Methylprednisolone Side Effects

Not all side effects for methylprednisolone may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to methylprednisolone: oral tablet

In addition to its needed effects, some unwanted effects may be caused by methylprednisolone. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking methylprednisolone:

More common
  • Aggression
  • agitation
  • anxiety
  • blurred vision
  • decrease in the amount of urine
  • dizziness
  • fast, slow, pounding, or irregular heartbeat or pulse
  • headache
  • irritability
  • mental depression
  • mood changes
  • nervousness
  • noisy, rattling breathing
  • numbness or tingling in the arms or legs
  • pounding in the ears
  • shortness of breath
  • swelling of the fingers, hands, feet, or lower legs
  • trouble thinking, speaking, or walking
  • troubled breathing at rest
  • weight gain
Incidence not known
  • Abdominal cramping and/or burning (severe)
  • abdominal pain
  • backache
  • bloody, black, or tarry stools
  • cough or hoarseness
  • darkening of skin
  • decrease in height
  • decreased vision
  • diarrhea
  • dry mouth
  • eye pain
  • eye tearing
  • facial hair growth in females
  • fainting
  • fatigue
  • fever or chills
  • flushed, dry skin
  • fractures
  • fruit-like breath odor
  • full or round face, neck, or trunk
  • heartburn and/or indigestion (severe and continuous)
  • increased hunger
  • increased thirst
  • increased urination
  • loss of appetite
  • loss of sexual desire or ability
  • lower back or side pain
  • menstrual irregularities
  • muscle pain or tenderness
  • muscle wasting or weakness
  • nausea
  • pain in back, ribs, arms, or legs
  • painful or difficult urination
  • skin rash
  • sleeplessness
  • sweating
  • trouble healing
  • trouble sleeping
  • unexplained weight loss
  • unusual tiredness or weakness
  • vision changes
  • vomiting
  • vomiting of material that looks like coffee grounds

Some of the side effects that can occur with methylprednisolone may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Increased appetite
Incidence not known
  • Abnormal fat deposits on the face, neck, and trunk
  • acne
  • dry scalp
  • lightening of normal skin color
  • red face
  • reddish purple lines on the arms, face, legs, trunk, or groin
  • swelling of the stomach area
  • thinning of the scalp hair

For Healthcare Professionals

Applies to methylprednisolone: compounding powder, injectable powder for injection, injectable suspension, oral tablet

General

Adverse effects have occurred less frequently when minimum dosages have been administered.

Adverse effects of corticosteroid therapy may be subdivided into those associated with short-term therapy (to three weeks) and those of long-term therapy (> three weeks).

Short-term effects have included sodium retention-related weight gain and fluid accumulation, hyperglycemia and glucose intolerance, hypokalemia, gastrointestinal upset and ulceration, reversible depression of the hypothalamic-pituitary-adrenal (HPA) axis, and mood changes ranging from mild euphoria and insomnia to nervousness, restlessness, mania, catatonia, depression, delusions, hallucinations, and violent behavior.

Long-term effects have included HPA suppression, Cushingoid appearance, hirsutism or virilism, impotence, and menstrual irregularities, peptic ulcer disease, cataracts and increased intraocular pressure/glaucoma, myopathy, osteoporosis, and vertebral compression fractures.[Ref]

Cardiovascular

Cardiovascular side effects have included hypertension and congestive heart failure due to long-term fluid retention as well as direct vascular effects. Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, fat embolism, myocardial rupture following recent myocardial infarction, syncope, tachycardia, thromboembolism, thrombophlebitis, and vasculitis have also been reported.[Ref]

Hypertension has been associated with long-term therapy with corticosteroids and is thought to be due to fluid retention.[Ref]

Endocrine

Corticosteroid therapy may induce glucose intolerance by reducing the utilization of glucose in tissues and increasing hepatic glucose output. Patients on alternate day therapy may exhibit significantly higher serum glucose on the day methylprednisolone is taken. Diabetes mellitus requiring diet modifications and hypoglycemic agents has developed in some patients.

