Mifron Tablet 4mg (Methylprednisolone)

Adult dosage

The initial dosage may vary from 4mg to 48mg per day of methylprednisolone, depending on the symptoms of the specific disease. In general, a low dose is sufficient for less severe conditions, although a high initial dose may be required in certain patients. The initial dose should be maintained or adjusted until a satisfactory response is achieved. If a satisfactory clinical result is not obtained after a reasonable period, treatment should be discontinued and another appropriate therapy initiated. The dosage must be determined individually according to the various diseases being treated and the patient's response. After an adequate response is obtained, 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 dosage is required. Situations that may require dosage adjustment include remission or worsening of the disease; individual patient responses to the drug; and the effects on the patient of exposure to stressors unrelated to the symptoms of the disease being treated. In the latter case, it may be necessary to increase the dosage for a period sufficient to meet the patient's needs. After long-term treatment, gradual dose reduction is recommended when discontinuing the drug. For 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 (4mg of methylprednisolone is equivalent to 5mg of prednisolone). Alternate-day therapy is a regimen in which twice the daily dose is administered on one morning out of every two days. The purpose of this regimen is to enhance the effects of corticosteroids in patients requiring long-term drug therapy while minimizing 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 persist longer than their physical presence and metabolic effects; and 2) Taking corticosteroids in the morning every other day restores nearly normal hypothalamic-pituitary-adrenal (HPA) activity on the days when corticosteroids are not administered. A brief summary of HPA physiology may help explain this rationale. Free cortisol acts primarily through the hypothalamus, so 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 PM to a peak at 6 AM. The increased ACTH stimulates adrenal cortical activity, causing plasma cortisol to peak between 2 AM and 8 AM. This rise in cortisol reduces ACTH production and, consequently, adrenal cortical synthesis. Plasma corticosteroid levels therefore gradually decrease during the day, reaching their lowest level at midnight. The 24-hour HPA rhythm is absent in Cushing's disease, a condition of adrenal cortical hyperfunction characterized by obesity with centripetal fat distribution, thin skin that bruises easily, weakness and muscle wasting, hypertension, latent diabetes, osteoporosis, and electrolyte imbalance. The clinical manifestations of the same hyperadrenocorticoism may typically occur during long-term corticosteroid therapy administered in divided doses throughout the day. If they occur, disruption of the diurnal rhythm due to elevated corticosteroid levels maintained overnight 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 typical pharmacologic-dose corticosteroid therapy, ACTH production is suppressed along with suppression of cortisol production by the adrenal cortex. The time required for recovery of 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 taking prednisolone (10mg) in four divided doses every 6 hours, there is evidence that, with pharmacologic doses, some suppression of adrenal activity persists into the following day. In addition, a single dose of any corticosteroid has been shown to suppress the adrenal cortex for 2 days or more. Methylprednisolone, hydrocortisone, prednisone, prednisolone, and other corticosteroids are considered short-acting (adrenocortical suppression occurs for 1¼ to 1½ days after a single dose) 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 followed. The benefits 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 drug therapy. 3) For less severe diseases for which corticosteroid therapy is indicated, ADT may be used initially. For more severe diseases, a regimen of high doses in divided daily doses will usually be required to achieve initial control of disease progression. The initial suppressive dose should be continued until a satisfactory clinical response is obtained, 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 is achieved, two approaches are possible. 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 level as soon as possible, depending on control of disease progression, and then switch to an alternate-day schedule. Theoretically, approach ① is preferable. 4) Because of the benefits of ADT, this form of therapy is desirable for patients who have taken corticosteroids daily for a long time (for example, rheumatoid arthritis). These patients may already have HPA axis suppression, so establishing ADT may be difficult and is not always successful. Nevertheless, regular attempts to make the change are recommended. If this is difficult, it is preferable to administer 3 or even 4 times the daily dose every other day rather than 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, certain corticosteroids are not recommended for alternate-day therapy because they suppress adrenal function for a long time (for example, dexamethasone, betamethasone). 6) Adrenal cortical activity is highest from 2 AM to 8 AM and lowest from 4 PM 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, it is important when using ADT to provide individualized and appropriate treatment for each patient. Complete control of symptoms is not possible in every patient. Explaining the benefits of ADT will help patients understand and tolerate unstable symptoms that may occur later in 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 the course of the disease, it may be necessary to return to a fully suppressive dose of corticosteroids administered in divided doses throughout the day to achieve control. Once control is achieved, the established alternate-day regimen may be attempted again. 9) Although many adverse effects of corticosteroid therapy may be minimized with ADT, as in any treatment setting, the physician must carefully consider the benefit-risk ratio of treatment for each patient for whom corticosteroid therapy is being considered.

