Solu-Medrol (Methylprednisolone)
Injectable corticosteroid for severe inflammation, allergic emergencies and shock
Solu-Medrol (methylprednisolone sodium succinate) is a powerful injectable corticosteroid used in hospital and emergency settings to treat severe inflammatory and allergic conditions. It is administered intravenously or intramuscularly when rapid anti-inflammatory action is required, such as during severe asthma attacks, anaphylaxis, shock, and cerebral edema. This medication is available by prescription only and should always be administered under medical supervision.
Quick Facts
Key Takeaways
- Solu-Medrol is a fast-acting injectable corticosteroid administered intravenously or intramuscularly in emergency and hospital settings for severe inflammatory conditions.
- It is used to treat severe asthma exacerbations, anaphylaxis, allergic emergencies, shock, croup in children, and cerebral edema associated with cancer.
- Do not use Solu-Medrol if you have a systemic fungal infection or known allergy to methylprednisolone. Always inform your doctor about all existing medical conditions.
- Solu-Medrol interacts with many medications including anticoagulants, anti-epileptics, certain antibiotics, and HIV medications. Provide your doctor with a complete medication list.
- Long-term use must be tapered gradually to avoid adrenal insufficiency. Side effects from short-term emergency use are generally less severe than those from prolonged therapy.
What Is Solu-Medrol and What Is It Used For?
Solu-Medrol contains the active substance methylprednisolone sodium succinate, which is a water-soluble prodrug that is rapidly converted to free methylprednisolone after injection. It belongs to a group of medicines called corticosteroids (glucocorticoids), which are synthetic analogs of the naturally occurring hormones produced by the adrenal glands. Methylprednisolone has approximately five times the anti-inflammatory potency of hydrocortisone, with minimal mineralocorticoid (salt-retaining) activity, making it particularly useful in conditions where fluid retention should be minimized.
The injectable formulation of Solu-Medrol is specifically designed for situations requiring rapid onset of action, typically within minutes to hours of administration. Unlike oral corticosteroids, which must first be absorbed through the gastrointestinal tract, intravenous methylprednisolone reaches therapeutic blood levels almost immediately, making it indispensable in emergency medicine and critical care settings.
Approved Medical Uses
Solu-Medrol is approved and used globally for the following indications:
- Shock treatment: As adjunctive therapy alongside other treatments in various forms of shock, including septic shock and anaphylactic shock, to reduce inflammation and stabilize hemodynamics.
- Severe asthma attacks (status asthmaticus): When inhaled bronchodilators and other first-line treatments provide insufficient relief, high-dose intravenous methylprednisolone helps reduce airway inflammation and bronchospasm.
- Severe allergic reactions and anaphylaxis: Used alongside epinephrine as part of the emergency management of severe systemic allergic reactions to prevent biphasic reactions and reduce prolonged inflammation.
- Severe hypersensitivity reactions: Including drug reactions, serum sickness, and transfusion reactions that do not respond to standard antihistamine therapy.
- Croup (laryngotracheobronchitis): Reduces laryngeal edema and inflammation in children with moderate to severe croup, typically as a single dose or short course.
- Severe reactions to insect and snake bites: Manages severe inflammatory and immune-mediated responses to venomous bites and stings.
- Cerebral edema: Particularly edema associated with brain tumors (primary or metastatic) and edema occurring during cancer treatment, where it helps reduce intracranial pressure.
Beyond these primary indications, methylprednisolone may also be used in high-dose pulse therapy for acute exacerbations of multiple sclerosis (MS), acute transplant rejection, and other severe autoimmune flare-ups. The decision to use Solu-Medrol is always made by a physician based on the specific clinical situation, and the lowest effective dose for the shortest possible duration is the guiding principle.
Methylprednisolone sodium succinate that is present in Solu-Medrol may also be approved for the treatment of other conditions not specifically mentioned here. Always follow your physician's instructions regarding dosage, timing, and duration of treatment.
What Should You Know Before Taking Solu-Medrol?
Before receiving Solu-Medrol, it is essential that your healthcare provider has a complete picture of your medical history and current health status. Corticosteroids are potent medications that affect nearly every organ system in the body, and certain pre-existing conditions may require dose adjustments, closer monitoring, or alternative treatment approaches. Your doctor will weigh the potential benefits against the risks for your specific situation.