Adrenal suppression can persist for up to twelve months after long-term corticosteroid therapy. Adrenal suppression may be reduced by giving corticosteroids once a day or once every other day. After corticosteroid therapy has been tapered, supplemental corticosteroid therapy during times of physical stress may be required.[Ref]

Endocrine side effects have included decreased glucose tolerance and hyperglycemia resulting in diabetes-like symptoms. Hypothalamic-pituitary-adrenal activity has been suppressed 12 months or more following long-term corticosteroid administration. Cushingoid appearance commonly has occurred with chronic therapy. Hirsutism or virilism, impotence, and menstrual irregularities may occur. Glycosuria, hirsutism, and hypertrichosis have also been reported.[Ref]

Gastrointestinal

Gastrointestinal effects most commonly occurring during corticosteroid therapy have included nausea, vomiting, dyspepsia, and anorexia. Peptic ulcer disease has been associated with long-term corticosteroid therapy, but is relatively uncommon. Routine prophylactic therapy is not warranted in all individuals. Aluminum/magnesium containing antacids generally have been used to manage GI complaints without significant drug interactions.[Ref]

Gastrointestinal side effects have included gastrointestinal upset, nausea, vomiting, and peptic ulcer disease. Pancreatitis, ulcerative esophagitis, gastrointestinal perforation and hemorrhage have also been reported. Additionally, abdominal distention, bowel/bladder dysfunction (after intrathecal administration), increased appetite, and perforation of the small and large intestine (particularly in patients with inflammatory bowel disease) have been reported.[Ref]

Metabolic

Metabolic side effects have included hypernatremia (rare), hypokalemia, fluid retention, negative nitrogen balance and increase in blood urea nitrogen concentration.[Ref]

Musculoskeletal

Musculoskeletal side effects have included myopathy, osteoporosis, vertebral compression fractures, tendon rupture (particularly the Achilles tendon), and aseptic necrosis of bone have occurred during corticosteroid therapy. Aseptic necrosis most often has affected the femoral head. Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, and vertebral compression fractures has also been reported.[Ref]

Corticosteroid myopathy presenting as weakness and wasting of the proximal limb and girdle muscles has occurred, but has generally resolved following cessation of therapy.

Corticosteroids inhibit intestinal absorption and increase urinary excretion of calcium leading to bone resorption and bone loss. Bone loss of 3% over one year has been demonstrated with prednisolone 10 mg per day. Postmenopausal females are at risk of loss of bone density. Up to 16% of elderly patients treated with corticosteroids for 5 years may experience vertebral compression fractures. One author reported measurable bone loss over two years in women on concomitant therapy with prednisone 7.5 mg per day and tamoxifen.[Ref]

Hematologic

Hematologic side effects have included thrombocytopenia, lymphopenia, and platelet alterations resulting in thrombolic events.[Ref]

Immunologic

Immunologic side effects have included impairment in cell-mediated immunity and increased susceptibility to bacterial, viral, fungal and parasitic infections. Immune response to skin tests may be suppressed.[Ref]

Hepatic

Hepatic side effects have included reversible increases in serum transaminase and alkaline phosphatase concentrations. Hepatomegaly has also bee reported.[Ref]

Ocular

Ocular side effects have included increased intraocular pressure, glaucoma, and posterior subcapsular cataracts.[Ref]

In renal transplant patients maintained on prednisone 10 mg per day, 33% developed posterior subcapsular cataracts. Mean time to cataract development was 26 months. Increased intraocular pressure has occurred in 5% of patients.[Ref]

Psychiatric

Psychiatric side effects have included psychoses, personality or behavioral changes, depression, emotional instability, euphoria, mood swings, and psychic disorders.[Ref]

Dermatologic

Dermatologic side effects have included bruising, ecchymosis, petechiae striae, delayed wound healing, and acne. Allergic dermatitis, cutaneous and subcutaneous atrophy, dry scaly skin, erythema, hyperpigmentation, hypopigmentation, increase sweating, rash, sterile abscess, striae, thin fragile skin, and thinning scalp hair, and urticaria have also been reported.[Ref]

