Methylprednisolone, adverse reactions

The incidence and severity of adverse reactions to glucocorticoids depend on the dose and duration of treatment. Even the very high single doses of glucocorticoids, such as methylprednisolone, which are sometimes used, do not cause serious adverse effects, whereas an equivalent dose given over a long period of time can cause many long-term effects. 

Table 3 Adverse reactions in 213 children given intravenous methylprednisolone...

Intravenous methylprednisolone was associated with a spectrum of adverse reactions, most frequently behavioral disorders, in 213 children with rheumatic disease, according to the results of a US study (191). However, intravenous methylprednisolone was generally well tolerated. The children received their first dose of intravenous methylprednisolone 30 mg/kg over at least 60 minutes, and if the first dose was well tolerated they were given... 

A 13-year-old girl with bipolar disorder and a history of adverse reactions to contrast media was given methylprednisolone (32 mg/day) and ranitidine (300 mg/day) before a CT scan of the head with intravenous contrast enhancement. One day after, she developed psychiatric symptoms, which were more severe than her initial symptoms, including extreme agitation and mental confusion. All medications were withdrawn and her symptoms resolved within 2 weeks. 

It is established that the pharmacokineties of some corticosteroids are affected by oral contraceptives, but the elinical importance of any such changes is not known. The therapeutie and adverse effects would be expected to be increased but there appear to be no clinical reports of adverse reactions arising from concurrent use. In fact the authors of one study concluded that women can be dosed similarly with methylprednisolone irrespective of oral contraceptive use. 

In a retrospective study in 21 patients with refractory pemphigus who were treated with intravenous methylprednisolone for 3 consecutive days at monthly intervals plus intravenous cyclophosphamide 500 mg on day 2, the most common adverse reaction was transient lymphopenia or thrombocytopenia (12 of 21 patients) [26 ]. In two patients, this necessitated a dosage reduction of cyclophosphamide. Other reversible abnormalities included hypokalemia (n=4). There were generally mild post-infusion symptoms of fatigue, headache, and fever in seven patients, which necessitated a dosage reduction in one. One patient had had three pulses when treatment was halted prematurely because of recurrent pneumonia another withdrew after five pulses as she developed premature ovarian failure and two patients had premature menopause, in whom cyclophosphamide was not withdrawn. There were seven episodes of sepsis during therapy, which were mild and responded to antibiotics. There were two cases of localized herpes zoster infection and one of bronchial... 

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

Corticosteroids also may be delivered by injection. The intramuscular route is preferable in patients with compliance problems, since a depot effect is achieved. Depot forms of corticosteroids include triamcinolone acetonide, triamcinolone hexacetonide, and methylprednisolone acetate. This provides the patient with 2 to 8 weeks of symptomatic control. The depot effect provides a physiologic taper, avoiding withdrawal reaction associated with hypothalamic-pituitary axis suppression. It should be noted that the onset of effect via this route may be delayed by several days. Intravenous corticosteroids may be used to provide the patient with large amounts of drug during a steroid burst to control severe symptoms. Intra-articular injections of depot forms of corticosteroids can be useful in treating synovitis and pain when a small number of joints are affected. The onset and duration of symptomatic relief are similar to those of intramuscular injection. The intra-articular route often is preferred because it is associated with the fewest number of systemic adverse effects. If efficacious, intra-articular injections may be repeated every 3 months. No one joint should be injected more than two to three times per year because of the risk of accelerated joint destruction and atrophy of tendons. Soft tissues such as tendons and bursae also may be injected. This may help control the pain and inflammation associated... 

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