A-Methapred

A-Methapred (Methylprednisolone) is slightly more potent and more selective than prednisolone. Methylprednisolone acetate has been used as a retention enema in ulcerative colitis. The common indications of methylprednisolone are cardiac arrest, multiple sclerosis, acute bronchitis, vestibular neuritis etc.

Pulse therapy with high dose methylprednisolone has been tried in nonresponsive active rheumatoid arthritis, renal transplant, pemphigus, etc. with good results and minimal suppression of pituitary-adrenal axis.

If you are about to start a drug therapy, the risk and benefit ratio of taking the medication should be considered. This is a decision that your doctor will make with your active participation. Certain factors such as present and past illness, drug interactions, hypersensitivity reactions, pregnancy, lactation, metabolic impairments etc. may alter the drug action that should be considered cautiously.

Methylprednisolone has the potential to cause dramatic improvement in many severe diseases as well as produce equally dramatic adverse effects if not properly used. Thus, the following general principles must be observed:

•  A single dose (even excessive) is not harmful. It can be used to tide over mortal crisis.

• Short courses (even high dose) are not likely to be harmful in the absence of contraindications. Starting doses can be high in severe illness.

• Initial dose depends on severity of the diseases. You should start with a high dose in severe illness. The dose may be reduced gradually as symptoms subside.

• Abrupt withdrawal is not allowed after long-term methylprednisolone administration for more than 2 to3 weeks. Such medications should be given with tapering doses before fully stopped, as it may precipitate adrenal insufficiency.

• Long-term use is potentially hazardous. It is recommended to keep the duration of treatment and dose to minimum.

There are some drugs that should not be used concurrently with methylprednisolone. It is always recommended to consult with your doctor if you are in need of medicines for another health problem. That’s why it is must to avoid the particular medicines during this drug therapy in order to get rid of serious drug reactions.

The initial dosage of parentally administered A-Methapred may vary from 4 to 120 mg depending on the specific disease entity being treated. It should be emphasized that dosage requirements are variable and must be individualized on the basis of the disease under treatment and the response of the patient.

The proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until an adequate clinical response is reached with the minimum therapeutic dosage. It is recommended that methylprednisolone should be withdrawn gradually rather than abruptly.

A-Methapred is widely prescribed to treat following health disorders:

• Rheumatoid arthritis and osteoarthritis: depending upon the size of the joint and severity of the condition the dose for intra-articular administration may vary. Injections may be repeated at intervals ranging from 1 to 5 or more weeks in chronic cases. The following doses are given as a general guide:
  • Large joint: kness, ankles and shoulders: 20-80 mg
  • Medium joint: elbows and wrist: 10-40 mg
  • Small joint: metacarpophalangeal joint, interphalangeal, sternoclavicular and acromioclavicular joint: 4-10 mg.

• The dose in the treatment of the various conditions of the tendinous or bursal structures varies with the condition ranging from 4 to 30 mg in recurrent or chronic conditions.

• Following cleansing with an appropriate antiseptic such as 70% alcohol, 20-60 mg of the suspension is injected into certain dermatological lesions. It may be necessary to distribute doses ranging from 20-40 mg by repeated local injections in the case of large lesions.

• As a temporary substitute for oral therapy, a single injection during each 24-hour period of a dose of the suspension equal to the total daily oral dose of methylprednisolone tablets is usually sufficient. When a prolonged effect is desired, the weekly dose may be calculated by multiplying the daily oral dose by 7 and given as a single intramuscular injection.

• In pediatric patients, the initial dose of methylprednisolone may vary depending on the specific disease entity being treated. Dosage must be individualized according to severity of the disease and respond of the patient. The recommended dosage may be reduced for pediatric patients, but dosage should be governed by the severity of the condition rather than by strict adherence to the ratio indicated by age or body weight.

• In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control this condition.

• Following intramuscular administration of 80 to 120 mg to asthmatic patients or patients with allergic rhinitis relief may result within 6 to 48 hours and persist for several days to 2 weeks. 

• In treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of methylprednisolone for a week followed by 64 mg every other day for 1 month have been shown to be effective.

Since complications of treatment with methylprednisolone are severe and even life-threatening, the dose and duration of A-Methapred should be considered.

However, in certain overwhelming, acute, life-threatening situations, administration in dosages exceeding the usual dosages must be justified. Sarcoma has been reported to occur in patients receiving methylprednisolone therapy, most often for chronic conditions.

The use of methylprednisolone is contraindicated in patients with known hypersensitivity to the product and its constituents. The use of methylprednisolone is strongly prohibited in idiopathic thrombocytopenic purpura and systemic fungal infections.

Additionally, there are some diseases in which methylprednisolone is relative contraindicated such as:

• Peptic ulcer
• Diabetes mellitus
• Hypertension
• Viral and fungal infections
• Tuberculosis
• Osteoporosis
• Keratitis
• Psychosis
• Epilepsy
• Congestive heart failure
• Renal failure etc. 

If a patient on methylprednisolone develops an infection, the steroid should not be discontinued without prior consultation with your health professional. Rather, the dose may have to be increased to meet the stress of infection. You should follow the instructions given by the doctor. 

There are some unwanted side-effects associated with A-Methapred that usually do not need medical attention. These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Additionally, your health care professional may advise you about the ways how to prevent or reduce those unwanted side-effects.

Sometimes you may need to consult with the doctor if you feel any of these: 

• Allergic reactions: allergic or hypersensitivity reactions, anaphylactoid reaction, anaphylaxis, angioedema etc.

• Cardiovascular: cardiac arrest, cardiac arrhythmias, circulatory collapse, congestive heart failure, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, syncope, thromboembolism, thrombophlebitis etc.

• Dermatologic: acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scaly skin, edema, erythema, impaired wound healing, increase sweating, rash, suppressed reactions to skin tests, thin fragile skin etc.

• Endocrine: decreased carbohydrate and glucose tolerance, development of cushingoid state, glycosuria, hirsutism, increased requirements for insulin or hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, suppression of growth in pediatric patients etc.

• Fluid and electrolyte disturbances: fluid retention, hypokalemic alkalosis, potassium loss, sodium retention etc.

• Gastrointestinal: abdominal distention, bowel or bladder dysfunction, hepatomegaly, increased appetite, pancreatitis, ulcerative esophagus, peptic ulcer with possible subsequent perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with IBD) etc.

• Musculoskeletal: loss of muscle mass, muscle weakness, pathological fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures etc. 

• Neurologic/psychiatric: convulsions, depression, emotional instability, euphoria, increased intracranial pressure with papilledema usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy etc.

• Fetal abnormalities: cleft palate and other defects are produced in animals, but have not been encountered on clinical use in pregnant women. Prolonged corticosteroid therapy during pregnancy increases the risk of gestational diabetes, intrauterine growth retardation, pregnancy induced hypertension and preeclampsia.