Composition
Inj: Per ml: Methylprednisolone acetate 40 mg; vi-als of 1 ml& 2 ml.
Indications & Dosage
Anti-inflammatory or immunosuppressive: BY IM INJ: Adult: 10-80 mg every 1-2 week. Rheumatoid Arthritis: BY INTRA-ARTICULAR INJ: Adult: every 1-5 week; Large joints (e.g. knee, ankle): 20-80 mg; Medium joints (e.g. elbow, wrist): 10-40 mg; Small joints: 4-10 mg. Acute or severe Dermatitis: BY IM INJ: Adult: 80-120 mg as a single dose. Chronic Dermatitis: BY IM INJ: Adult: 40-120 mg every 5-10 days. Keloid, Lichen planus and other dermatologic conditions: BY INTRALESIONAL INJ: Adult: 20-60 mg.
Administration
Methylprednisolone acetate has a low solubility and has a sustained IM effect. Do not use in trathecally. Intra-articular: A sterile 20- to 24-gauge needle (on a dry syringe) is quickly inserted into the synovial cavity, Procaine infiltration is elective. The aspiration of only a few drops of joint fluid proves the joint space has been entered by the needle. The inj site for each joint is determined by that location where the synovial cavity is most superficial & most free of large vessels & nerves. With the needle in place, the aspirating syringe is removed and replaced by a second syringe containing the desired amount of methylprednisolone. The plunger is then pulled outward slightly to aspirate synovial fluid and to make sure the needle is still in the synovial space after inj, the joint is moved gentle a few times to aid mixing of the synovial fluid and the suspension. The site is covered with a small dressing. Intralesional: Make multiple small injections into the area of the lesion whenever possible. Care should be taken to avoid inj of the sufficient material to cause blanching because this may be followed by a small slough. IM: Inj IM form deep into gluteal muscle. Avoid inj into the deltoid muscle. Take precautions against inj or leakage into the dermis.
Compatibility
Do not mix with other drugs, stable in D5W, NS.
Stability
Store at 20C-25C. Do not autoclave when it is desirable to sterilize the outside of the vial.
Contraindications
Systemic fungal infections unless specific anti-infective therapy is used, head injury, stroke.
Precautions
Active infections not controlled by antibiotics, latent or active amoebiasis, history of TB, septicaemia, symptoms may be masked, avoid or maintain extreme cautions in chickenpox, measles, psychiatric disorders, renal impairment, hepatic failure, cirrhosis, active peptic ulcer, myasthenia gravis, previous steroid myopathy, osteoporosis, epilepsy, hypothyroidism, diabetes, adrenal suppres-sion, hypertension, recent MI, congestive heart failure, thromboembolic disorders, glaucoma, corneal perforation. Withdraw gradually, withdrawal symp-toms may include fever, myalgia, arthralgia, rhinitis, itchy skin nodules and weight loss.
Interactions
Live vaccines or other vaccines, anticoagulants, hypoglycaemia agents, antihypertensives, diuretics, erythromycin, rifamycin, amphotericin, azole antifungals, ritonavir, cyclosporin, cardiac glycosides, Oestrogens including oral contraceptives, somatropin, Carbamazepine, phenytoin, primicane, barbiturates. Muscle relaxants, NSAIDs, salicylates, sympathomimetics, mifepristone, methotrexate, theophylline, aprepitant.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Endocrine irregularities including menstrual problems, cushingoid state, adrenal suppression, growth suppression in children, increased susceptibility to infection, increased severity of infection, fluid/electrolyte disturbance, hypertension, negative protein, nitrogen and calcium balance, myopathy, tendon rupture, osteoporosis, osteonecrosis and fractures, impaired wound healing, sweating, hirsutism, striae, telangiectasia, acne, GI disturbance, peptic ulceration, acute pancreatitis, candidiasis, psychiatric effects, neurological effects, insomnia, diabetes, impaired glucose tolerance, weight gain, increased appetite, ocular disturbances including cataracts, raised in-traocular pressure, optic nerve damage, corneal changes, glaucoma, thromboembolism, leukocytosis