Methylprednisolone belongs to a class of synthetic anti-inflammatory drugs called corticosteroids. It changes the body’s immune response to reduce inflammation in disorders such as arthritis. However, there are serious side effects related to long-term methylprednisolone use at high doses. Keep reading to learn more about the uses, side effects, and dosage of methylprednisolone.
What Is Methylprednisolone?
Methylprednisolone (brand names: Medrol, Depo-Medrol, Solu-Medrol) is a corticosteroid used to reduce inflammation or immune response in various conditions, including [R]:
It is also available as a generic medication. It is taken either in tablet form (2mg, 4mg, 8mg, 16mg, 32mg) or as injections into a vein or muscle.
The Food and Drug Administration (FDA) approved its use in 1957. Methylprednisolone is listed on the WHO List of Essential Medicines [R].
Methylprednisolone vs. Other Corticosteroids
Methylprednisolone is the standard corticosteroid drug in Europe, while in the US it is prednisone (Deltasone). The main difference between these drugs is that methylprednisolone is also available as injections.
Some other corticosteroid drugs are [R]:
- Dexamethasone (Dexamethasone Intensol)
- Prednisolone (Orapred, Prelone)
- Betamethasone (Celestone)
- Hydrocortisone (Cortef)
- Triamcinolone (Aristocort, Kenalog)
The choice of corticosteroid drug depends on how you are advised to take the drug and how effective it is for the specific disease/disorder you are suffering from.
Mechanisms of Action
Methylprednisolone mimics the function of glucocorticoid steroid hormones that the body produces, such as cortisol.
- Blocking the production and release of compounds (prostaglandins) that cause inflammation and pain [R, R].
- Increasing the production of anti-inflammatory compounds (cytokine IL-10).
- Blocking the production of pro-inflammatory compounds (cytokines IFN-γ, TNF-α, and IL-2).
- Blocking the activation of immune cells (T-cells), which trigger inflammation.
- Decreasing the damage from high amounts of nitric oxide and tumor necrosis factor alpha (TNF-α).
- Increasing cell death of activated immune cells.
Uses of Methylprednisolone
1) Decreased Pain in Rheumatoid Arthritis
Rheumatoid arthritis is a chronic inflammatory disease of the joints.
Methylprednisolone injection reduces pain and improves physical function in knee osteoarthritis. Multiple studies have shown that methylprednisolone injection greatly decreased pain, stiffness, and improved function in knee osteoarthritis [R, R, R, R].
In one study on 83 rheumatoid arthritis patients, methylprednisolone injection with a local anesthetic (bupivacaine) reduced shoulder pain and improved shoulder movement [R].
A third study on 10 rheumatoid arthritis patients, intravenous methylprednisolone pulse therapy was given every month for 6-months. Patients treated with methylprednisolone could walk faster, grip things with their hands, and felt pain relief from inflamed joints. However, methylprednisolone did not delay the progression of arthritis [R].
Intravenous methylprednisolone decreased the blood levels of proteins involved in inflammation (C-reactive protein, IgG, and IgA) in 14 patients with severe rheumatoid arthritis. Three patients showed remarkable improvements in arthritic symptoms lasting for more than 42 weeks [R].
2) May Help With Lupus
Lupus occurs when someone’s immune system attacks healthy cells in the body for reasons mostly unknown. Since methylprednisolone reduces the immune system’s response, it may lessen the severity of lupus symptoms.
Intravenous methylprednisolone suppressed the immune system in the initial stages of lupus in a small study on 25 patients [R].
In a study on 82 patients with inflamed kidneys caused by lupus (lupus nephritis), combination therapy of methylprednisolone and an immunosuppressive drug (cyclophosphamide) greatly reduced inflammation of the kidneys after 1 year [R].
Methylprednisolone and an immunosuppressive drug (azathioprine) improved quality of life in a study on 47 patients with inflamed kidneys. Multiple studies in children with the same condition have shown that methylprednisolone was also effective in improving kidney function [R, R, R].
However, the standard dose of methylprednisolone used for lupus (1 g/day for 3 consecutive days) may lead to infections. Lower doses (≤ 1500 mg/day) are still effective in improving symptoms of lupus [R, R].
3) May Help With Sarcoidosis
In a study of 12 patients with sarcoidosis, high-dose intravenous methylprednisolone quickly improved symptoms when given weekly for 6 weeks. However, 8 of the 12 patients relapsed after a year and required additional treatment [R].
