Methylprednisolone
Methylprednisolone is a corticosteroid. Its label covers a wide range of inflammatory and immune conditions, and it carries an instruction that runs against intuition: someone on this medicine who becomes seriously unwell generally needs more of it, not less.
Key points
- In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated.
- In less severe disease processes where corticoid therapy is indicated, it may be possible to initiate treatment with alternate-day therapy.
- It is a corticosteroid, so the same class considerations apply as for prednisolone, including that long courses are not stopped abruptly.
How it works
Methylprednisolone suppresses inflammation and immune activity in the way corticosteroids do. Because sustained treatment reduces the body’s own steroid production, the body loses its ability to mount the surge that illness, injury or surgery would normally trigger. That is the mechanism behind the stress-dose rule rather than a separate precaution.
Safety specific to methylprednisolone
Unusual stress. In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated.
The practical consequence: anyone on longer-term methylprednisolone who is admitted to hospital, has an operation, sustains a significant injury or becomes seriously ill needs whoever is treating them to know they take it. That is not a general courtesy, it is the trigger for a specific dose change.
Alternate-day therapy. In less severe disease processes in which corticoid therapy is indicated, it may be possible to initiate treatment with alternate-day therapy.
When to seek urgent care
Becoming acutely unwell, being injured, or being unable to keep tablets down while on longer-term methylprednisolone needs prompt medical advice rather than simply missing doses, because of the stress-dose requirement above.