This medication should not be used in certain patients. For instance, patients with allergies to this drug or its ingredients, or those with infections should not receive it. Additionally, patients with herpes simplex, shingles, chickenpox, or those receiving live vaccines should avoid this medication. Patients with genetic issues such as lactose intolerance should also refrain from using it. Care should be taken when using this drug in patients with conditions such as glaucoma, tuberculosis, cataracts, hypertension, thrombosis, peptic ulcer, psychosis, and osteoporosis. Patients with infections or diabetes, renal failure, hypothyroidism, fatty liver disease, and elderly individuals should be closely monitored as well. This medication may cause various side effects such as edema, hypertension, muscle weakness, osteoporosis, gastrointestinal disturbances, skin changes, psychiatric symptoms, endocrine abnormalities, and eye diseases. Therefore, if any unusual symptoms occur, immediate consultation with medical personnel is required. Since there is a risk of infection with chickenpox or measles, it is crucial to verify medical history and vaccination status before using this medication. In case of suspected infections, immediate medical attention should be sought, and prolonged use should not be suddenly halted, but rather decreased gradually. This drug may interact with other medications, so patients should inform their healthcare provider about any medications they are currently taking, especially with cardiovascular medicines, antibiotics, anticoagulants, diuretics, and anticonvulsants. Pregnant or breastfeeding women should consult their doctor before using this medication as it may affect the fetus or newborn. For children, careful consideration of dosage and duration of treatment is necessary as it may impact growth. Elderly individuals are at higher risk of side effects such as infections, diabetes, osteoporosis, and glaucoma and should be monitored more closely while using this medication. Lastly, during the use of this medication, it is safer to consult with a specialist before proceeding with vaccinations or skin tests.

edema, sodium retention, potassium loss, fluid retention, hypokalemic metabolic alkalosis, congestive heart failure, hypertension, myasthenia, aseptic necrosis of the femoral and humeral epiphyses, steroid myopathy, muscle wasting, pathological fractures of the iliac bone, osteoporosis, vertebral compression fractures, arthralgia, tendon rupture, increased ALT, increased AST, increased ALP, nausea, thirst, vomiting, gastric pain, anorexia, hyperphagia, peptic ulcer, abdominal distension, pancreatitis, ulcerative esophagitis, diarrhea, delayed wound healing, facial erythema, thin and fragile skin, abnormal sweating, petechiae, purpura, suppression of skin reactions, purpura, acne, hirsutism, alopecia, pigmentation, nipple edema, increased intracranial pressure, convulsions, dizziness, headache, insomnia, sense of well-being, depression, Cushing's syndrome, menstrual irregularities, growth suppression in children, signs of latent diabetes, secondary adrenal insufficiency, pituitary resistance, decreased glucose tolerance, increased insulin or oral hypoglycemic agent requirements, suppression of adrenocorticotropic hormone secretion, increased intraocular pressure, glaucoma, posterior capsule cataract, secondary infections of the eye due to fungi or viruses, retinal disorders, exophthalmos, negative nitrogen balance due to protein catabolism, immune system disorders, allergic reactions, shock, urticaria, anaphylactic reactions, hypersensitivity reactions

This medication should be stored in a tightly sealed container to prevent the ingress of air and moisture, ideally at a temperature between 1 and 30 degrees Celsius. Storing it this way can help maintain the drug's efficacy over time.

Appearance

White oval tablet

Package unit

30 tablets/bottle, 500 tablets/bottle