Methylprednisolone belongs to a class of synthetic anti-inflammatory drugs called corticosteroids. It changes the body’s immune response and is commonly used to treat arthritis. However, long-term use and high doses can cause serious side effects. Keep reading to learn about this drug and how it works.
What Is Methylprednisolone?
Methylprednisolone is a prescription medication that belongs to a group of drugs called corticosteroids, which are typically used to reduce inflammation and suppress the immune system [1].
Brand names of methylprednisolone include Medrol, Depo-Medrol, Solu-Medrol.
Methylprednisolone is used in a wide range of conditions, some of which include [1]:
- Arthritic conditions, such as rheumatoid arthritis and osteoarthritis
- Allergy-related conditions, such as seasonal allergies and allergic reactions
- Gastrointestinal diseases, such as ulcerative colitis
- Lupus
- Multiple sclerosis
- Management of certain cancers, such as leukemia
Mechanism of Action
Methylprednisolone mimics the function of glucocorticoids, a type of steroid hormone that the body naturally produces. Examples of natural glucocorticoids include cortisol and cortisone.
Corticosteroid drugs like methylprednisolone work through several mechanisms, some of which include [1]:
- Blocking the production of COX-2 enzymes, which are responsible for producing prostaglandins [2, 3]
- Increasing the production of anti-inflammatory compounds, such as cytokine IL-10
- Blocking the production of pro-inflammatory compounds, such as cytokines IFN-γ, TNF-α, and IL-2
- Blocking the activation of immune cells( T-cells)
There’s some evidence that methylprednisolone may also reduce the breakdown of myelin (by decreasing calpain), which could be helpful for multiple sclerosis [4].
Uses of Methylprednisolone
Methylprednisolone is FDA-approved to treat a large number of disorders. In the section below, we’ll highlight some of these uses. In addition to its FDA-approved uses, methylprednisolone is sometimes used for several off-label uses as well. Always take your medications as directed by your doctor.
1) Joint Disorders (Rheumatic Disorders)
Methylprednisolone is FDA-approved to treat a number of conditions that affect the joints, tendons, ligaments, bones, and muscles, otherwise known as rheumatic disorders. Some examples include [5]:
- Rheumatoid arthritis
- Osteoarthritis
- Ankylosing spondylitis, a type of arthritis that mainly affects the spine
- Bursitis, inflammation of the small sacs that help cushion the joints
- Tenosynovitis, inflammation of the sheath that surrounds the tendons
- Psoriatic arthritis
- Gouty arthritis
Methylprednisolone is generally used in these conditions to relieve pain, reduce inflammation, and improve mobility [1].
For example, a systematic review of 4 clinical trials including 739 patients with osteoarthritis in the knee found that methylprednisolone injections provided pain relief and improved physical function [6].
2) Skin Conditions
Methylprednisolone is used to treat several conditions that affect the skin, usually by reducing inflammation, swelling, pain, and allergic reactions. Some examples include [5]:
- Steven-Johnson syndrome
- Severe psoriasis
- Dermatitis herpetiformis
- Pemphigus
- Mycosis fungoides
In a randomized controlled study of 221 patients with atopic dermatitis, application of topical methylprednisolone combined with a moisturizer (Advabase) twice weekly reduced itching intensity, decreased incidences of relapse, and improved overall skin health [7].
3) Allergic Reactions
Corticosteroid drugs, including methylprednisolone, are sometimes used to control inflammation and swelling during severe allergic conditions, such as:
- Seasonal allergies
- Allergic reaction to medications
- Asthma
- Skin rash (contact dermatitis)
- Eczema (atopic dermatitis)
- Serum sickness
A randomized placebo-controlled trial of 97 patients who required emergency treatment for their asthma suggests that methylprednisolone (given through IV with standard treatment) may reduce the number of hospitalizations [8].
Methylprednisolone injections into the muscle may reduce the relapse of asthma attacks, according to a randomized placebo-controlled trial of 70 asthma patients [9].
4) Lupus
Lupus, also known as systemic lupus erythematosus (SLE), is an autoimmune condition where the body’s immune system attacks its own healthy cells. Drugs like methylprednisolone may be used to suppress the immune system to prevent flare-ups of the condition [10].