Other

Pseudorheumatism, or glucocorticoid-withdrawal syndrome not related to adrenal insufficiency has occurred on withdrawal of corticosteroids. Patients experienced anorexia, nausea, vomiting, lethargy, headache, fever, arthralgias, myalgias and postural hypotension. Symptoms resolved when corticosteroid therapy was reinstated.[Ref]

Other side effects have included a glucocorticoid withdrawal syndrome seen upon abrupt discontinuation of corticosteroid therapy that was not associated with adrenal suppression.[Ref]

Oncologic

Oncologic side effects have included Kaposi's sarcoma. Clinical remission may occur with discontinuation of therapy.[Ref]

Hypersensitivity

Hypersensitivity side effects have included anaphylaxis with or without circulatory collapse, cardiac arrest, or bronchospasm with parenteral administration of methylprednisolone. Anaphylactoid reactions and angioedema have also been reported.[Ref]

Local

Local side effects have included hyperpigmentation, hypopigmentation, subcutaneous and cutaneous atrophy, and sterile abscess at injection sites following parenteral administration.[Ref]

Respiratory

Respiratory side effects have included pulmonary edema.[Ref]

Nervous system

Nervous system side effects have included convulsions, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, neuritis, neuropathy, paresthesia, and vertigo.[Ref]

References

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2. Baethge BA, Lidsky MD, Goldberg JW "A study of adverse effects of high-dose intravenous (pulse) methylprednisolone therapy in patients with rheumatic disease." Ann Pharmacother 26 (1992): 316-20

3. Belmonte MA, Cequiere A, Roig-Escofet D "Severe ventricular arrhythmia after methylprednisolone pulse therapy in rheumatoid arthritis." J Rheumatol 13 (1986): 477-9

4. Chikanza C, Fernandes L "Arrhythmia after pulse methylprednisolone therapy." Br J Rheumatol 30 (1991): 392-3

5. Lyons PR, Newman PK, Saunders M "Methylprednisolone therapy in multiple sclerosis: a profile of adverse effects." J Neurol Neurosurg Psychiatry 51 (1988): 285-7

6. Fujimoto S, Kondoh H, Yamamoto Y, Hisanaga S, Tanaka K "Holter electrocardiogram monitoring in nephrotic patients during methylprednisolone pulse therapy." Am J Nephrol 10 (1990): 231-6

7. Swartz SL, Dluhy RG "Corticosteroids: clinical pharmacology and therapeutic use." Drugs 16 (1978): 238-55

8. Spoor TC, Rockwell DL "Treatment of optic neuritis with intravenous megadose corticosteroids: a consecutive series." Ophthalmology 95 (1988): 131-4

9. Bernini JC, Carrillo JM, Buchanan GR "High-dose intravenous methylprednisolone therapy for patients with diamond-blackfan anemia refractory to conventional doses of prednisone." J Pediatr 127 (1995): 654-9

10. Black DM, Filak AT "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract 28 (1989): 462-3

11. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl 54 (1980): 135-8

12. Chrousos GA, Kattah JC, Beck RW, Cleary PA "Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial." JAMA 269 (1993): 2110-2

13. Dandona P, Junglee D, Katrak A, Fonseca V, Havard CW "Increased serum pancreatic enzymes after treatment with methylprednisolone: possible evidence of subclinical pancreatitis." Br Med J (Clin Res Ed) 291 (1985): 24

14. Pateman J, Williams MP, Filshie J "Retroperitoneal fibrosis after multiple coeliac plexus blocks." Anaesthesia 45 (1990): 309-10

15. Lieberman A, Le Brun Y, Glass P, Goodgold A, Lux W, Wise A, Ransohoff J "Use of high dose corticosteroids in patients with inoperable brain tumours." J Neurol Neurosurg Psychiatry 40 (1977): 678-82

