Prond Tablet (Methylprednisolone)

Adult dosage

1. The initial dosage may vary from 4mg to 48mg of methylprednisolone per day, depending on the symptoms of the specific disease. In general, a low dose is sufficient for less severe conditions, but a high initial dose may be required in some patients. The initial dose should be maintained or adjusted until a satisfactory response is achieved. If a satisfactory clinical outcome is not achieved after a reasonable period, discontinue administration and switch to another appropriate treatment. The dose should 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. Continuous monitoring of the dose is required. Situations that may require dosage adjustment include improvement or worsening of the disease, individual patient responsiveness to the medication, and the effect 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 achieve a satisfactory response in 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 requiring long-term medication and to minimize adverse effects, including pituitary-adrenal suppression, 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 persist longer than their physical presence and metabolic effects; and 2) Taking corticosteroids in the morning every other day allows almost normal hypothalamic-pituitary-adrenal (HPA) activity to be reestablished on days when corticosteroids are not administered. A brief summary of HPA physiology may help explain this rationale. Free cortisol acts primarily through the hypothalamus; therefore, a decrease in free cortisol stimulates the pituitary gland to increase production of adrenocorticotropic hormone (ACTH), while an increase in free cortisol suppresses ACTH secretion. Normally, the HPA system is characterized by an activity rhythm over 24 hours. Serum ACTH levels rise from a low level at 10 p.m. to a peak at 6 a.m. The increased ACTH levels stimulate adrenocortical activity, causing plasma cortisol levels to peak between 2-8 a.m. This increase in cortisol decreases ACTH production and, consequently, adrenocortical synthesis. Plasma corticosteroid levels therefore gradually decrease throughout the day, reaching a minimum around midnight. The 24-hour HPA rhythm is absent in Cushing's disease, a condition characterized by symptoms of adrenocortical hyperfunction, including obesity with central fat distribution, thin skin that bruises easily, weakness and muscle wasting, hypertension, latent diabetes, osteoporosis, and electrolyte imbalance. The same clinical manifestations of hyperadrenocorticism can 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 maintenance of elevated corticosteroid levels during the night is likely to play an important role in the development of corticosteroid adverse effects. Avoiding persistently elevated plasma concentrations, even for a short period, may help prevent adverse effects. During typical pharmacologic-dose corticosteroid therapy, ACTH production is suppressed along with cortisol production by the adrenal cortex. The time required to recover 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 significantly less adrenal suppression than taking prednisolone (10mg) in 4 divided doses every 6 hours, there is evidence that, at pharmacologic doses, 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. Methylprednisolone, hydrocortisone, prednisone, prednisolone, and other corticosteroids are considered short-acting (a single dose causes adrenocortical suppression for 1¼ to 1½ days); therefore, alternate-day therapy is recommended. 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 who require long-term corticosteroid therapy. 3) ADT may be used initially for less severe diseases for which corticosteroid therapy is indicated. For more severe conditions, a regimen of high doses divided throughout the day will usually be required for initial control of 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, especially if continued use of alternate-day therapy is intended. Once control has been achieved, two approaches are possible: ① Switch to ADT and gradually reduce the amount of corticosteroid given every other day. ② Depending on control of disease progression, reduce the daily corticosteroid dose to the minimum effective dose as quickly as possible, and then switch to an alternate-day schedule. Theoretically, approach ① is more desirable. 4) Because of the advantages of ADT, this form of treatment is desirable for patients who have been taking corticosteroids daily for a long time (for example, rheumatoid arthritis). Since the HPA axis may already be suppressed in these patients, establishing an ADT regimen may be difficult and is not always successful. However, regular attempts to make the change are recommended. If this is difficult, administering 3 times or even 4 times the daily dose every other day is preferable to simply doubling the daily dose. Once the patient is controlled again, attempts should be made to reduce this dose to the minimum. 5) As noted above, some corticosteroids are not recommended for alternate-day therapy because they suppress adrenal function for a long time (for example, dexamethasone, betamethasone). 6) Maximum adrenal cortical activity occurs from 2 a.m. to 8 a.m., and minimum activity from 4 p.m. to midnight. When administered during the period of maximum activity (in the morning), exogenous corticosteroids suppress adrenocortical 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 later in the day when they are not receiving corticosteroids. If necessary, other symptomatic treatments may be added or increased during this period. 8) If an acute exacerbation occurs during the course of the disease, 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 attempted again. 9) Although many adverse effects of corticosteroid therapy can be minimized with ADT, as in any treatment setting, the physician should carefully weigh the benefit-risk ratio of treatment for each patient being considered for corticosteroid therapy.

