Methylprednisolone Tablets (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, 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 has been 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 dose adjustment include remission or worsening of the disease, individual differences in the patient's response to the drug, and the effect on the patient of exposure to stressful circumstances that have no direct effect on 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 address the patient's condition. After long-term treatment, gradual dose reduction is recommended when discontinuing the drug. Multiple sclerosis 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). ADT (Alternate Day Therapy) Alternate day therapy is a regimen in which twice the daily dose is administered on one morning every other day. This regimen is intended to enhance the effects of corticosteroids in patients requiring long-term drug treatment and to minimize adverse effects, such as pituitary-adrenal suppression, Cushingoid state, corticosteroid withdrawal symptoms, and growth suppression in children. The rationale for this treatment regimen is based on the following 2 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 near-normal hypothalamic-pituitary-adrenal (HPA) activity to be re-established 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, 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 p.m. to a peak at 6 a.m. Increased ACTH levels stimulate adrenal cortical activity, causing plasma cortisol to peak between 2 a.m. and 8 a.m. This increase in cortisol decreases ACTH production and thus reduces adrenal cortical synthesis. As a result, plasma corticosteroid levels gradually decline during the day, reaching a minimum around midnight. The 24-hour HPA rhythm is absent in Cushing's disease, which is a condition of adrenocortical 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 same clinical manifestations of hyperadrenocorticism 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 sustained elevated corticosteroid levels 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 inhibition 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 4 divided doses every 6 hours, there is evidence that, when pharmacologic doses are used, some suppression of adrenal activity continues into the following day. Furthermore, suppression of the adrenal cortex has been observed after a single dose of any corticosteroid, lasting up to 2 days or longer. Methylprednisolone, hydrocortisone, prednisone, prednisolone, and other corticosteroids are considered short-acting (a single dose produces adrenocortical suppression for 1¼ to 1½ days) and are therefore suitable 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 who require 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 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, particularly 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 According to control of disease progression, reduce the daily corticosteroid dose to the minimum effective level as soon as possible, and then switch to an alternate-day schedule. Theoretically, approach ① is preferable. 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 these patients may already have suppression of the HPA axis, establishing ADT may be difficult and is not always successful. However, regular attempts to switch are recommended. If this is difficult, administering 3 or even 4 times the daily dose every other day is preferable to simply doubling the daily dose. Once the patient is again controlled, attempts should be made to reduce this dose to the minimum. 5) As mentioned 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, it is important to provide individualized and appropriate treatment for each patient when using ADT. Complete control of symptoms is not possible in every patient. Explaining the advantages of ADT may help patients understand and tolerate unstable symptoms that may occur during the latter part of days when corticosteroids are not administered. 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 attempted again. 9) Although many adverse effects of corticosteroid therapy may 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 medication should not be used in certain patients. For example, patients who have an allergy to this drug or its ingredients, or patients with infections lacking effective antibiotics or systemic fungal infections may have worsening of the infection upon using this medication. Additionally, patients with herpes simplex, shingles, chickenpox or those receiving live vaccines should not use this medication. It contains lactose and should not be administered to individuals with a genetic lactose intolerance issue. Some patients should use this medication with caution. For example, patients with glaucoma should be careful as intraocular pressure may rise and worsen symptoms. Patients with tuberculosis, herpetic keratitis, subcapsular cataracts, electrolyte abnormalities, hypertension, thrombosis, or those who have recently undergone bowel anastomosis may also experience worsening symptoms upon using this medication, so caution is necessary. Patients with diabetes may experience an increase in blood sugar, and patients with osteoporosis should be closely monitored as their bone health may deteriorate. This medication can lead to various side effects, so the patient's condition should be carefully monitored during administration. Possible side effects include edema, hypertension, muscle weakness, fractures, gastrointestinal symptoms, skin changes, and neuropsychiatric symptoms. Particularly with long-term use, adrenal insufficiency, growth suppression, worsening diabetes, increased intraocular pressure, and heightened risk of infections may occur, necessitating regular examinations and monitoring. This medication may interact with other drugs, so if the patient is taking other medications, they must inform their healthcare provider. Caution should be exercised as the risk of side effects may increase when used in conjunction with certain antibiotics, antiarrhythmic agents, diuretics, anticoagulants, etc. Pregnant women or those who may become pregnant should consider the potential effects on the fetus when using this medication, weighing the benefits against the risks. Additionally, breastfeeding mothers should discontinue nursing as it may be transmitted to the baby through breast milk. In children, growth disturbances may occur, so it should be administered cautiously at the minimal effective dose while carefully monitoring growth status. The elderly are at higher risk for side effects such as infections, diabetes, osteoporosis, and glaucoma, so extra caution is necessary. When taking this medication long-term, abrupt discontinuation should be avoided, and the dosage should be gradually reduced following the guidance of healthcare providers. Sudden discontinuation may induce adrenal insufficiency or withdrawal symptoms, so care is required. Finally, during the administration of this medication, special attention should be paid to avoid exposure to infections such as chickenpox or measles, and if an infection is suspected or occurs, immediate consultation with healthcare providers should be sought.

Edema, sodium retention, potassium loss, fluid retention, hypokalemic alkalosis, congestive heart failure, hypertension, myasthenia, aseptic necrosis of the femoral and humeral heads, steroid myopathy, loss of muscle mass, pathological fractures of the pelvis, osteoporosis, spinal compression fractures, arthralgia, tendon rupture, increased ALT, increased AST, increased ALP, nausea, dry mouth, vomiting, epigastric pain, anorexia, increased appetite, peptic ulcer, abdominal distension, pancreatitis, ulcerative esophagitis, diarrhea, delayed wound healing, facial erythema, thin and fragile skin, abnormal sweating, petechiae, ecchymosis, suppression of skin reactions, purpura, acne, hirsutism, hair loss, hyperpigmentation, papilledema, increased intracranial pressure, convulsions, dizziness, headache, insomnia, euphoria, depression, Cushing's syndrome, menstrual irregularities, growth suppression, symptoms of latent diabetes, secondary adrenal insufficiency, pituitary unresponsiveness, decreased glucose tolerance, increased demands for insulin or oral hypoglycemic agents, suppression of adrenocorticotropic hormone secretion, increased intraocular pressure, glaucoma, posterior subcapsular cataract, secondary infections of the eye, central serous chorioretinopathy, 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 sealed container to protect it from air and humidity. The storage temperature should ideally be maintained at room temperature between 1 to 30 degrees Celsius.

Appearance

White oval tablets

Package unit

30 tablets/bottle, 300 tablets/bottle