Methylprednisolone treatment

Clinical improvement usually begins during corticosteroid treatment. No standard exists for the administration of an oral prednisone taper after the intravenous methylprednisolone treatment. If a taper is given, it is usually completed over 1 to 2 weeks. 

The effects of prednisone on memory have been assessed (SEDA-21, 413 90). Glucocorticoid-treated patients performed worse than controls in tests of explicit memory. Pulsed intravenous methylprednisolone (2.5 g over 5 days, 5 g over 7 days, or 10 g over 5 days) caused impaired memory in patients with relapsing-remitting multiple sclerosis, but this effect is reversible, according to the results of an Italian study (91). Compared with ten control patients, there was marked selective impairment of explicit memory in 14 patients with relapsing-remitting multiple sclerosis treated with pulsed intravenous methylprednisolone. However, this memory impairment completely resolved 60 days after methylprednisolone treatment. 

Smith DR, Balashov KE, Hafler DA, Khoury SJ, Weiner HL. Immune deviation following pulse cyclo-phosphamide/methylprednisolone treatment of multiple sclerosis increased interleukin-4 production and associated eosinophiha. Ann Neurol 1997 42(3) 313-18. 

A. Bourbon, M. Vionnet, P. Lcprince, E. Vaissier, J Copeland, P. McDonagh, P. Debre and 1. Gandjba-khch, The effect of methylprednisolone treatment on the cardiopulmonary bypass-induced systemic inflammatory response, Eur. J. Cardiothorac. Surg. 26(5), 932-938 (2004). 

We have developed a model called the dispersion model (Figure 18.5) and compared it to the tanks-in-series and transit compartment models (139). The parameters of the dispersion model estimate the relative roles of diffusion, convection, and chemical reaction in signal transduction. We found that the dispersion model was capable of simultaneously fitting mRNA and protein dynamics for tyrosine aminotransferase (TAT) after methylprednisolone treatment from a published PD study quite well (140). 

Baker, T., Stanec, A., Methylprednisolone treatment of an organophosphorus-induced delayed neuropathy, Toxicol. Appl. Pharmacol., 79, 348-352,1985. 

Meduri GU, Tolley EA, Chrousos GP, et al. Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome. Am J Respir Crit Care Med 2002 165(7) 983-991. 

In rare instances (0.5% to 2% of pregnancies), NVP progresses to hyperemesis gravidarum.9 Treatment may require the use of enteral or parenteral nutrition if weight loss is present. A corticosteroid such as methylprednisolone may be considered. Methylprednisolone is associated with oral clefts in the fetus when used during the first trimester therefore, corticosteroids should be reserved as a last resort and should be avoided during the first 10 weeks of gestation.9,11... 

Corticosteroids hasten functional recovery after relapses.27 Intravenous adrenocorticotropic hormone, intravenous methylprednisolone, or oral prednisone are used for treatment of relapses. Generally, intravenous methylprednisolone is considered the drug of choice for acute relapses.28... 

CN begins to improve after 2 days of methylprednisolone 1 g intravenously daily. The treatment team wants to begin a disease-modifying treatment. 

A first open, uncontrolled study [46], performed in 12 patients with active IBD refractory to standard treatment who all had positive stool culture, suggested that adding rifaximin (800 mg daily) could be beneficial. A further small but controlled investigation performed in our unit [47] evaluated the efficacy and systemic absorption of rifaximin in patients with moderately to severely active UC refractory to steroid treatment. Patients were eligible if they had no response to intravenous corticosteroid therapy (methylprednisolone 1 mg/kg/day) after 7-10 days. Twenty-eight patients were randomized to receive rifaximin 400 mg b.i.d. or placebo for 10 days as an add-on... 

Koc RK, Akdemir H, Kurtsoy A, Pasaoglu H, Kavuncu I, Pasaoglu A, Karakucuk I. (1995). Lipid peroxidation in experimental spinal cord injury. Comparison of treatment with Ginkgo biloba, TRH, and methylprednisolone. Res Exp Med. 195(2) 117-123. 

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. 

Green SB, Byar DP, Walker MD, et al. Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep 1983 67 121-132. 

Urgent treatment is often begun with an oral dose of 30-60 mg prednisone per day or an intravenous dose of 1 mg/kg methylprednisolone every 6 hours the daily dose is decreased after airway obstruction has improved. In most patients, systemic corticosteroid therapy can be discontinued in a week or 10 days, but in other patients symptoms may worsen as the dose is decreased to lower levels. Because adrenal suppression by corticosteroids is related to dose and because secretion of endogenous corticosteroids has a diurnal variation, it is customary to administer corticosteroids early in the morning after endogenous ACTH secretion has peaked. For prevention of nocturnal asthma, however, oral or inhaled corticosteroids are most effective when given in the late afternoon. 

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. 

A 14-year-old boy received an intravenous dose of methylprednisolone 30 mg/kg for progressive glomerulonephritis. After 5 hours, his heart rate had fallen to 50/minute and an electrocardiogram showed sinus bradycardia. His heart rate then fell to 40/minutes and a temporary transvenous pacemaker was inserted and methylprednisolone was withdrawn. His heart rate increased to 80/minutes over 3 days. After a further 3 days, he was treated with oral methylprednisolone 60 mg/m2/day and his heart rate fell to 40/minutes in 5 days. Oral methylprednisolone was stopped on day 8 of treatment and his heart rate normalized. 

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