Menisolon Tablet 4 mg (Methylprednisolone)

Adult dosage

1. The initial dose may vary from 4mg to 48mg per day as methylprednisolone, depending on the symptoms of the specific disease. A low dose is generally sufficient for less severe conditions, but a high initial dose may be required in certain patients. The initial dose should be maintained or adjusted until a satisfactory response is obtained. If a satisfactory clinical outcome is not achieved after a reasonable period, treatment should be discontinued and another appropriate treatment initiated. The dosage must be determined individually according to the various diseases being treated and the patient's response. After an adequate response is achieved, an appropriate maintenance dose should be determined by reducing the initial dose at suitable intervals until the lowest dose that maintains an adequate clinical response is reached. Ongoing monitoring of the dosage is required. Situations that may require dosage adjustment include improvement or worsening of the disease, individual differences in the patient's response to the medication, and the effects on the patient of exposure to stressful circumstances that are not directly related to the symptoms of the disease being treated. In the latter case, it may be necessary to increase the dose for a period sufficient to satisfactorily manage the patient's condition. After long-term treatment, gradual dose reduction is recommended when discontinuing the medication. 2. Multiple sclerosis For the treatment of acute exacerbations of multiple sclerosis, administration of prednisolone 200mg daily for 1 week followed by prednisolone 80mg every other day for 1 month is effective (methylprednisolone 4mg is equivalent to prednisolone 5mg). 3. ADT (Alternate Day Therapy) Alternate-day therapy is a regimen in which twice the daily dose is administered on one morning every other day. The purpose of this regimen is to enhance the effects of corticosteroids in patients who require long-term medication and to minimize adverse effects such as pituitary-adrenal suppression, a Cushingoid state, corticosteroid withdrawal symptoms, and growth suppression in children. The rationale for this treatment plan is based on the following two important premises: 1) The anti-inflammatory and therapeutic effects of corticosteroids last longer than their physical presence and metabolic effects; and 2) Taking corticosteroids in the morning every other day allows near-normal hypothalamic-pituitary-adrenal (HPA) activity to be re-established on the days when corticosteroids are not administered. A brief review of HPA physiology may help explain this rationale. Free cortisol acts mainly through the hypothalamus. Therefore, a decrease in free cortisol stimulates the pituitary gland to increase production of adrenocorticotropic hormone (ACTH), whereas an increase in free cortisol suppresses ACTH secretion. Normally, the HPA system is characterized by a 24-hour activity rhythm. Serum ACTH levels rise from a low level at 10 p.m. to a peak at 6 a.m. The increased ACTH stimulates adrenal cortical activity, causing plasma cortisol to peak between 2-8 a.m. This rise in cortisol decreases ACTH production and thus also reduces adrenal cortical synthesis. As a result, plasma corticosteroid levels gradually decrease throughout the day, reaching their lowest level at midnight. The 24-hour HPA rhythm is lost in Cushing's disease, a condition characterized by hyperadrenocorticism with symptoms including obesity with centripetal fat distribution, thin skin that bruises easily, weakness and muscle wasting, hypertension, latent diabetes, osteoporosis, and electrolyte imbalance. The same clinical manifestations of hyperadrenocorticism may typically occur during long-term corticosteroid therapy when the medication is divided into daily doses. If they occur, disruption of the diurnal rhythm due to sustained elevated corticosteroid levels during the night is likely to play an important role in the development of corticosteroid adverse effects. Avoiding continuously elevated plasma concentrations, even for a short period, may help prevent adverse effects. During treatment with typical pharmacologic doses of corticosteroids, ACTH production is suppressed along with the inhibition of cortisol production by the adrenal cortex. The time required to restore normal HPA activity varies according to the dose and duration of treatment. During this period, the patient is sensitive to any stressful circumstances. Although a single morning dose causes considerably less adrenal suppression than prednisolone (10mg) taken in four divided doses every 6 hours throughout the day, there is evidence that when pharmacologic doses are used, a slight suppressive effect on adrenal activity continues into the following day. In addition, a single dose of any corticosteroid has been shown to suppress the adrenal cortex for 2 days or longer. Other corticosteroids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered short-acting (a single dose produces adrenal cortical suppression for 1¼ to 1½ days) and are therefore recommended for alternate-day therapy. The following points should be kept in mind when using alternate-day therapy. 1) The basic principles and indications for corticosteroid therapy should be applied. The advantages of ADT should not encourage indiscriminate use of corticosteroids. 2) ADT is a treatment technique that should generally be planned for patients requiring long-term corticosteroid therapy. 3) For less severe diseases for which corticosteroid therapy is indicated, ADT may be used from the outset. For more severe conditions, a regimen of high doses divided throughout the day will usually be required initially to control disease progression. The initial suppressive dose should be continued until a satisfactory clinical response is achieved, usually for 4 to 10 days in many allergic and collagen diseases. It is important to keep the initial suppressive-dose period as short as possible, particularly if continued use of alternate-day therapy is intended. Once control has been achieved, either of the following two approaches may be used. ① Switch to ADT and gradually reduce the amount of corticosteroid given every other day. ② Reduce the daily corticosteroid dose to the minimum effective dose as soon as possible, according to control of disease progression, and then change to an alternate-day schedule. In theory, approach ① is preferable. 4) Because of the advantages of ADT, this form of treatment is desirable for patients who have taken corticosteroids daily for a long period (for example, rheumatoid arthritis). These patients may already have HPA axis suppression, so establishing an ADT regimen may be difficult and is not always successful. However, regular attempts to make the change are recommended. If difficulties arise, it is preferable to administer three or even four times the daily dose every other day rather than merely doubling the daily dose. Once the patient's condition is controlled again, an attempt should be made to reduce this dose to the lowest possible level. 5) As noted above, some corticosteroids suppress adrenal function for a long time and are therefore not recommended for alternate-day therapy (for example, dexamethasone, betamethasone). 6) Adrenal cortical activity is highest from 2 a.m. to 8 a.m. and lowest from 4 p.m. to midnight. When administered during the period of peak activity (in the morning), exogenous corticosteroids suppress adrenal cortical activity the least. 7) As with any treatment setting, when using ADT it is important to provide individualized and appropriate treatment for each patient. Complete control of symptoms is not possible in every patient. Explaining the advantages of ADT will help patients understand and tolerate unstable symptoms that may occur during the latter part of the day when corticosteroids are not taken. If necessary, other symptomatic treatments may be added or increased during this period. 8) If an acute exacerbation occurs during disease progression, it may be necessary to return to a fully suppressive dose of corticosteroids divided throughout the day to achieve control. Once control has been achieved, the established alternate-day regimen may be tried again. 9) Although many adverse effects of corticosteroid therapy may be minimized with ADT, as in any treatment setting, the physician must carefully weigh the benefits and risks of treatment for each patient being considered for corticosteroid therapy.