Contraindications
Solu-Medrol must not be used in the following circumstances:
- Known hypersensitivity: If you are allergic to methylprednisolone sodium succinate or any other ingredient in the formulation, including excipients such as benzyl alcohol (present in the 500 mg and 1 g formulations).
- Systemic fungal infections: Active systemic fungal infections (e.g., systemic candidiasis, aspergillosis) are an absolute contraindication, as corticosteroids suppress immune function and can dramatically worsen fungal disease.
In emergency, life-threatening situations such as anaphylaxis, the benefits of immediate corticosteroid administration generally outweigh these contraindications, and your physician will make a clinical judgment accordingly.
Warnings and Precautions
Speak with your doctor before receiving Solu-Medrol if you have any of the following conditions or circumstances:
- Active or latent infections: Corticosteroids can mask the signs and symptoms of infection, making diagnosis more difficult. They may also reactivate dormant infections such as tuberculosis, herpes simplex, or strongyloidiasis. Your physician will carefully monitor for signs of infection during treatment.
- Osteoporosis: Glucocorticoids accelerate bone loss and increase fracture risk, particularly with prolonged use. Patients with existing osteoporosis require careful benefit-risk assessment.
- Recent gastrointestinal surgery: Corticosteroids can impair wound healing and increase the risk of gastrointestinal perforation, particularly in patients who have recently undergone intestinal surgery.
- Psychiatric conditions: Methylprednisolone can cause or exacerbate mood disturbances, insomnia, euphoria, depression, and in rare cases psychosis. Patients with a history of mental health conditions should be closely monitored.
- Peptic ulcer disease or gastritis: Corticosteroids increase the risk of gastrointestinal bleeding and perforation, particularly when combined with NSAIDs.
- Ulcerative colitis: Use with extreme caution in patients with nonspecific ulcerative colitis with impending perforation, abscess, or other pyogenic infections.
- Hypothyroidism: Patients with underactive thyroid may have enhanced glucocorticoid effects, potentially requiring dose reduction.
- Tuberculosis: Corticosteroids may reactivate latent tuberculosis. Use should be restricted to active disease cases where appropriate antimicrobial therapy is in place.
- Diabetes mellitus: Methylprednisolone causes hyperglycemia (elevated blood glucose) and may necessitate adjustment of insulin or oral hypoglycemic agents.
- Hypertension: Corticosteroids can elevate blood pressure through sodium and fluid retention. Blood pressure monitoring is recommended.
- Heart failure or cardiovascular disease: Fluid retention and electrolyte disturbances associated with corticosteroids may worsen heart failure symptoms.
- Epilepsy: Changes in electrolyte balance and direct effects on the central nervous system may lower seizure threshold.
- Impaired kidney function: Renal insufficiency may alter drug clearance and electrolyte balance, requiring dose adjustment and monitoring.
- Scleroderma (systemic sclerosis): Increased risk of scleroderma renal crisis, a potentially life-threatening complication.
- Glaucoma: Corticosteroids may increase intraocular pressure. Patients with glaucoma or a family history of glaucoma require monitoring.
- Neuromuscular diseases: Such as multiple sclerosis (MS) or myasthenia gravis. Corticosteroids can transiently worsen weakness before improvement occurs.
- Pheochromocytoma: Corticosteroids may precipitate a pheochromocytoma crisis with symptoms including palpitations, headache, and profuse sweating.
- Thromboembolic disorders: History of blood clots or current thromboembolic disease requires caution, as corticosteroids may increase clotting risk.
- Hyperthyroidism: An overactive thyroid may increase the risk of thyrotoxic periodic paralysis during methylprednisolone treatment. Contact your doctor immediately if you experience muscle weakness, muscle pain, cramps, or stiffness.
Solu-Medrol can worsen existing infections or cause dormant infections to reactivate or worsen. Your doctor will carefully monitor for signs of infection and may discontinue treatment or reduce the dose as needed. Additionally, Solu-Medrol should not be used for complications following severe head injuries or stroke, as it may be harmful rather than beneficial.
