You’ve likely administered methylprednisolone at one point in your career as it has a wide range of clinical applications and acts on most of our body systems. Have you ever stopped to think about how it works? Let’s explore the mechanisms of methylprednisolone.
How Does Methylprednisolone Work?
Methylprednisolone is a corticosteroid that prevents the release of substances in the body that cause inflammation. Tissue injury or trauma leads to tissue irritation, edema, inflammation, and production of scar tissue. Methylprednisolone counteracts the initial effects of tissue trauma, promoting healing. It achieves this by reversing capillary permeability, suppressing the movement of fibroblasts and leukocytes, controlling protein synthesis, and stabilizing lysosomes at the cellular level. It also executes various physiologic effects including the regulation of carbohydrate, protein, and lipid metabolism and the maintenance of fluid and electrolyte homeostasis (Lexicomp, n.d.).
Indications for Methylpredisolone (Facts and Comparisons, 2023)
An anti-inflammatory or immunosuppressive agent approved by the U.S. Food and Drug Administration (FDA), methylprednisolone is indicated to manage and treat a multitude of conditions including:
- Hematologic: immune thrombocytopenia and autoimmune hemolytic anemia
- Allergic: asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity, serum sickness, transfusion reactions, new onset urticaria
- Gastrointestinal: acute exacerbation of inflammatory bowel disease
- Neurologic: acute exacerbation of multiple sclerosis
- Rheumatic: antineutrophil cytoplasmic antibody-associated vasculitis, dermatomyositis/polymyositis, giant cell arteritis, gout (acute flare), mixed cryoglobulinemia syndrome, polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematosus
- Opthalmologic: uveitis, scleritis, chorioretinitis, iritis and iridocyclitis, keratitis, optic neuritis, retinal vasculitis, and allergic conjunctivitis
Nursing Considerations for Methylprednisolone (Facts and Comparisons, 2023)
Administration (Lexicomp, n.d.)
The following general administration recommendations are for adult patients. Please adhere to your institution-specific policies and procedures.
Monitoring (Lexicomp, n.d., Ocejo & Correa, 2022)
- Oral: administer tablets after meals or with food or milk to reduce gastrointestinal upset. If prescribed once daily, administer in the morning.
- Intramuscular (acetate, succinate): avoid injection into the deltoid muscle and avoid injection or leakage into the dermis. Do not inject into areas with acute local infection.
- Intravenous (IV) (succinate):
- IV push: administer as slow IV injection over several minutes to over at least 5 minutes for doses greater than or equal to 250 mg.
- IV infusion: rate depends on dose and severity of condition; typically administered as an intermittent infusion over 15 to 60 minutes. Administer doses greater than 250 mg over at least 30 to 60 minutes. Monitor for severe adverse effects such as hypoension, cardiac arrhythmias, and sudden death.
- Intra-articular or soft tissue (acetate) and intralesional injections should be administered by a qualified health care professional. See manufacturer’s labeling for details.
Methylprednisolone impacts cardiovascular, immunologic, musculoskeletal, endocrine, and neurologic physiology. When administering methylprednisolone, monitor the following parameters and adverse events:
- Cardiovascular: fluid retention, edema, hypertension, atherosclerotic disease, arrhythmias, hyperlipidemia
- Gastrointestinal: gastritis, ulcer, gastrointestinal bleeding
- Metabolic/endocrine: hyperglycemia, hypothalamic-pituitary-adrenal (HPA) axis suppression, increased need for insulin, Cushing syndrome (facial rounding, puffiness, fat deposition, “moon face”)
- Immunologic: increased susceptibility to infections
- Hematologic: leukocytosis and neutrophilia
- Neuropsychiatric: mood disorders, psychosis, memory impairment, insomnia
- Bone and muscle: osteoporosis, osteonecrosis, myopathy, muscle wasting
- Opthamologic: routine eye exams to detect cataracts, increased ocular pressure, exophthalmos
- Dermatologic: skin thinning, ecchymoses, steroid-induced acne
- Other: increased appetite, weight gain, fat redistribution from the extremities to trunk and back of neck; growth and development in pediatric patients
- Lab tests: blood glucose, electrolytes, glycosuria
For complete information, please consult the drug’s specific package insert or the Nursing2024 Drug Handbook® + Drug Updates
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