This drug should not be used in certain patients. For example, it should not be administered to those who are allergic to this drug or its components, have infections that are not effectively treated with antibiotics, or have conditions such as simple herpes, shingles, or chickenpox. Additionally, patients who are receiving live vaccines or have genetic issues such as lactose intolerance should not use this drug. This drug should be used cautiously in some patients. For instance, patients with various diseases such as glaucoma, tuberculosis, cataracts, hypertension, thrombosis, peptic ulcer, psychosis, osteoporosis, diabetes, renal failure, hypothyroidism, fatty liver, myasthenia gravis, and elderly individuals should use this medication with care. Various side effects may occur while taking this drug, such as edema, increased blood pressure, muscle weakness, osteoporosis, indigestion, skin changes, headaches, depression, increased blood sugar levels, and eye problems, so symptoms should be closely monitored. Long-term use of this medication may lead to adrenal insufficiency, and sudden cessation of the drug can result in severe symptoms, so it should be gradually tapered. Furthermore, there may be an increased risk of infections, so precautions should be taken to avoid exposure to infections. This drug may interact with other medications, so if any other medications are being taken, consultation with a physician or pharmacist is essential. Special caution is needed when used with heart-related medications, antibiotics, diuretics, and antidiabetic drugs. Women who are pregnant or breastfeeding should consult their physician before using this drug, as it may affect the fetus or newborn. In children and adolescents, growth delay may occur, so it should be used at the minimal necessary dosage, and growth should be monitored closely. Elderly patients are at higher risk for side effects such as infections, diabetes, osteoporosis, hypertension, and eye diseases caused by this medication, so careful management is required. Special precautions are necessary during vaccination or skin testing while using this drug, and there may be rare serious allergic reactions or skin diseases, so any unusual symptoms should be reported to healthcare personnel immediately.

Edema, sodium retention, potassium loss, fluid retention, hypokalemic alkalosis, congestive heart failure, hypertension, myasthenia, aseptic necrosis of the femoral and humeral heads, steroid myopathy, muscle mass loss, pathological fractures of the pelvis, osteoporosis, vertebral compression fractures, arthralgia, tendon rupture, increased ALT, increased AST, increased ALP, nausea, dry mouth, vomiting, abdominal pain, loss of appetite, increased appetite, peptic ulcer, abdominal distension, pancreatitis, ulcerative esophagitis, diarrhea, delayed wound healing, facial erythema, thin and fragile skin, abnormal sweating, petechiae, purpura, suppressed skin reactions, purpura, acne, hirsutism, hair loss, pigmentation, elevated intracranial pressure, papilledema, convulsions, dizziness, headache, insomnia, euphoria, depression, Cushing's syndrome, menstrual irregularities, growth suppression, symptoms of latent diabetes, secondary adrenal insufficiency, pituitary non-responsiveness, decreased insulin sensitivity, increased requirement for insulin or oral hypoglycemic agents, suppressed secretion of adrenocorticotropic hormone, increased intraocular pressure, glaucoma, posterior subcapsular cataract, secondary infections, central serous chorioretinopathy, retinal disorders, proptosis, negative nitrogen balance, immune system disorders, allergic reactions, shock, urticaria, anaphylactic reactions, hypersensitivity reactions

This medication may be sensitive to air or moisture, so it should be stored in a sealed container. It is advisable to maintain a storage temperature between 1 and 30 degrees Celsius.

Appearance

White oval tablet

Package unit

200 tablets/bottle