A small placebo-controlled trial of 25 patients found that intravenous methylprednisolone suppresses the immune system in the initial stages of lupus. However, this benefit did not persist after more than one month of treatment [11].
In a randomized controlled trial of 82 patients with inflamed kidneys caused by lupus (lupus nephritis), combination therapy of methylprednisolone and an immunosuppressive drug (cyclophosphamide) significantly reduced inflammation of the kidneys after 1 year [12].
Methylprednisolone and an immunosuppressive drug (azathioprine) may also improve quality of life, according to a study on 47 patients with inflamed kidneys. There is also evidence that methylprednisolone may also improve kidney function in children with the same condition [13, 14, 15].
5) Multiple Sclerosis
A relapse or acute attack in multiple sclerosis (MS) occurs when disease symptoms suddenly increase in severity.
Multiple clinical trials show that treatment with intravenous methylprednisolone can improve relapse symptoms and reduce disability in MS patients [16, 17, 18].
A number of clinical trials also suggest that the oral and intravenous forms of methylprednisolone have similar effectiveness in treating symptoms of relapse in MS [18, 19, 20, 21, 22].
6) Inflammatory Bowel Disease (IBD)
In irritable bowel disease (IBD), the digestive tract and inner lining of the colon are acutely or chronically inflamed. Methylprednisolone is sometimes used to help treat the two major types of IBD – ulcerative colitis and Crohn’s disease [23].
Ulcerative Colitis
According to some estimates, the use of steroids (like methylprednisolone) has brought the death rate from severe ulcerative colitis from 30-60% to only about 1-2.9% [24].
In a randomized open-label trial of 40 patients, intramuscularly methylprednisolone and oral prednisolone were equally effective at inducing remission in moderately active ulcerative colitis after 2 weeks of treatment [25].
Crohn’s Disease
An 8-week randomized trial of 67 patients found that methylprednisolone and budesonide (another type of corticosteroid) are equally effective at inducing remission of Crohn’s disease [26].
In a study on 70 patients with Crohn’s disease, methylprednisolone treatment for 3-weeks induced remission in 91% of patients. Researchers also found that multiple courses of steroid treatment in the previous 3 years may increase the risk of relapse [27].
7) Other Conditions
Methylprednisolone is FDA-approved to treat a wide variety of conditions, some of which include [5]:
- Disorders that affect hormone balance (endocrine disorders)
- Eye disorders, such as keratitis, optic neuritis, chorioretinitis, iritis, and iridocyclitis
- Lung diseases, such as berylliosis, sarcoidosis, and aspiration pneumonitis
- Management of certain cancers, including leukemia and lymphomas
Other Corticosteroids
There are many different corticosteroids available, which all have different potencies, half-lives, and available formulations.
Some other corticosteroid drugs are [28]:
- Prednisone (Deltasone)
- Dexamethasone (Dexamethasone Intensol)
- Prednisolone (Orapred, Prelone)
- Betamethasone (Celestone)
- Hydrocortisone (Cortef)
- Triamcinolone (Aristocort, Kenalog)
The choice of corticosteroid drugs depends on a number of factors, including the condition being treated, the severity of the disease, cost, availability, and doctor preference [29].
Methylprednisolone Safety
Side Effects
Below are some reported side effects of methylprednisolone. If any side effects persist or worsen, let your doctor know. This is also not a complete list of possible side effects. Tell your doctor if you experience any serious side effects or notice any effects not listed here.
Side effects from methylprednisolone can range from mild to severe depending on dosage and the way it’s taken (injections or by mouth).
Some common side effects include [5]:
- Increased appetite
- Weight gain
- Nausea
- Vomiting
- Heartburn
- Dizziness
- Trouble sleeping
- Sweating
- Increased acne
Some rare but serious side effects include [5]:
- Joint pain
- Increased bruising or bleeding
- Changes in mood or behavior
- Vision changes
- Irregular heartbeat
- Signs of an allergic reaction (itching, swelling, hives, shortness of breath)
In addition, corticosteroids may mask or increase the risk of infections.
Pregnancy and Breastfeeding
Due to a lack of strong clinical research, it’s unclear how methylprednisolone affects the fetus. There is some conflicting evidence that shows that corticosteroids may increase the risk of birth defects. Methylprednisolone should only be used during pregnancy if a doctor determines that the benefits outweigh the risks [5].
