Methylprednisolone Side Effects

Brand Names: A-methapred, Depo-Medrol, Solu-Medrol, Medrol

Please note - some side effects for Methylprednisolone may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Methylprednisolone - for the Consumer

Methylprednisolone

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Methylprednisolone:

Dizziness; facial flushing; feeling of whirling motion; headache; increased sweating.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody, black, or tarry stools; changes in body fat; changes in menstrual period; chest pain; fainting; fever, chills, or sore throat; increased hunger, thirst, or urination; mental or mood changes; muscle pain, weakness, or wasting; seizures; severe nausea or vomiting; slow wound healing; stomach pain; sudden, severe dizziness or headache; swelling of the feet or legs; tendon, bone, or joint pain; thinning of the skin; unusual bruising or bleeding; unusual skin sensation; unusual weight gain; vision changes or other eye problems; vomit that looks like coffee grounds.

Methylprednisolone Solution

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Methylprednisolone Solution:

Dizziness; facial flushing; feeling of whirling motion; headache; increased sweating; pain, swelling, or redness at the injection site.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody, black, or tarry stools; changes in body fat; changes in menstrual period; chest pain; fainting; fever, chills, or sore throat; increased hunger, thirst, or urination; mental or mood changes; muscle pain, weakness, or wasting; seizures; severe nausea or vomiting; slow wound healing; stomach pain; sudden, severe dizziness or headache; swelling of the feet or legs; tendon, bone, or joint pain; thinning or discoloration of the skin; unusual bruising or bleeding; unusual skin sensation; unusual weight gain; vision changes or other eye problems; vomit that looks like coffee grounds.

Methylprednisolone Suspension

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Methylprednisolone Suspension:

Dizziness; facial flushing; feeling of whirling motion; headache; increased sweating; pain, swelling, or redness at the injection site.

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody, black, or tarry stools; changes in body fat; changes in menstrual period; chest pain; fainting; fever, chills, or sore throat; increased hunger, thirst, or urination; mental or mood changes; muscle pain, weakness, or wasting; seizures; severe nausea or vomiting; slow wound healing; stomach pain; sudden, severe dizziness or headache; swelling of the feet or legs; tendon, bone, or joint pain; thinning or discoloration of the skin; unusual bruising or bleeding; unusual skin sensation; unusual weight gain; vision changes or other eye problems; vomit that looks like coffee grounds.

Methylprednisolone Side Effects - for the Professional

Methylprednisolone

Fluid and Electrolyte Disturbances:

Sodium retention

Fluid retention

Congestive heart failure in susceptible patients

Potassium loss

Hypokalemic alkalosis

Hypertension

Musculoskeletal:

Muscle weakness

Steroid myopathy

Loss of muscle mass

Osteoporosis

Tendon rupture, particularly of the Achilles tendon

Vertebral compression fractures

Aseptic necrosis of femoral and humeral heads

Pathologic fracture of long bones

Gastrointestinal:

Peptic ulcer with possible perforation and hemorrhage

Pancreatitis

Abdominal distention

Ulcerative esophagitis

Increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphatase have been observed following corticosteroid treatment. These changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation.

Dermatologic:

Impaired wound healing

Petechiae and ecchymoses

Increased sweating

May suppress reactions to skin tests

Thin fragile skin

Facial erythema

Metabolic:

Negative nitrogen balance due to protein catabolism

Neurological:

Increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment

Convulsions

Vertigo

Headache

Endocrine:

Menstrual irregularities

Development of Cushingoid state

Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness

Suppression of growth in children

Decreased carbohydrate tolerance

Manifestations of latent diabetes mellitus

Increased requirements for insulin or oral hypoglycemic agents in diabetics

Ophthalmic:

Posterior subcapsular cataracts

Increased intraocular pressure

Glaucoma

Exophthalmos

The following additional reactions are related to oral as well as parenteral therapy:

Urticaria and other allergic, anaphylactic or hypersensitivity reactions.

Methylprednisolone Tablets

Fluid and Electrolyte Disturbances

Sodium retention

Congestive heart failure in susceptible patients

Hypertension

Fluid retention

Potassium loss

Hypokalemic alkalosis

Musculoskeletal

Muscle weakness

Loss of muscle mass

Steroid myopathy

Osteoporosis

Tendon rupture, particularly of the Achilles tendon

Vertebral compression fractures

Aseptic necrosis of femoral and humeral heads

Pathologic fracture of long bones

Gastrointestinal

Peptic ulcer with possible perforation and hemorrhage

Pancreatitis

Abdominal distention

Ulcerative esophagitis

Increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphatase have been observed following corticosteroid treatment. These changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation.

Dermatologic

Impaired wound healing

Petechiae and ecchymoses

May suppress reactions to skin tests

Thin fragile skin

Facial erythema

Increased sweating

Neurological

Increased intracranial pressure with papilledema (pseudo-tumor cerebri) usually after treatment

Convulsions

Vertigo

Headache

Endocrine

Development of Cushingoid state

Suppression of growth in children

Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness

Menstrual irregularities

Decreased carbohydrate tolerance

Manifestations of latent diabetes mellitus

Increased requirements of insulin or oral hypoglycemic agents in diabetics

Ophthalmic

Posterior subcapsular cataracts

Increased intraocular pressure

Glaucoma

Exophthalmos

Metabolic

Negative nitrogen balance due to protein catabolism

The following additional reactions have been reported following oral as well as parenteral therapy:

Urticaria and other allergic, anaphylactic or hypersensitivity reactions.

Side Effects by Body System

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.

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.

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

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.

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.

Gastrointestinal

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.

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.

Metabolic

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

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.

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.

Hematologic

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

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.

Hepatic

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

Ocular

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.

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

Psychiatric

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

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.

Other

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

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.

Oncologic

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

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.

Local

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

Respiratory

Respiratory side effects have included pulmonary edema.

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.

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