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Here’s what to ask a doctor about hereditary angioedema

methylprednisolone (injection)

Pronunciation

Generic Name: methylprednisolone (injection) (METH il pred NIS oh lone)
Brand Name: A-Methapred, Depo-Medrol, Solu-MEDROL

What is methylprednisolone?

Methylprednisolone is a steroid that prevents the release of substances in the body that cause inflammation.

Methylprednisolone is used to treat many different inflammatory conditions such as arthritis, lupus, psoriasis, ulcerative colitis, allergic disorders, gland (endocrine) disorders, and conditions that affect the skin, eyes, lungs, stomach, nervous system, or blood cells.

Methylprednisolone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about methylprednisolone?

You should not use methylprednisolone if you have a fungal infection anywhere in your body. Methylprednisolone injection should not be given to a premature baby.

What should I discuss with my healthcare provider before using methylprednisolone?

You should not use methylprednisolone if you are allergic to it, or if you have a fungal infection anywhere in your body. Methylprednisolone injection should not be given to a premature baby.

Methylprednisolone can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Tell your doctor about any illness or infection you have had within the past several weeks.

To make sure methylprednisolone is safe for you, tell your doctor if you have:

  • heart disease, high blood pressure;

  • kidney disease;

  • cirrhosis or other liver disease;

  • past or present tuberculosis;

  • glaucoma or cataracts;

  • herpes infection of the eyes;

  • seizures, epilepsy or recent head injury;

  • stomach ulcers, ulcerative colitis, diverticulitis, or recent intestinal surgery;

  • a parasite infection that causes diarrhea (pinworms, or threadworms);

  • a thyroid disorder;

  • osteoporosis or low bone mineral density (steroid medication can increase your risk of bone loss);

  • depression or mental illness;

  • a muscle disorder such as myasthenia gravis;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • high levels of calcium in the blood related to cancer (also called hypercalcemia of malignancy);

  • if you use insulin or oral diabetes medication; or

  • if you take aspirin on a daily basis or at high doses.

It is not known whether methylprednisolone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether methylprednisolone passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Steroids can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medication.

Do not give this medicine to a child (especially a baby) without medical advice.

How is methylprednisolone given?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Methylprednisolone is injected into a muscle or soft tissue, into a skin lesion, into the space around a joint, or into a vein through an IV. A healthcare provider will give you this injection.

If you have major surgery or a severe injury or infection, your methylprednisolone dose needs may change. Make sure any doctor caring for you knows you are using this medicine.

Steroid medication can weaken your immune system, making it easier for you to get an infection. Call your doctor if you have any signs of infection (fever, chills, body aches).

You should not stop using methylprednisolone suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctor's instructions about tapering your dose.

Wear a medical alert tag or carry an ID card stating that you use methylprednisolone. Any medical care provider who treats you should know that you use steroid medication.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of methylprednisolone.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of methylprednisolone is not expected to produce life threatening symptoms. However, long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

What should I avoid while using methylprednisolone?

Do not receive a "live" vaccine while using methylprednisolone. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication.

Methylprednisolone side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • shortness of breath (even with mild exertion), swelling, rapid weight gain;

  • severe depression, changes in personality, unusual thoughts or behavior;

  • new or unusual pain in an arm or leg or in your back;

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • a seizure (convulsions); or

  • low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common side effects may include:

  • headache;

  • mild muscle pain or weakness; or

  • stomach discomfort, bloating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Methylprednisolone dosing information

Usual Adult Dose for Allergic Rhinitis:

Acetate suspension:
80 to 120 mg IM

Comment:
-Symptom relief may occur within 6 hours and persist for several days to 3 weeks.

Use: For symptom relief of allergic rhinitis (hay fever).

Usual Adult Dose for Alopecia:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Dermatologic Lesion:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Lichen Simplex Chronicus:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Psoriasis:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Dermatological Disorders:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Granuloma Annulare:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Lichen Planus:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Keloids:

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks
-For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
-For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
-For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.
-The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:
-To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Rheumatoid Arthritis:

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral: Acetate suspension: Provides prolonged systemic effect
Maintenance dose: 40 to 120 mg IM once a week

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRA-ARTICULAR INJECTION: Acetate suspension:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

Use: For the treatment of rheumatoid arthritis; short-term intra-articular administration may be used to tide patients over an acute episode or exacerbation

Usual Adult Dose for Adrenogenital Syndrome:

Acetate suspension:
Initial dose: 40 mg IM every 2 weeks
Maintenance: Adjust dose as needed for individual patient

Use: For the treatment of adrenogenital syndrome.

Usual Adult Dose for Acute Gout:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Allergic Reaction:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Bursitis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Nephrotic Syndrome:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Osteoarthritis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Rejection Prophylaxis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Rejection Reversal:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Tendonitis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Anti-inflammatory:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Neoplastic Diseases:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Epicondylitis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Synovitis:

Dosing should be individualized based on disease and patient response:

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.
-Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition
-Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
-Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
-Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection
Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:
-For conditions of the tendinous or bursal structures: 4 to 30 mg
-Repeat injections may be needed for recurrent or chronic conditions.
-Product Information may be consulted for specific administration instructions

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
-Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Asthma -- Acute:

Oral:
Burst therapy: 32 to 64 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best
-Therapy is usually required for 3 to 10 days but in some cases, may be longer

Comments:
-There is no known advantage for using higher doses to treat acute asthma episodes.
-Orally administered prednisone is as effective as IV methylprednisolone in treating acute asthma; because oral corticosteroids are less invasive, they are preferred unless gastrointestinal transit time or absorption is impaired.
-Tapering the dose of oral corticosteroids following short course or burst therapy of less than 1 week is generally not necessary, especially if patients are concurrently taking inhaled corticosteroids.

