Methylon Tablet 4mg (Methylprednisolone)

Adult use

1. The initial dosage may vary from 4mg to 48mg per day as 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 satisfactory clinical results are not achieved after a reasonable period, treatment should be discontinued and another appropriate therapy should be started. 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 dosage is required. Circumstances that may require dose adjustment include improvement or worsening of the disease, individual patient response to the drug, and the effect on the patient of exposure to stressful situations 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 response in the patient's 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, it is effective to administer prednisolone 200mg daily for 1 week, followed by prednisolone 80mg every other day for 1 month (4mg of methylprednisolone is equivalent to 5mg of prednisolone). 3. ADT (Alternate Day Therapy) 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 treatment 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 2 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 restores nearly normal hypothalamic-pituitary-adrenal (HPA) activity on the days when corticosteroids are not administered. A brief review 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 levels stimulate adrenocortical activity, causing plasma cortisol levels to peak between 2-8 a.m. This increase in cortisol reduces ACTH production and therefore also decreases adrenocortical synthesis. Plasma corticosteroid levels gradually decrease during the day, reaching a minimum around midnight. The 24-hour HPA rhythm is absent in Cushing's disease, a condition characterized by hyperadrenocorticism with symptoms such as 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 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 therapy with typical pharmacologic doses of corticosteroids, 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 situation. Although a single morning dose causes considerably less adrenal suppression than taking prednisolone (10mg) in 4 divided doses every 6 hours throughout the day, there is evidence that, when pharmacologic doses are used, some suppression of 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 (one dose causes adrenocortical suppression for 1¼ to 1½ days) and 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 requiring long-term corticosteroid 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 doses 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 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). As 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, 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 mentioned above, some corticosteroids suppress adrenal function for a long time and are therefore not recommended for alternate day therapy (for example, dexamethasone and betamethasone). 6) Adrenocortical activity is greatest from 2 a.m. to 8 a.m. and lowest from 4 p.m. to midnight. When administered during the period of greatest activity (in the morning), exogenous corticosteroids suppress adrenocortical 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 advantages of ADT will help patients understand and tolerate unstable symptoms that may occur later in the day when no corticosteroid is 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 fully suppressive doses of corticosteroids divided 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 should carefully consider the benefit-risk ratio of treatment for each patient in whom corticosteroid therapy is being considered.

This drug should not be administered to certain patients. For example, patients with allergies to this drug, infectious diseases, herpes simplex, herpes zoster, chickenpox patients, and those receiving live vaccines should not use this drug. Additionally, individuals with lactose intolerance or certain genetic diseases may face risks when taking this drug. When using this medication, caution is advised for patients with specific conditions or diseases such as glaucoma, tuberculosis, cataracts, electrolyte imbalances, hypertension, thrombosis, and recent surgical procedures. Patients with diabetes, osteoporosis, renal failure, heart failure, hypothyroidism, epilepsy, the elderly, etc., also require caution. During the use of this drug, symptoms such as edema, increased blood pressure, muscular weakness, osteoporosis, gastrointestinal issues, skin changes, neuropsychiatric symptoms, endocrine disorders, and ocular problems may occur, so these symptoms should be closely monitored. Abrupt discontinuation of long-term use can be dangerous, so the dosage should be gradually reduced, and during stressful situations, temporary increases in dosage may be necessary. This drug suppresses immune function, potentially increasing the risk of infections, thus special attention must be paid to infection prevention. Due to numerous drug interactions, it is essential to consult with a physician or pharmacist when used in conjunction with other medications, particularly cardiac medications, antibiotics, anticoagulants, diuretics, etc. During pregnancy, it may affect the fetus and should only be used when absolutely necessary, and it is advisable to discontinue use during breastfeeding. In pediatric patients, there may be side effects such as growth retardation, so it should be used cautiously at the lowest effective dosage, and elderly patients also require monitoring for higher risks of side effects. Attention is also required for vaccinations or skin tests during the use of this drug, and if abnormal symptoms occur, immediate consultation with healthcare professionals is necessary.

Edema, sodium retention, potassium loss, fluid retention, hypokalemic alkalosis, congestive heart failure, hypertension, myasthenia, avascular necrosis of the femoral and humeral heads, steroid myopathy, loss of muscle mass, pathologic fractures of the pelvis, osteoporosis, spinal compression fractures, arthralgia, tendon rupture, elevated ALT, elevated AST, elevated ALP, nausea, thirst, vomiting, abdominal pain, loss of appetite, increased appetite, peptic ulcer, abdominal distention, pancreatitis, esophagitis, diarrhea, delayed wound healing, facial erythema, thin and fragile skin, abnormal sweating, petechiae, ecchymosis, skin reaction suppression, purpura, acne, hirsutism, alopecia, pigmentation, papilloedema, increased intracranial pressure, seizures, dizziness, headache, insomnia, euphoria, depression, Cushing's syndrome, menstrual irregularities, impaired growth in children, latent diabetes symptoms, secondary adrenal insufficiency, pituitary unresponsiveness, decreased glucose tolerance, increased requirement for insulin or oral hypoglycemic agents, suppression of adrenocorticotropic hormone secretion, increased intraocular pressure, glaucoma, posterior capsule cataract, secondary eye infections, 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 prevent exposure to air or moisture and kept at a temperature between 1 degree and 30 degrees Celsius. This storage method ensures optimal efficacy and safe use of the medication.

Appearance

White oval-shaped tablet

Package unit

30 tablets/bottle, 500 tablets/bottle