Vaccination Considerations
Inform your doctor if you are due for any vaccination or skin testing (such as allergy prick tests or tuberculin tests) while receiving Solu-Medrol. Live vaccines are generally contraindicated during immunosuppressive corticosteroid therapy due to the risk of disseminated infection. Inactivated vaccines may have reduced efficacy. Your doctor will advise on appropriate timing of vaccinations in relation to your treatment.
Tumor Lysis Syndrome
When corticosteroids are used in cancer treatment, there is a risk of tumor lysis syndrome (TLS), a potentially life-threatening metabolic emergency caused by the rapid breakdown of cancer cells. Symptoms may include muscle cramps, weakness, confusion, irregular heartbeat, visual disturbances, and shortness of breath. Inform your doctor immediately if you experience any of these symptoms during treatment.
Children and Adolescents
Solu-Medrol should be used with caution in pediatric patients. Corticosteroids can suppress growth in children when used over prolonged periods. If Solu-Medrol is administered to premature infants, cardiac function and structure may need to be monitored, as corticosteroids can affect cardiac development. Pediatric dosing is carefully calculated by the treating physician based on the child's weight, age, and the severity of the condition.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor before receiving Solu-Medrol.
Pregnancy: Corticosteroids cross the placenta and may affect fetal development. Long-term use has been associated with low birth weight in newborns. Solu-Medrol should only be used during pregnancy when the potential benefit justifies the potential risk to the fetus, and only under strict medical supervision. The 500 mg and 1 g formulations contain benzyl alcohol, which requires additional consideration in pregnant women.
Breastfeeding: Small amounts of methylprednisolone are excreted in breast milk and may affect the nursing infant. Solu-Medrol should only be used during breastfeeding when clearly necessary and prescribed by a physician. The 500 mg and 1 g formulations contain benzyl alcohol, which is an additional concern for nursing infants.
Driving and Operating Machinery
Solu-Medrol does not usually affect the ability to drive or operate machinery. However, some patients may experience side effects such as dizziness, visual disturbances, or fatigue that could impair these abilities. You should assess your own fitness to drive or operate machinery based on how you feel after treatment.
Important Information About Excipients
Benzyl alcohol (500 mg and 1 g formulations): These strengths contain 9 mg benzyl alcohol per 1 mL of reconstituted solution. Benzyl alcohol may cause allergic reactions and has been associated with serious adverse effects including respiratory distress in infants and young children. It should not be given to neonates (up to 4 weeks of age) and should not be used for more than 1 week in children under 3 years unless prescribed by a physician. Patients with impaired liver or kidney function should consult their doctor, as large volumes of benzyl alcohol may accumulate and cause metabolic acidosis.
Sodium content: The 40 mg and 125 mg formulations are essentially sodium-free (less than 1 mmol/23 mg per vial). The 500 mg formulation contains 58.3 mg sodium per vial (approximately 2.9% of the WHO-recommended maximum daily intake for adults). The 1 g formulation contains 116.8 mg sodium per vial (approximately 5.8% of the recommended maximum daily intake). This should be considered for patients on a sodium-restricted diet.
How Does Solu-Medrol Interact with Other Drugs?
Methylprednisolone is primarily metabolized by the cytochrome P450 enzyme CYP3A4 in the liver. Consequently, medications that induce or inhibit this enzyme can significantly alter methylprednisolone blood levels and its therapeutic effects. Additionally, corticosteroids can affect the metabolism and efficacy of numerous other medications. Always provide your doctor with a complete list of all medications you are taking, including prescription drugs, over-the-counter medicines, and herbal supplements.