Parenteral:
Sodium succinate: IV administration may be used if rapid hormonal effect of maximum intensity is required.
-High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally 48 to 72 hours; following initial emergency period, a longer-acting injectable or oral preparation should be considered
-Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension: For prolonged systemic effect
240 mg IM once (guideline dosing); 80 to 120 mg IM (manufacturer dosing)

Comments:
-IM (acetate) administration may result in relief within 6 to 48 hours and persist for several days to 2 weeks.
-IM administration is not preferred, but may be used in patients who are vomiting or if there is a concern with adherence.

Use: For the treatment of acute asthma; to prevent progression of exacerbation, reverse inflammation, speed recovery, and reduce rate of relapse.

Usual Adult Dose for Asthma -- Maintenance:

Initial dose: 6 to 48 mg orally once a day or every other day
Maintenance dose: Gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses should be given in the morning, either daily or every other day; alternate-day-therapy is recommended when chronic administration is necessary as it may produce less adrenal suppression.
-Chronic administration of corticosteroids in patients with asthma is reserved for only the most severe, difficult-to-control asthma.

Use: For patients with the most severe, difficult-to-control asthma.

Usual Adult Dose for Multiple Sclerosis:

160 mg orally once a day for 1 week; then 64 mg orally every other day for 1 month

-When oral therapy is not feasible, may administer IM (sodium succinate or acetate) or IV (sodium succinate); dosing will be the same as oral.

Comments:
-Controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, although they have not been shown to affect the natural history of the disease.

Use: For the treatment of acute exacerbations of multiple sclerosis.

Usual Pediatric Dose for Nephrotic Syndrome:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM
-When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Rejection Prophylaxis:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM
-When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Rejection Reversal:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM
-When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Anti-inflammatory:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM
-When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Neoplastic Diseases:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:
-Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM
-When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:
-As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Asthma -- Acute:

0 to 11 years of age:
Initial dose: 0.8 to 1.6 mg/kg oral or IV (succinate) once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best
-Therapy is usually required for 3 to 10 days but in some cases, may be longer
Maximum dose: 48 mg

12 years or older:
Initial dose: 32 to 48 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best
-Therapy is usually required for 3 to 10 days but in some cases, may be longer

Comments:
-There is no known advantage for using higher doses to treat acute asthma episodes.
-Orally administered prednisone is as effective as IV methylprednisolone in treating acute asthma; because oral corticosteroids are less invasive, they are preferred unless gastrointestinal transit time or absorption is impaired.
-Tapering the dose of oral corticosteroids following short course or burst therapy of less than 1 week is not necessary, especially if patients are concurrently taking inhaled corticosteroids.

IM (acetate):
0 to 4 years of age: 7.5 mg/kg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)

5 years or older: 240 mg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)

Comments:
-IM (acetate) administration may result in relief within 6 to 48 hours and persist for several days to 2 weeks.
-IM (acetate) administration is not preferred, but may be used in patients who are vomiting or if adherence is a concern.

Use: For the treatment of acute asthma; to prevent progression of exacerbation, reverse inflammation, speed recovery, and reduce rate of relapse.

Usual Pediatric Dose for Asthma -- Maintenance:

0 to 11 years of age:
Maintenance dose: 0.2 to 1.6 mg/kg orally once a day or every other day as needed for asthma control
Maximum dose: 48 mg

12 years or older:
Maintenance dose: 6 to 48 mg orally once a day or every other day as needed for asthma control

-Gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:
-The most important determinant of appropriate dosing is response to therapy; once control is achieved and sustained for 3 months, the dose should be carefully titrated down to the minimum dose necessary to maintain control.
-Doses should be given in the morning, either daily or every other day; alternate-day-therapy is recommended when chronic administration is necessary as it may produce less adrenal suppression.
-Chronic administration of corticosteroids in patients with asthma is reserved for only the most severe, difficult-to-control asthma.

Use: For patients with the most severe, difficult-to-control asthma.

Usual Pediatric Dose for Juvenile Rheumatoid Arthritis:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
SUCCINATE: May administer IM or IV
-Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses throughout the day
-As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses throughout the day

ACETATE suspension: IM administration only
-Initial dose: 0.11 to 1.6 mg/kg IM once a day
-As a substitute for oral therapy: a single IM injection during each 24-hour period equal to the total daily oral dose is generally sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Use: For the treatment of juvenile rheumatoid arthritis; selected cases may require low-dose maintenance therapy.

Usual Pediatric Dose for Allergic Reaction:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Alopecia:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Dermatologic Lesion:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Lichen Simplex Chronicus:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Psoriasis:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Dermatological Disorders:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Allergic Urticaria:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Granuloma Annulare:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Lichen Planus:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Keloids:

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size

Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses
-Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.
-Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

What other drugs will affect methylprednisolone?

Other drugs may interact with methylprednisolone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about methylprednisolone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.03.

Last reviewed: April 03, 2014
Date modified: November 30, 2016

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