16. Williams IA, Mitchell AD, Rothman W, Tallett P, Williams K, Pitt P "Survey of the long term incidence of osteonecrosis of the hip and adverse medical events in rheumatoid arthritis after high dose intravenous methylprednisolone." Ann Rheum Dis 47 (1988): 930-3

17. Saisu T, Sakamoto K, Yamada K, Kashiwabara H, Yokoyama T, Iida S, Harada Y, Ikenoue S, Sakamoto M, Moriya H "High incidence of osteonecrosis of femoral head in patients receiving more than 2 g of intravenous methylprednisolone after renal transplantation." Transplant Proc 28 (1996): 1559-60

18. Cruess RL "Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip." Clin Orthop Jan-Feb(13 (1978): 86-93

19. Clinkscales A, Cleary JD "Steroid-induced avascular necrosis." Ann Pharmacother 36 (2002): 1105

20. Bijlsma JW, Duursma SA, Bosch R, Raymakers JA, Huber-Bruning O "Acute changes in calcium and bone metabolism during methylprednisolone pulse therapy in rheumatoid arthritis." Br J Rheumatol 27 (1988): 215-9

21. Decramer M, Stas KJ "Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma." Am Rev Respir Dis 146 (1992): 800-2

22. Salomon F, Weinberger A, Levy L, Gelber M, Pinkhas J "Intra-articular corticosteroid-induced peripheral leukocytosis." Isr J Med Sci 22 (1986): 408-9

23. Gutknecht DR "Chemical meningitis following epidural injections of corticosteroids." Am J Med 82 (1987): 570

24. John GR, Stark WJ "Periorbital urticarial drug reaction associated with intravenously administered methylprednisolone." Am J Ophthalmol 113 (1992): 588-90

25. Pies R "Persistent bipolar illness after steroid administration." Arch Intern Med 141 (1981): 1087

26. Judd FK, Burrows GD, Norman TR "Psychosis after withdrawal of steroid therapy." Med J Aust 2 (1983): 350-1

27. Campbell IA "Aggressive psychosis in AIDS patient on high-dose steroids." Lancet 2 (1987): 750-1

28. Klein JF "Adverse psychiatric effects of systemic glucocorticoid therapy." Am Fam Physician 46 (1992): 1469-74

29. Travlos A, Hirsch G "Steroid psychosis: a cause of confusion on the acute spinal cord injury unit." Arch Phys Med Rehabil 74 (1993): 312-5

30. Louis DS, Hankin FM, Eckenrode JF "Cutaneous atrophy after corticosteroid injection." Am Fam Physician 33 (1986): 183-6

31. Rao KV, Anderson RC, O'Brian TJ "Successful renal transplantation in a patient with anaphylactic reaction to Solu-Medrol (Methylprednisolone sodium succinate)." Am J Med 72 (1982): 161-3

32. Kamm GL, Hagmeyer KO "Allergic-type reactions to corticosteroids." Ann Pharmacother 33 (1999): 451-60

33. Mansfield LE, Ting S, Haverly RW "Anaphylaxis caused by the sodium succinate ester of hydrocortisone and methylprednisolone." J Asthma 23 (1986): 81-3

34. Mendelson LM, Hamburger RN "Anaphylaxis-like reactions to corticosteroid therapy." J Allergy Clin Immunol 54 (1974): 125-31

35. McDougal BA, Whittier FC, Cross DE "Sudden death after bolus steroid therapy for acute rejection." Transplant Proc 8 (1976): 493-6

36. Freedman MD, Schocket AL, Chapel N, Gerber JG "Anaphylaxis after intravenous methylprednisolone administration." JAMA 245 (1981): 607-8

37. Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ, Light RW, Anderson P, Morgan MA "Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease." N Engl J Med 340 (1999): 1941-7

38. Wysenbeek AJ, Leibovici L, Zoldan J "Acute central nervous system complications after pulse steroid therapy in patients with systemic lupus erythematosus." J Rheumatol 17 (1990): 1695-6

39. Baethge BA, Lidsky MD "Intractable hiccups associated with high-dose intravenous methylprednisolone therapy." Ann Intern Med 104 (1986): 58-9

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