Major Interactions
| Drug / Drug Class | Interaction Effect | Clinical Action |
|---|---|---|
| Phenytoin, Carbamazepine, Phenobarbital (Anti-epileptics / Barbiturates) | These enzyme inducers accelerate methylprednisolone metabolism via CYP3A4, reducing its blood levels and therapeutic effect | Dose increase of methylprednisolone may be required; monitor clinical response |
| Rifampicin (Anti-tuberculosis) | Potent CYP3A4 inducer that can dramatically reduce methylprednisolone levels and effectiveness | Significant dose increase may be needed; consider alternative corticosteroid or anti-TB agent |
| Oral anticoagulants (e.g., Warfarin) | Increased risk of bleeding; anticoagulant effect may be enhanced or reduced unpredictably | Regular coagulation monitoring (INR) required; dose adjustment of anticoagulant may be needed |
| NSAIDs (Aspirin, Ibuprofen, Diclofenac, Naproxen) | Significantly increased risk of gastrointestinal bleeding, ulceration, and perforation | Use combination with extreme caution; consider gastroprotective therapy (PPI) |
| Ciclosporin, Tacrolimus (Immunosuppressants) | Mutual inhibition of metabolism; increased levels of both drugs, increased risk of seizures with ciclosporin | Therapeutic drug monitoring recommended for both agents |
| Ritonavir, Cobicistat (HIV Antivirals) | Potent CYP3A4 inhibitors that significantly increase methylprednisolone levels, raising risk of Cushing syndrome | Close monitoring required; consider dose reduction or alternative corticosteroid |
| Potassium-depleting diuretics (e.g., Furosemide, Hydrochlorothiazide) | Increased risk of hypokalemia (dangerously low potassium levels) | Monitor serum potassium; consider potassium supplementation |
Other Notable Interactions
| Drug / Drug Class | Interaction Effect | Clinical Action |
|---|---|---|
| Erythromycin, Clarithromycin | CYP3A4 inhibitors that increase methylprednisolone levels | Monitor for corticosteroid side effects; dose reduction may be needed |
| Ketoconazole, Itraconazole | Potent CYP3A4 inhibitors; significant increase in methylprednisolone exposure | Consider dose reduction; monitor for Cushingoid effects |
| Isoniazid | Methylprednisolone may reduce isoniazid levels; isoniazid may also alter steroid metabolism | Monitor treatment efficacy of both agents |
| Oral contraceptives (containing ethinylestradiol) | Estrogens may increase methylprednisolone levels by inhibiting its metabolism | Be aware of potential enhanced corticosteroid effects |
| Diltiazem | CYP3A4 inhibitor; may increase methylprednisolone levels | Monitor for corticosteroid side effects |
| Aprepitant, Fosaprepitant (Anti-emetics) | CYP3A4 inhibitors; can increase methylprednisolone exposure | Consider methylprednisolone dose reduction when used together |
| Cyclophosphamide (Chemotherapy) | Methylprednisolone may alter cyclophosphamide metabolism | Monitor treatment response and toxicity |
| Anticholinesterases (for Myasthenia Gravis) | Corticosteroids may antagonize the effects of anticholinesterase agents | Monitor neuromuscular function closely; temporary dose adjustments may be needed |
Grapefruit and grapefruit juice can inhibit the CYP3A4 enzyme that metabolizes methylprednisolone, potentially increasing drug levels in the blood. If you regularly consume grapefruit products, discuss this with your doctor during treatment with Solu-Medrol.
This list does not include all possible interactions. Methylprednisolone can affect or be affected by the effectiveness of many other medications. It is essential that your treating physician is aware of all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Always inform any new prescribing physician that you are receiving or have recently received Solu-Medrol treatment.
What Is the Correct Dosage of Solu-Medrol?
Solu-Medrol is always administered by or under the supervision of a healthcare professional, either as an intravenous (IV) injection, IV infusion, or intramuscular (IM) injection. Your doctor determines the appropriate dose, route, frequency, and duration based on your specific condition, its severity, and your individual response to treatment. The fundamental principle guiding corticosteroid dosing is to use the lowest effective dose for the shortest time necessary to achieve the desired clinical outcome.
Adults
Adult dosing varies considerably based on the indication. The following are general dosing guidelines, though your physician may adjust based on your individual needs:
Severe Asthma / Status Asthmaticus
Typically 40–125 mg IV as an initial dose, followed by additional doses as clinically indicated. Some protocols use up to 1–2 mg/kg IV every 6–8 hours for acute severe asthma.
Anaphylaxis / Severe Allergic Reactions
As adjunctive therapy to epinephrine: typically 125–250 mg IV. This is given after epinephrine and is used to prevent biphasic reactions and ongoing inflammation.
Shock (Adjunctive Therapy)
High-dose protocols: 30 mg/kg IV administered over at least 30 minutes. May be repeated every 4–6 hours for up to 48–72 hours depending on the clinical scenario.