Methylprednisolone improved lung function in 39 patients with stage 2 lung sarcoidosis, but the improvements were not different from the untreated patients after 2-4 years. It also reversed the progression of sarcoidosis in the lungs in 24 patients with pulmonary sarcoidosis [R, R].
4) May Improve Relapse Symptoms in Multiple Sclerosis
A relapse or acute attack in multiple sclerosis (MS) occurs when disease symptoms suddenly increase in severity.
In another study, methylprednisolone was better at reducing relapse symptoms rapidly than ACTH, the standard treatment for relapses in multiple sclerosis. However, its beneficial effects were similar to ACTH after 3-months, suggesting that it is an effective short-term treatment [R].
In a study on 199 MS patients, oral and intravenous methylprednisolone improved symptoms of relapse in MS after 1-month [R].
5) May Help With Inflammatory Bowel Disease (IBD)
In Irritable Bowel Disease (IBD), the digestive tract and inner lining of the colon are acutely or chronically inflamed. The two major types of IBD are ulcerative colitis and Crohn’s disease. An acute attack can be fatal if not handled quickly and properly, due to bleeding and severe inflammation [R].
Methylprednisolone Improves Symptoms of Ulcerative Colitis
The death rates from ulcerative colitis have reduced from 30-60% before corticosteroid use to about 1 – 2.9% at present [R].
Methylprednisolone (pulsed high-dose) improved symptoms in 12 of the 20 patients with ulcerative colitis. 8 patients had to undergo surgery due to more severe disease [R].
In another study (open-label, randomized), methylprednisolone reduced symptoms of ulcerative colitis in 40 patients after 2 weeks of treatment [R].
Methylprednisolone Improves Symptoms of Crohn’s Disease
Methylprednisolone reduced symptoms of Crohn’s disease in 24 of the 33 patients treated for 8-weeks in one study [R].
In a study on 70 patients with Crohn’s disease, methylprednisolone treatment for 3-weeks abolished all symptoms (remission) in 91% of patients but, symptoms started coming back 6 months after stopping treatment [R].
6) May Decrease Pain Sensitivity
Hyperalgesia refers to higher than usual sensitivity to pain. It is a result of increased levels of pro-inflammatory compounds in the body (platelet-activating factor PAF and cytokines), which produce the sensation of pain [R].
In one study, 12 healthy participants were subjected to a burn injury on their abdomen before being given either methylprednisolone, ketorolac (a non-steroidal anti-inflammatory drug), or placebo. Methylprednisolone increased pain tolerance, but less than ketorolac [R].
Methylprednisolone prevented hyperalgesia from nerve injuries in mice [R].
7) May Reduce Asthma Attacks
Corticosteroids are often used to reduce inflammation in asthma. But, methylprednisolone is not available as inhaled medication and is only used in emergency situations.
In a study on 99 asthma patients who had an emergency attack, intravenous methylprednisolone was given along with the standard treatment for asthma. Methylprednisolone reduced the need for hospital admission to 19% of patients, compared to 47% of patients not given the methylprednisolone [R].
Methylprednisolone injections into the muscle reduced asthma attacks from coming back in 70 patients with acute asthma in a study [R].
In another study of 28 children with asthma, short-term methylprednisolone treatment (8-days) resolved symptoms of acute asthma attacks [R].
8) Helps With Skin Conditions
Methylprednisolone is applied on the skin for many conditions related to inflammation or allergies, such as [R]:
In a study of 221 patients with atopic dermatitis, application of methylprednisolone combined with a moisturizer (Advabase) twice weekly reduced the risk of relapse, itching intensity, and improved overall skin health [R].
In a study of 16 eczema patients, methylprednisolone cream provided rapid itch relief when applied for 5-days [R].
Methylprednisolone ointment application for 11-days improved psoriasis symptoms in a study on 14 patients [R].
9) May Reduce Pain in Bursitis
Bursitis is the painful inflammation of fluid-filled cavities in the joints in the body, including knees, shoulders, elbows, and hips [R].
Injection of methylprednisolone and an anesthetic (lidocaine) provided pain relief in 65 out of 72 patients with bursitis of the hip joint [R].
10) May Increase Quality of Life in Cancer Patients
Methylprednisolone increased appetite, activity level, decreased depressive symptoms, and the need for painkillers in 40 terminally ill cancer patients in one study [R].
