerative colitis.
Eye diseases (severe acute, chronic inflammatory and allergic processes with eye damage):
- Allergic conjunctivitis;
- Sympathetic ophthalmia;
- Optic neuritis;
- Allergic corneal ulcers;
- Diffuse posterior uveitis and choroiditis;
- Irit and iridocyclitis;
- Inflammation of the anterior segment of the eye.
Diseases of the nervous system:
- Cerebral edema due to a brain tumor;
- Exacerbations of multiple sclerosis.
Oncological diseases (Medrol is used as palliative therapy):
- Acute leukemia in children;
- Lymphomas and leukemias in adults;
Other indications for use:
- Tuberculous meningitis with a subarachnoid block or the threat of a block (in combination with appropriate anti-tuberculosis chemotherapy);
- Trichinosis with lesions of the myocardium or nervous system;
- Organ transplantation;
- Edematous syndrome in patients with nephrotic syndrome without uremia, idiopathic type or caused by systemic lupus erythematosus (to stimulate diuresis and achieve proteinuria remission).
Absolute contraindication to the use of Medrol is only individual sensitivity to its components.
It is not recommended to prescribe a remedy for systemic fungal infections.
Medrol should be used with caution in such cases:
- Peptic ulcer and 12 duodenal ulcer;
- Intestinal anastomosis (in the immediate history);
- Acute or latent peptic ulcer;
- Nonspecific ulcerative colitis with the threat of an abscess or perforation;
- Diabetes mellitus and predisposition to it;
- Myasthenia gravis;
- Acute and subacute myocardial infarction;
- Arterial hypertension;
- Congestive heart failure;
- Acute psychosis;
- Severe renal dysfunction;
- Severe abnormal liver function, especially with concomitant hypoalbuminemia;
- Herpes simplex (eye form);
- Open-angle glaucoma;
- Active and latent tuberculosis;
- Severe viral and bacterial infectious diseases;
- AIDS virus;
- Acquired Immunodeficiency Syndrome.
Dosing and Administration
Medrol should be taken orally.
The initial daily dose may vary from 4 to 48 mg, depending on the type and nature of the disease. In less severe cases, the drug is usually prescribed in lower doses, although individual patients may require higher ones.
In high daily doses, Medrol is prescribed for such conditions and diseases: organ transplantation - up to 7 mg / kg, multiple sclerosis - 200 mg, brain swelling - 200-1000 mg. If, after a sufficient period of time, a satisfactory response to the drug is not received, it should be canceled and alternative therapy should be prescribed.
The dose for children is determined depending on the mass or surface area of the body. The daily dose for adrenal insufficiency is 0.18 mg / kg or 3.33 mg / m 2 ; for other indications, 0.42-1.67 mg / kg or 12.5-50 mg / m 2 . The daily dose is divided into 3 doses.
If a good response is obtained during treatment, an individual maintenance dose is selected, gradually and at regular intervals reducing the baseline until the lowest, but effective dose is found to maintain the effect achieved.
It requires constant monitoring of the dosing regimen, since There may be situations in which a dose adjustment is required, for example, an individual patient's response to the drug, changes in the clinical condition due to exacerbation or the onset of remission of the disease, the effect of stressful situations not directly related to the underlying disease being treated. In the latter case, it may be necessary to increase the dose for some time.
- Metabolism: increased blood pressure, chronic heart failure in patients with appropriate predisposition, sodium and fluid retention, negative nitrogen balance due to protein catabolism, loss of potassium, and hypokalemic alkalosis;
- Endocrine system: hirsutism, menstrual disorders, the development of Cushing's syndrome, the manifestation of latent diabetes, reduced carbohydrate tolerance, suppression of the pituitary-adrenal system, growth retardation in children, increased need for oral hypoglycemic agents or insulin in diabetic patients;
- Digestive system: esophagitis, pancreatitis, intestinal perforation, gastric bleeding, peptic ulcer with possible perforation and bleeding, increased activity of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase in the blood serum;
- Musculoskeletal system: osteoporosis, muscle weakness, pathological fractures, steroid myopathy, vertebral compression fractures, tendon ruptures (especially Achilles tendon), aseptic necrosis of the epiphysis of the tubular bones;
- Nervous system: mental disorders, brain pseudo-tumor, seizures, increased intracranial pressure;
- Organ vision: increased intraocular pressure with the risk of damage to the optic nerve, posterior subcapsular cataract, exophthalmos;
- Dermatological reactions: decrease in strength and thinning of the skin, petechiae, slow healing of wounds, ecchymosis;
- Allergic reactions: hypersensitivity reactions (including systemic allergic reactions), suppression of reactions during skin tests;
- Other: withdrawal of glucocorticosteroids, activation of latent infections, erased clinical picture of infectious diseases, the occurrence of infections caused by opportunistic pathogens.