Cerebral Edema (Tumor-Related)
Typical starting dose: 40–120 mg IV. In severe cases associated with brain tumors, higher doses may be used. The dose is gradually reduced as the clinical situation improves.
Pulse Therapy (e.g., MS Relapse, Transplant Rejection)
500 mg to 1 g IV daily for 3–5 consecutive days. This high-dose, short-duration approach is used in specific autoimmune and transplant-related conditions.
Children
Pediatric dosing is typically weight-based and determined by the treating physician. For croup, a single dose of 1–2 mg/kg IV or IM may be administered. For acute severe asthma, doses of 1–2 mg/kg per day (divided into 2–4 doses) are commonly used. The duration of treatment should be minimized as corticosteroids can affect growth in children with prolonged use.
Elderly
Elderly patients may be more susceptible to the adverse effects of corticosteroids, including osteoporosis, hypertension, fluid retention, and hyperglycemia. No specific dose adjustment is routinely required, but elderly patients should be monitored more closely and treated with the minimum effective dose.
Administration and Reconstitution
Solu-Medrol is supplied as a powder that must be reconstituted with the provided diluent before injection. The 40 mg and 125 mg strengths are available in Act-O-Vial systems that simplify the reconstitution process. For IV infusion, the reconstituted solution is further diluted in 100–500 mL of sodium chloride 0.9% or glucose 5% solution. Up to 3 g of Solu-Medrol may be dissolved in 50 mL of diluent for concentrated administration when necessary.
The ideal pH range for the prepared solution is 7.4–7.9. Cloudy solutions should not be used, and the drug should not be mixed with other IV medications. Appropriate measures must be taken to avoid inadvertent intrathecal or epidural injection.
Missed Dose
Because Solu-Medrol is administered by healthcare professionals in clinical settings, missed doses are uncommon. If a scheduled dose is delayed or missed, your medical team will determine the appropriate course of action based on your clinical condition.
Overdose
As Solu-Medrol is administered by physicians in controlled settings, overdose is unlikely. There is no specific antidote for acute methylprednisolone overdose. Treatment of overdose is supportive, addressing symptoms as they arise. Chronic overexposure to corticosteroids can lead to Cushing syndrome, characterized by weight gain, moon face, skin changes, muscle weakness, and metabolic disturbances.
Stopping Treatment
If Solu-Medrol has been used for an extended period, treatment must be tapered gradually rather than stopped abruptly. Sudden discontinuation after prolonged therapy can cause adrenal insufficiency (adrenal crisis), with symptoms such as fatigue, chills, dizziness, nausea, and low blood pressure. If you develop signs of adrenal insufficiency after discontinuing Solu-Medrol, contact your doctor immediately.
What Are the Side Effects of Solu-Medrol?
Like all medicines, Solu-Medrol can cause side effects, although not everyone will experience them. An important distinction exists between the side effects seen with short-term emergency use and those associated with long-term corticosteroid therapy. Many of the classic corticosteroid side effects (such as osteoporosis, weight gain, and skin thinning) are primarily concerns with prolonged use and are very uncommon when Solu-Medrol is used for short-term emergency or acute treatment.
The severity and likelihood of side effects generally correlate with the dose used and the duration of treatment. Your physician will use the lowest effective dose for the shortest possible duration to minimize adverse effects.
