Methylprednisolone dosage

Troleandomydn. A pharmacokinetic study in 4 children and 6 adult corticosteroid-dependent asthmatics found that troleandomycin 14 mg/kg daily for one week increased the half-life of methylprednisolone by 88%, from 2.46 to 4.63 hours, and reduced the total body clearance by 64%. All 10 had Cushingoid symptoms (cushingoid facies and weight gain), which resolved when the methylprednisolone dosage was reduced, without any loss in the control of the asthma. Another study found that the dose of methylprednisolone could be reduced by 50% in the presence of troleandomycin, without loss of disease control. Other studies have found similar effects. However, a randomised, placebo-controlled 2-year study found that although troleandomycin modestly reduced the lequiied dose... 

Information about the clarithromycin or erythromycin interactions with methylprednisolone is much more limited than with the interaction between troleandomycin and methylprednisolone, but they all appear to be established and of clinical importance. The effect should be taken into account during concurrent use and appropriate dosage reductions made to avoid the development of corticosteroid adverse effects. The authors of one study suggest that this reduction should be empirical, based primarily on clinical symptomatology. Another group found that a 68% reduction in methylprednisolone dosage was possible within 2 weeks. Troleandomycin appears to have a greater effect than erythromycin or clarithromycin. 

Prevention/Minimization - Manifestations of the CRS may be prevented or minimized by pretreatment with 8 mg/kg methylprednisolone, given 1 to 4 hours prior to administration of the first dose of muromonab-CD3 and by closely following recommendations for dosage and treatment duration. 

A 33-year-old woman took immunosuppressive therapy after renal transplantation ciclosporin (dosage adjusted to achieve blood concentrations of 120-160 ng/ml), azathioprine 1 mg/kg (frequency of administration not stated), and methylprednisolone 40 mg/ day from day 1 after transplantation, tapered weekly by 4—8 mg/day. Because of rejection symptoms at weeks 1, 4, and 7, she received three cycles of intravenous methylprednisolone 250 mg/day, each cycle lasting 5-7 days she also received a bolus dose of methylprednisolone 500 mg on day 0. Pregnancy was diagnosed on day 12 after transplantation (9 weeks after conception). At week 6 after transplantation she had a missed abortion. Curettage was performed and a partial hydatidiform mole was detected. She was discharged at week 10 and immunosuppressive therapy was tapered. 

Inflammations of the posterior segment, optic nerve, or orbit usually require systemic administration of steroids. Selection of the particular steroid preparation and the dosage remains largely an individual choice, but the tendency is to use compoimds with minimal mineralocor-ticoid activity. Table 12-2 compares various systemic steroids to hydrocortisone in terms of equivalent dose (20 mg) and relative anti-inflammatory and sodium-retaining activities when giving a value of 1.0 for hydrocortisone. Prednisone is a popular agent of choice for oral administration. For intravenous administration, methylprednisolone sodiiun succinate has proven useful. 

Latent epilepsy can be made manifest by glucocorticoid treatment. Seizures in patients with lung transplants were related to glucocorticoids, which had been used in high dosages to prevent organ rejection. There was an increased risk of seizures in younger patients (under 25 years) and with intravenous methylprednisolone (SEDA-21, 413) (38). 

A 34-year-old renal transplant recipient taking a stable regimen of tacrolimus and methylprednisolone was given itraconazole 100 mg bd for a yeast infection of the urinary tract (115). Concomitant therapy with itraconazole led to a marked increase in tacrolimus trough concentrations on the second day of therapy (from 13 to 21 ng/ml) and an increase in serum creatinine concentrations, necessitating dosage reduction of tacrolimus by 50%. 

Linear IgA dermatosis with erythema multiforme-Uke clinical features has been reported in a 19-year-old man several days after completion of a 5-day-course treatment with sulfadimethoxine (500 mg bd) for a flu-like syndrome (134). Treatment with methylprednisolone (150 mg) with gradnal dosage rednction was started. Slow improvement was followed by a flare-up after reduction to 80mg/day. Therapy was changed to dapsone 100 mg/day, and there was a dramatic improvement. 

The prodrug approach described above also can be used to alter the solubility characteristics, which, in turn, can increase the flexibility in formulating dosage forms. The solubility of methylprcdnisolonc can be altered from essentially water-insoluble methylpredni.solone acetate to slightly water-insoluble methylprednisolone to water-soluble meth-ylprednisolone. sodium succinate. The water-soluble sodium hemisuccinate salt is used in oral, intravenous, and intramuscular dosage forms. Methylprednisolone itself is normally found in tablels. The acetate ester is found in topical ointments and sterile aqueous suspensions for intramuscular injection. Both the succinate and acetate esters are hydrolyzed to the active methylprednisolone by the patient s own systemic hydrolytic enzymes (esterases). 

Home care can also give support to heart transplant patients. In our center we have the experience of a program for organ rejection therapy, antilymphocyte immunoglobulin, and high dosage of methylprednisolone at home. After the experience, we can say that it is feasible to carry out this treatment at home and the satisfaction of the patients is high. ... 

The role of systemic corticosteroids for acute exacerbations of COPD has been clarified in recent years. However, the appropriate dosage regimen is not well established. Regimens range from initial high doses (methylprednisolone 125 mg every 6 hours) to more conservative dosing (prednisone 40-60 mg/day). 

Low-molecular-weight carboxylic acids such as acetic acid and propionic are totally water soluble. However, as they go beyond a five-carbon content their solubility decreases rapidly. An interesting example of how advantage can be taken of these factors to form a water-soluble parenteral dosage form of a drug that is highly insoluble is the steroid methylprednisolone (structure I). 

The interaction between the corticosteroids and phenobarbital is well documented, well established and of clinical importance. Concurrent use need not be avoided but the outcome should be monitored. Increase the corticosteroid dosage as necessary. The extent of the increase is variable. Dex-amethasone, hydrocortisone, " methylprednisolone, prednisone and prednisolone are all known to be affected. Prednisone and prednisolone appear to be less affected than methylprednisolone and may be preferred. Be alert for the same interaction with other corticosteroids and other barbiturates, which also are enzyme-inducers, although direct evidence seems to be lacking. The dexamethasone adrenal suppression test may be expected to be unreliable in those taking phenobarbital, just as it is with pheny-toin, another potent enzyme-inducer. See Corticosteroids + Phenytoin , p.1059. 

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... 

Jayne DR, Gaskin G, Rasmussen N, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol. 2007 18 2180-2188. 

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