Methylprednisolone Sodium Succinate for Injection USP (DBL)

Generic Name: Methylprednisolone sodium succinate
Product Name: Methylprednisolone Sodium Succinate for Injection USP (DBL)

Indication

Methylprednisolone sodium succinate is a corticosteroid medication that reduces inflammation. This leads to a reduction in pain and improvement of a variety of symptoms associated with injury, inflammation and allergy. Methylprednisolone sodium succinate is used in emergency or acute type conditions where a rapid response is required. The main uses of methylprednisolone sodium succinate include:

• Severe allergic reactions– Methylprednisolone sodium succinate should be given after immediate treatment with adrenaline or an Epipen.
• Severe skin reactions secondary to drugs and other causes.
• Status asthmaticus (severe asthma attacks)- Although methylprednisolone sodium succinate doesn’t act immediately it should still be given in the event of an acute attack.
• Suppression of transplant rejection.
• Cerebral oedema (swelling due to fluid).
• Inflammatory bowel disease in severely ill patients.
• Systemic lupus erythematosus (a multi-system inflammatory disorder).
• Shock due to shutdown of the adrenal gland (a gland involved in secreting steroids).
• Rheumatic disorders– Useful in acute attacks.
• Certain types of meningitis and pneumonia.
• Multiple sclerosis (MS)- Short courses of high dose corticosteroids are used in the treatment of acute attacks of MS. Recall that MS is a disease of the nervous system with acute attacks of neurological symptoms such as weakness and problems with bowel and bladder function. Methylprednisolone is administered intravenously and helps aid recovery from attacks but does not cure the disease.

Methylprednisolone sodium succinate may have been administered to you for a reason other than those listed above. Likewise, not all patients with the above conditions will be suitable for this medication. You should discuss with your doctor whether methylprednisolone sodium succinate is a suitable medication for you.

Action

Methylprednisolone belongs to a class of drugs called corticosteroids. This basically means that it is a steroid medication produced in the centre (cortex) of the adrenal gland. Methylprednisolone has specific ‘glucocorticoid’ effects meaning that it predominantly acts to reduce the body’s normal inflammation and immune responses. It achieves this by altering the expression of various genes within tissue cells. Like other steroids, methylprednisolone also causes mild water and salt retention in the kidneys. However this effect is far less potent.

Dose advice

You should not be given Methylprednisolone sodium succinate:

• If you are allergic to Methylprednisolone sodium succinate or any of the inactive ingredients of the capsules.
• If you are severely ill with an infection or septic shock. Methylprednisolone affects your ability to fight infections so could worsen these conditions.

Before taking Methylprednisolone sodium succinate you should tell your doctor:

1. If you are pregnant or intend on becoming pregnant- When taken during pregnancy, methylprednisolone may affect your baby’s adrenal gland. Thus it is ciurrently not recommended during pregnancy. Your doctor will discuss the risks and benefits of using this drug during your pregnancy.
2. If you are breastfeeding or intend to breastfeed- Methylprednisolone is excreted in the breast milk and can cause your baby’s growth to be affected. Thus it is recommended that you don’t breastfeed during your therapy.
3. If you have any other medical conditions- In particular tell your doctor if you have psychosis (thought disorder), herpes infection of the eye, tuberculosis, Cushing’s syndrome (a disorder of the adrenal gland), malaria, bowel disease, osteoporosis, kidney disease, ulcers, high blood pressure, myasthenia gravis (fatigue of the muscles), diabetes, glaucoma or any infections. These conditions may increase your risk of side effects so an alternative treatment may be needed. In an acute emergency however, methylprednisolone can still be given as a short course.
4. If you are allergic to any medications, foods or dyes.
5. Any other medications you are taking (including those bought from supermarkets or the chemist)- Methylprednisolone can interact with other anti-inflammatory drugs and fluid tablets. It may also reduce the effectiveness of vaccines. You should always tell any doctor treating you that you are on steroid medications.

Doses

Methylprednisolone Sodium Succinate is supplied as a dry white powder that requires dissolution in special water before administration. Methylprednisolone is given either by injection into a muscle (such as the buttocks) or as a slow injection or infusion into a vein. Methylprednisolone Sodium Succinate should only be administered by experienced medical personnel. Two different strengths of Methylprednisolone Sodium Succinate are currently available which are 500mg (in a 20mL glass vial) or 1000mg (in a 30mL glass vial). The usual doses vary according to your condition and weight. Your doctor with decide the best regimen for you which may be a short course over a number of days or a longer course. Following treatment it is likely that your doctor will slowly reduce your dose to prevent withdrawal effects. You should always take this medication as prescribed by your doctor.

Schedule

S4 (presription required).

Common side effects

Methylprednisolone helps most patients with inflammation but can cause side effects in some patients. As it is a steroid medication, it causes similar side effects to other members of its class. Short courses of methylprednisolone tend to be well tolerated in most patients. Side effects are more commonly associated with prolonged treatment. If you notice any of the following symptoms or anything else that you think may be associated with this drug, make sure you discuss them with your doctor. Note that the following lists of side-effects are not necessarily exhaustive as medications can affect all patients differently. Side effects really depend on the dose, route of administration and duration of your treatment so it is difficult to quote which percentage of patients will experience side effects. Some common side effects of methylprednisolone include:

• Nausea.
• Vomiting.
• Bad taste in the mouth.
• Heartburn (often due to peptic ulceration).
• Muscle weakness and wasting.
• Osteoporosis and fractures.
• Increased susceptibility to infection (such as thrush)..
• Prolonged time for wounds to heal.
• Irregular menstruation.
• Weight gain.
• Acne.
• Easy bruising and thin skin.
• Increased body hair.
• Fluid retention.
• Striae (purple stretch marks on the abdomen).
• Growth retardation in children and adolescents.
• Mood disturbances.
• Visual disturbances.
• High blood pressure.

Uncommon side effects

Methyprednisolone can cause some more serious side effects that require medical attention. Fortunately these occur in a small number of patients but it is important to be aware of them so they can be detected early. More serious side effects include:

• Severe allergic reactions- Seek urgent medical advice if you notice rash, swelling of the tongue lips or face (angioedema), wheezing or difficulty breathing.
• Cardiovascular problems- Methylprednisolone can cause a fall in blood pressure or irregularity of the heartbeat. If you notice you fell dizzy, faint or your heart beating irregularly see a doctor urgently. Note that heart failure tends to occur only in patients with underlying cardiac disease. This may cause swelling of the lower limbs.
• Nasty infections- If you notice you have a temperature and feel sweaty you may have an underlying infection developing.
• Depression.
• Suppression of the adrenal gland- If steroids are ceased suddenly you may experience what is called an acute adrenal crisis which is associated with a sudden fall in blood pressure. The body is unable to cope with infections or stress in these circumstances.

Do not be alarmed by these long lists of side effects as most patients will tolerate the medication well with only minor side effects. Your doctor will be able to discuss in detail further the risks and benefits of this medication for you.

References

1. Australian Medicines Handbook- 14.1.2 Methylprednisolone. AMH Pty Ltd. 2006.
2. Methylprednisolone Sodium Succinate for Injection USP (DSL)- Consumer Medicine Information, Mayne Pharma Pty Ltd 1999. Available from: [PDF File]
3. Methylprednisolone Sodium Succinate for Injection USP- Product Information, Mayne Pharma Pty Ltd 2004. Available from: [PDF File]
4. MIMS online- Prescribing Information. Methylprednisolone Sodium Succinate for Injection USP (DBL), MIMS Australia Pty Ltd 2003.

For further information talk to your doctor.