Complications from the use of glucocorticosteroids depend on the dose and duration of treatment. Therefore, the need for such therapy is determined in each case individually, after assessing the expected benefits and possible risks.
Medrol should be prescribed in the smallest effective dose that can provide a sufficient therapeutic effect. Dose reduction should be carried out gradually.
Patients who may be exposed to stress during treatment are shown to increase the dose of methylprednisolone before, during and after a stressful situation.
The introduction of live (including attenuated) vaccines is contraindicated in patients receiving a dose that has an immunosuppressive effect. If necessary, inactivated or killed vaccines can be administered, but it should be borne in mind that the response to vaccination may be reduced. If patients receive the drug in doses that do not have an immunosuppressive effect, immunization can be carried out according to the appropriate indications.
Like all glucocorticosteroids, Medrol increases the excretion of calcium from the body.
Methylprednisolone, taken in high doses, can cause water retention and sodium ions, high blood pressure and increased excretion of potassium. In this case, it is shown the use of potassium preparations and limiting the consumption of salt.
In children taking Medrol daily, several times a day for a long period, growth is possible. Therefore, this dosing regimen should be used only for absolute reasons. Alternating therapy helps minimize this side effect or even avoid it.
Alternating therapy is a special dosing regimen, in which a double daily dose of the drug is taken every other day in the morning. The goal of this therapy is to achieve a maximum clinical effect in a patient taking the drug for a long time and to minimize certain side effects, such as stunting in children, Cushing's syndrome, suppression of the pituitary-adrenal system and withdrawal syndrome.
Inductors of liver microsomal enzymes (phenobarbital, theophylline, rifampicin, ephedrine, phenytoin) reduce the therapeutic effect of methylprednisolone, so an increase in its dose may be required.
Oral estrogen-containing contraceptives, ketoconazole and oleandomycin can inhibit the metabolism of methylprednisolone, reduce its clearance, increase the half-life and, consequently, enhance the action and toxic effects. When using such combinations, reduce the dose of Medrol.
With simultaneous use of cyclosporine, mutual inhibition of metabolism is noted, therefore, it is assumed that the side effects caused by each of the drugs may occur more often.
It has been reported that methylprednisolone affects the effectiveness of oral anticoagulants. And it can both strengthen their action and weaken. Therefore, during treatment, it is necessary to constantly determine coagulation rates.
With the simultaneous use of mitotane or other inhibitors of the function of the adrenal cortex, it may be necessary to increase the dose of Medrol.
Methylprednisolone can increase the clearance of acetylsalicylic acid (ASA), which is used for a long time in high doses, which is fraught with an increase in the concentration of salicylates in the blood and the risk of their toxicity. In addition, with the simultaneous use of salicylates increases the risk of gastropathy. With extreme caution, ASA in combination with Medrol should be prescribed to patients with hypoprothrombinemia.
In the case of combined use with thiazide diuretics, other glucocorticosteroids, carbonic anhydrase inhibitors, amphotericin B, the risk of hypokalemia increases, with sodium-containing drugs - edema and high blood pressure, with paracetamol - hepatotoxicity, with androgens - edema.
Like all glucocorticosteroids, Medrol can cause hypokalemia, therefore, when used simultaneously, increases the toxicity of cardiac glycosides (manifested by arrhythmias).
Methylprednisolone reduces the effectiveness of hypoglycemic agents, somatotropin and vaccines.
Non-steroidal anti-inflammatory drugs (NSAIDs) and alcohol increase the risk of gastrointestinal ulceration and bleeding. When prescribing NSAIDs in combination with Medrol for the treatment of arthritis, it may be necessary to reduce the dose of the latter.
Antacids reduce the absorption of methylprednisolone.
With hypothyroidism, the clearance of methylprednisolone decreases, with hyperthyroidism - increases. If it is necessary to prescribe thyroid hormones and antithyroid drugs, the dose of Medrol should be selected depending on the results of functional tests.
Methylprednisolone accelerates the metabolism of mexelitin and isoniazid, resulting in a reduced plasma concentration of drugs.
Terms and conditions of storage
Store at room temperature (20-25 ° C). Keep out of the reach of children.
Shelf life - 5 years.