11) Helps Prevent Rejection of Organ Transplants
Rejection of a transplanted organ can happen if the immune system recognizes them as foreign. Drugs are used to reduce the immune response for a short time until the organ and body adjust. A combination of drugs is typically used (methylprednisolone, cyclosporine, and azathioprine) to triple the effect [R].
Intravenous methylprednisolone alone resolved the rejection of a liver transplant of 38 patients in one study [R].
12) May Reduce Swelling In Thyroid Eye Disease
In a study of 376 patients with this disease, intravenous methylprednisolone (pulse therapy) was more effective than oral tablets as it reduced eye swelling before vision loss occurs [R].
Two studies on 70 and 52 patients with severe thyroid eye disease, intravenous methylprednisolone was well-tolerated and improved disease symptoms better, quicker, and longer-lasting than oral methylprednisolone [R, R].
13) May Reduce Hair Loss and Baldness
Alopecia is an autoimmune disease in which hair is lost from the scalp in patches that can progress to total loss of scalp hair and total loss of body hair [R].
Side effects from methylprednisolone can range from mild to severe depending on dosage and the way it’s taken (injections or pills), including [R]:
- Increased appetite
- Weight gain around the neck, upper back, chest, waist, wrist, or ankles
- More serious side effects include [R]:
- Slow wound healing
- Swelling of fingers, hands, or feet
- Nausea and vomiting
- Stomach pain
- Depression, mood changes
- Blurred vision
- Pounding in the ears
- Irregular heartbeat
- Tingling sensation in arms or legs
- Itching, hives, swollen throat, shortness of breath (signs of allergic reaction)
Rapid, high doses of methylprednisolone can have adverse effects, such as [R]:
- Hypersensitivity to methylprednisolone or any other ingredient
- Serious yeast infections
- Excessive bruising and bleeding due to low platelets (a condition known as Idiopathic thrombocytopenic purpura) for muscle injections.
- Patients receiving vaccines such as the chickenpox, and measles, mumps, and rubella (MMR) vaccine (which contain the whole virus, live or deactivated).
Premature infants (since the formulations contain benzyl alcohol).
- Patients with herpes simplex of the eye
- As injections into the spinal cord
- Antibiotics (Troleandomycin, Erythromycin, Isoniazid, Rifampin, Clarithromycin, Erythromycin)
- Antifungals (Ketoconazole, Itraconazole)
- Antivirals (Indinavir, Ritonavir)
- Muscle relaxants used for anesthesia (Pancuronium, Neuromuscular blockers)
- Drugs used for extreme muscle weakness (Neostigmine, Pyridostigmine)
- Anticoagulants (Aspirin or Warfarin, Heparin)
- Anti-seizure drugs (Phenobarbital, Phenytoin, Carbamazepine)
- Drugs used to lower blood sugar in diabetes (Insulin, Glibenclamide, Metformin)
- Other drugs that reduce immune response (Cyclosporine, Cyclophosphamide, Tacrolimus)
- Drugs used to reduce nausea (Aprepitant, Fosaprepitant)
- Drugs that reduce cholesterol or laxatives (Cholestyramine)
- Blood pressure lowering drugs
- Antisteroid drug (Aminoglutethimide)
- Anti-anxiety and antipsychotic drugs
- Hormones, such as estrogens in oral contraceptives (Ethinylestradiol)
- Drugs used for heart conditions (Digoxin, Diltiazem)
- Diuretics (Furosemide)
Forms and Dosage
The dosage, form of the drug, and how often it should be taken will depend on various factors, such as age, disease/disorder, severity, reaction to first drug dose, and other existing medical conditions.
- Oral: 2 mg, 4 mg, 8 mg, 16 mg, 32 mg, 48 mg
- Intramuscular injection (per mL): 20 mg, 40 mg, 80 mg
- Intravenous injection (per mL): 40 mg, 125 mg, 500 mg, 1 g, 2 g
It is also available as a cream/ointment.
Methylprednisolone Pulse Therapy
- Pulse therapy involves giving high doses of methylprednisolone under careful supervision when the patient needs quick or effective action to suppress the immune system such as in [R, R]:
- Skin disease (pemphigus)
- Kidney Transplants
- Kidney damage (nephrotic syndrome)
Limitations and Caveats
The long-term effects of methylprednisolone on the body are not well-known, especially for children and adolescents.
Since methylprednisolone reduces the immune response, it may hypothetically increase the risk of cancer. But the potential of methylprednisolone to increase this risk has not been evaluated yet.
Hence, it should be used cautiously under medical supervision.