Mloid Tablet 4 mg (Methylprednisolone)

Adult dosage

1. The initial dose 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, 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 result is not obtained after a reasonable period, discontinue administration and switch to another appropriate treatment. The dose must be determined individually according to the various diseases being treated and the patient's response. After an adequate response is achieved, the 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 patient response to the drug, and the effect on the patient of exposure to stressful circumstances that do not directly affect 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 patient condition. After long-term treatment, gradual dose reduction is recommended when discontinuing the drug. 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 drug treatment, 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 allows almost normal hypothalamic-pituitary-adrenal (HPA) activity to be reestablished 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; 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. Increased ACTH stimulates adrenal cortical activity, causing plasma cortisol to reach its peak between 2 a.m. and 8 a.m. This increase in cortisol reduces ACTH production and consequently reduces adrenal cortical synthesis. Plasma corticosteroid levels then gradually decrease during the day, reaching a minimum around 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 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 maintenance of elevated corticosteroid levels during the night is likely to play an important role in the development of corticosteroid adverse effects. Even a brief period without continuously elevated plasma concentrations 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 normal HPA activity to recover 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) administered in 4 divided doses every 6 hours, evidence indicates that, with 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 suppresses the adrenal cortex 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) ADT may be used initially for less severe diseases for which corticosteroid therapy is indicated. For more severe diseases, 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, 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 dose as soon as possible, according to control of disease progression, 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). These patients may already have HPA axis suppression, so establishing ADT 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 3 or even 4 times the daily dose every other day rather than simply doubling the daily dose. Once the patient is again controlled, attempt to reduce this dose to the minimum. 5) As mentioned above, certain 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 (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 for all patients. Explaining the benefits of ADT will help patients understand and tolerate unstable symptoms that may occur during the latter part of the day 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 the course of the disease, it may be necessary to return to a suppressive corticosteroid dose divided throughout the day for control. Once control is 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 consider the benefit-risk ratio of treatment for each patient in whom corticosteroid therapy is being considered.

This medication should not be used in certain patients. For instance, it should not be given to individuals who are allergic to this medicine or its components, patients with non-bacterial infections or systemic fungal infections, patients with herpes simplex, shingles, chickenpox, and patients receiving live vaccines. Additionally, due to the presence of lactose, patients with galactose intolerance, lactose deficiency, or glucose-galactose malabsorption should not use this medicine. This medication should be used with caution in some patients. This includes patients with glaucoma, tuberculous diseases, keratitis, cataracts, electrolyte imbalances, hypertension, thrombosis, those who have recently undergone bowel resection, patients with a history of acute myocardial infarction, diverticulitis, peptic ulcers, psychosis, and severe osteoporosis, among others. Patients with infections or those with diabetes, renal failure, congestive heart failure, hypothyroidism, fatty liver, fat embolism, severe myasthenia gravis, elderly patients, epilepsy patients, and those with ulcerative colitis should use this medicine cautiously. Side effects may occur while using this medication; therefore, careful monitoring for fluid retention, edema, increased blood pressure, muscle weakness, osteoporosis, gastrointestinal symptoms, skin changes, neuropsychiatric symptoms, endocrine abnormalities, eye issues, and immune system abnormalities is necessary. Particularly, infection with chickenpox or measles during treatment can be fatal, so it is essential to confirm medical history and vaccination status and take precautions to prevent infections. In case of long-term use, avoid sudden discontinuation and taper off gradually. In stressful situations, the dosage should be temporarily increased. This medication may interact with various drugs, so consult healthcare professionals when taking other medications. Pregnant women or those who may become pregnant should carefully consider the risks and benefits of this medication, and nursing mothers should discontinue breastfeeding. In pediatric patients, there may be side effects such as growth inhibition, so the minimum effective dose should be used, and growth status should be monitored. Elderly patients have a higher risk of side effects such as infections, diabetes, osteoporosis, cataracts, and glaucoma and should be given this medication with greater caution. Finally, during the use of this medication, specific vaccinations should be avoided, and precautions should be taken when performing skin tests or other examinations.

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, vertebral compression fractures, arthralgia, tendon rupture, increased ALT, increased AST, increased ALP, nausea, dry mouth, vomiting, abdominal pain, anorexia, increased appetite, peptic ulcer, abdominal bloating, 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, increased intracranial pressure, papilledema, seizures, dizziness, headache, insomnia, euphoria, depression, Cushing's syndrome, menstrual irregularities, pediatric growth suppression, latent diabetes symptoms, secondary adrenal insufficiency, pituitary unresponsiveness, decreased glucose tolerance, increased requirements 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 medicine may be sensitive to air or moisture, so it should be stored in a tightly closed container. It is advisable to keep the storage temperature between 1 degree and 30 degrees Celsius. Proper storage will help maintain the effectiveness of the medication for a longer time.

Appearance

White oval tablet

Package unit

30 tablets/bottle, 300 tablets/bottle