Methylprednisolone

Methylprednisolone is a potent corticosteroid with anti-inflammatory activity at least five times that of hydrocortisone. It has greater glucocorticoid activity and insignificant mineralocorticoid activity, making it particularly suitable for conditions where sodium and water retention would be a disadvantage. Corticosteroids have been suggested to reduce lung inflammation in ARDS. The fibroproliferative phase occurs between 7 and 14 days from the onset of ARDS.There are no large controlled trials at present to show conclusive benefit from this practice.

Uses
Fibroproliferative phase of ARDS (unlicensed)
Adjunct in Pneumocystis carinni pneumonia (see co-trimoxazole and pentamidine)

Contraindications
Systemic infection (unless specific anti-microbial therapy given)

Administration
• Fibroproliferative phase of ARDS (unlicensed)
IV infusion: 2 mg/kg loading dose (rounded to nearest 20 mg) then 0.5 mg/kg (rounded to the nearest 10 mg) 6 hourly for 14 days or until extubation whichever is quicker.Then convert to prednisolone 1 mg/kg orally each morning for 7 days, then 0.5 mg/kg each morning for 7 days daily, then 0.25 mg/kg for 2 days, then 0.125 mg/kg for 2 days then stop.
• Adjunct in Pneumocystis carinii pneumonia (see co-trimoxazole and pentamidine)
IV infusion: 1 g once daily for 3 days; if the patient responds well steroids may be stopped, if not continue as follows: days 4 and 5 500 mg IV once daily, then days 6–16 prednisolone reducing regimen, i.e. 60 mg, 50 mg, 40 mg, 30 mg, 20 mg 15 mg, 10 mg, 10 mg,
5 mg, 5 mg then stop.

The steroid should be started at the same time as the co-trimoxazole or pentamidine and should be withdrawn before the antibiotic treatment is complete.
Reconstitute with WFI. Make up to 50 ml sodium chloride 0.9% or glucose 5% give over at least 30 min.

How not to use methylprednisolone
Do not give by rapid IV injection (hypotension, arrhythmia, cardiac arrest)
Avoid live virus vaccinations

Adverse effects
Prolonged use may also lead to the following problems:
• increased susceptibility to infections
• impaired wound healing
• peptic ulceration
• muscle weakness (proximal myopathy)
• osteoporosis
• hyperglycaemia

Cautions
Diabetes mellitus
Concurrent use of NSAID (increased risk of GI bleeding)