According to research, a small amount of methylprednisolone is transferred through breast milk. It’s unclear if this small amount affects the baby. Methylprednisolone should only be used during breastfeeding if a doctor determines that the benefits outweigh the risks [5].
Contraindications
Methylprednisolone should not be taken in the following cases [5]:
- Those that are allergic or hypersensitive to methylprednisolone or any of its components
- Those with serious fungal infections
- Those with immune thrombocytopenia (for IM injections)
- Those receiving live or attenuated virus vaccines (for immunosuppressive doses)
- In premature infants (with formulations containing benzyl alcohol).
Drug Interactions
The following drugs have been reported to interact with methylprednisolone. However, this is not a complete list, let your doctor know of all the medications you are currently taking to avoid any unexpected interactions.
- Antibiotics (erythromycin, isoniazid, rifampin, clarithromycin, erythromycin)
- Antifungals (ketoconazole, itraconazole)
- Antivirals (indinavir, ritonavir)
- Muscle relaxants used for anesthesia (pancuronium, neuromuscular blockers)
- Drugs used for extreme muscle weakness (neostigmine, pyridostigmine)
- Anticoagulants (aspirin, warfarin, heparin)
- Anti-seizure drugs (phenobarbital, phenytoin, carbamazepine)
- Drugs used to lower blood sugar in diabetes (insulin, glibenclamide, metformin)
- Other drugs that reduce immune response (cyclosporine, cyclophosphamide, tacrolimus)
- Drugs used to reduce nausea (aprepitant, fosaprepitant)
- Drugs that reduce cholesterol or laxatives (cholestyramine)
- Blood pressure-lowering drugs
- Anti-steroid drugs (aminoglutethimide)
- Anti-anxiety and antipsychotic drugs
- Hormones, such as estrogens in oral contraceptives (ethinylestradiol)
- Drugs used for heart conditions (digoxin, diltiazem)
- Diuretics (furosemide)
Methylprednisolone Dosage and Forms
The dosing of methylprednisolone can vary. Always take this medication as directed by a doctor.
The dosage, form of the drug, and how often it should be taken will depend on various factors, such as age, disease/disorder, severity, reaction to first drug dose, and other existing medical conditions.
Methylprednisolone can be taken orally or through injection in the following doses [30, 31, 32, 33]:
- Oral: 2 mg, 4 mg, 8 mg, 16 mg, 32 mg, 48 mg
- Intramuscular injection (per mL): 20 mg, 40 mg, 80 mg
- Intravenous injection (per mL): 40 mg, 125 mg, 500 mg, 1 g, 2 g
It is also available as a cream/ointment.
Medrol Dose Pack
Methylprednisolone is commonly prescribed as a blister pack, sometimes called a Medrol Dose Pack (Dosepak). They are typically used to provide immediate, short-term inflammation control.
These packs are specially designed to show how many tablets to take each day and when to take them. Packs contain a total of 21 tablets, with each tablet being 4 mg [5].
The standard dosing regimen is [5]:
- Day One: 2 before breakfast, 1 after lunch, 1 after dinner, 2 at bedtime (6 total)
- Day Two: 1 before breakfast, 1 after lunch, 1 after dinner, 2 at bedtime (5 total)
- Day Three: 1 before breakfast, 1 after lunch, 1 after dinner, 1 at bedtime (4 total)
- Day Four: 1 before breakfast, 1 after lunch, 1 at bedtime (3 total)
- Day Five: 1 before breakfast, 1 at bedtime (2 total)
- Day Six: 1 before breakfast (1 total)
Why do this? This kind of dosing strategy is called a taper, where the dose starts high and is gradually decreased. This ensures an immediate reduction of inflammation while minimizing withdrawal effects [34].
It’s important to take methylprednisolone exactly how it was prescribed by your doctor. If side effects occur or if there is an issue that stops you from taking the drug, you should talk to your doctor immediately.
Pulse Therapy
Pulse therapy involves giving high doses of methylprednisolone under careful supervision when the patient needs quick or effective action to suppress the immune system such as in [35, 36]:
- Lupus
- Skin disease (pemphigus)
- Kidney Transplants
- Kidney damage (nephrotic syndrome)