This medication should not be used in certain patients. For example, patients who are allergic to this medicine or any of its components, patients with infections without appropriate antibiotics or systemic fungal infections, patients suffering from herpes simplex, herpes zoster, or chickenpox, patients receiving live vaccines, and patients with lactose intolerance should not take this medication. There are also patients who need to be cautious while using this medication. Those with glaucoma, tuberculosis, cataracts, electrolyte imbalances, hypertension, thrombosis, recent bowel anastomosis, acute myocardial infarction, diverticulitis, peptic ulcers, psychosis, severe osteoporosis, diabetes, renal failure, hypothyroidism, fatty liver, myasthenia gravis, elderly patients, epilepsy, and ulcerative colitis need special care when using this medication. This medication can cause various side effects, so careful monitoring is required. Side effects may include edema, sodium retention, potassium loss, muscle weakness, osteoporosis, gastrointestinal problems, skin changes, neuropsychiatric symptoms, endocrine abnormalities, eye-related problems, and immune system issues. Prolonged use can lead to adrenal insufficiency, so do not suddenly stop taking the medication. Instead, taper off the dose gradually and temporarily increase it during stressful situations. Also, due to its immunosuppressive effects, there is an increased risk of infections, so care should be taken to avoid exposure to chickenpox or measles. There may be interactions with other medications, so always consult with healthcare professionals when taking this medication alongside others, especially cardiac medications, antibiotics, anticoagulants, diuretics, anticonvulsants, and antacids. Women who are pregnant or breastfeeding should carefully consider the benefits and risks of using this medication, as it may affect the fetus or newborn, and it is advisable to discontinue breastfeeding. In pediatric patients, side effects such as growth retardation may occur, so only the minimum effective dose should be used while closely monitoring growth status. Elderly patients are at higher risk for side effects and should use this medication with extra caution. During the use of this medication, there is also a risk of hypokalemia or skin reaction suppression and reduced vaccine efficacy, thus it is essential to follow medical advice.

Edema, sodium retention, potassium loss, fluid retention, hypokalemic alkalosis, congestive heart failure, hypertension, myasthenia, avascular necrosis of the femoral and humeral epiphyses, steroid myopathy, loss of muscle mass, pathologic fractures of the ilium, osteoporosis, spinal compression fractures, arthralgia, tendon rupture, increased ALT, increased AST, increased ALP, nausea, thirst, vomiting, gastric pain, loss of appetite, increased appetite, peptic ulcer, abdominal distension, pancreatitis, ulcerative esophagitis, diarrhea, delayed wound healing, facial flushing, thin and fragile skin, abnormal sweating, petechiae, purpura, suppression of skin reactions, purpura, acne, hirsutism, hair loss, pigmentation, increased intracranial pressure, papilledema, seizures, dizziness, headache, insomnia, euphoria, depression, Cushing's syndrome, menstrual disorders, growth suppression in children, latent diabetes symptoms, secondary adrenal insufficiency, pituitary unresponsiveness, decreased insulin sensitivity, increased requirement for insulin or oral hypoglycemic agents, suppression of adrenocorticotropic hormone secretion, elevated intraocular pressure, glaucoma, subcapsular cataract, secondary eye infections due to fungal or viral causes, retinal disorders, exophthalmos, negative nitrogen balance, immune system disorders, allergic reactions, shock, urticaria, anaphylactic reactions, hypersensitivity reactions

This medication should be stored in a tightly closed container to protect it from air and moisture. The recommended storage temperature is between 1°C and 30°C in a room.

Appearance

White oval tablets

Package unit

30 tablets/bottle, 300 tablets/bottle