Rare
May affect up to 1 in 1,000 patients
- Allergic reaction
- Circulatory shock (cardiovascular collapse) with symptoms such as palpitations and cold sweats
- Irregular heartbeat (cardiac arrhythmias)
- Cardiac arrest
- Slow heart rate (bradycardia) — particularly with high doses
Frequency Not Known
Cannot be estimated from available data
- Increased white blood cell count (leukocytosis)
- Severe allergic reaction (anaphylaxis) with fever, rash, swelling, and sometimes low blood pressure
- Drug hypersensitivity
- Pheochromocytoma-related crisis (palpitations, headache, sweating)
- Fat redistribution to isolated areas of the body (lipodystrophy)
- Decreased bicarbonate levels in the blood (metabolic acidosis) causing nausea, vomiting, and fatigue
- Disease of the eye's retina and choroid (chorioretinopathy), blurred vision
- Increased risk of blood clots (thromboembolism)
- Flushing and skin redness (hot flushes)
- Liver inflammation (hepatitis), elevated liver enzymes
- Inflammation of subcutaneous fat (panniculitis) — reported after dose reduction or discontinuation of long-term high-dose therapy; usually resolves on its own
- Increased blood urea nitrogen levels
- Fluid retention (edema in ankles, feet, and legs)
Side Effects Associated with Prolonged Corticosteroid Use
While the following side effects are uncommon with short-term Solu-Medrol treatment, they are important to be aware of if treatment extends beyond a few days:
- Metabolic effects: Hyperglycemia (high blood sugar), altered fat distribution (Cushingoid appearance), weight gain, increased appetite, sodium and fluid retention, potassium loss
- Musculoskeletal: Osteoporosis, steroid myopathy (muscle weakness), avascular necrosis of bone
- Gastrointestinal: Peptic ulcer, gastritis, gastrointestinal hemorrhage, pancreatitis
- Skin: Skin thinning, easy bruising, impaired wound healing, acne, striae (stretch marks)
- Neuropsychiatric: Insomnia, mood swings, euphoria, depression, psychosis, cognitive impairment
- Ocular: Posterior subcapsular cataracts, increased intraocular pressure, glaucoma
- Endocrine: Adrenal suppression, growth retardation in children
- Immune: Increased susceptibility to infections, reactivation of latent infections
Withdrawal Symptoms
After prolonged treatment with Solu-Medrol, abrupt discontinuation can cause withdrawal symptoms including: decreased appetite, nausea, vomiting, fatigue, headache, fever, joint and muscle pain, skin peeling, weight loss, and low blood pressure. This is why your doctor will always taper the dose gradually when ending prolonged therapy.
Contact your healthcare provider or seek emergency care immediately if you experience: signs of a severe allergic reaction (difficulty breathing, swelling of face/throat, severe rash), chest pain or irregular heartbeat, sudden severe headache or visual disturbances, signs of infection (high fever, persistent cough, painful urination), or severe abdominal pain.
How Should You Store Solu-Medrol?
Solu-Medrol is typically stored and handled by healthcare professionals in hospital pharmacies, emergency departments, and clinical settings. However, the following storage information is provided for reference:
- Keep out of the sight and reach of children.
- Do not use after the expiration date printed on the packaging (EXP). The expiration date refers to the last day of that month.
- The unreconstituted powder does not require special storage conditions.
Stability After Reconstitution
- 40 mg formulation: Reconstituted solution is chemically stable for 48 hours at 2–8°C (refrigerated). If stored at room temperature (up to 25°C), it should be used immediately.
- 125 mg, 500 mg, and 1 g formulations: Reconstituted solution is chemically stable for 12 hours at up to 25°C. From a microbiological perspective, the solution should be used immediately after reconstitution.
- After further dilution for IV infusion: Chemically stable for 3 hours at up to 25°C or 24 hours at 2–8°C. Should be used immediately from a microbiological perspective.
Cloudy solutions should not be used. This is particularly important to note when mixing with acidic solutions, as cloudiness may occur. Medicines should not be disposed of via wastewater or household waste; ask your pharmacist how to dispose of medicines that are no longer needed in order to protect the environment.
What Does Solu-Medrol Contain?
Understanding the complete composition of Solu-Medrol is important for identifying potential allergenic components and for healthcare professionals preparing the medication for administration.
Active Ingredient
The active substance is methylprednisolone sodium succinate. Each injection vial contains an amount of methylprednisolone sodium succinate equivalent to 40 mg, 125 mg, 500 mg, or 1 g of methylprednisolone (the active corticosteroid).
Inactive Ingredients
Powder component:
- Anhydrous disodium phosphate
- Sodium dihydrogen phosphate monohydrate
- Sucrose (40 mg formulation only)
Diluent (reconstitution fluid):
- Water for injections (all strengths)
- Benzyl alcohol (500 mg and 1 g formulations only)
Appearance and Packaging
Solu-Medrol is supplied as a white to off-white powder in combination with a diluent for reconstitution. The 40 mg and 125 mg strengths are available in Act-O-Vial dual-chamber containers that facilitate easy reconstitution. The 500 mg and 1 g formulations are supplied as separate vials of powder with accompanying diluent ampoules.
Frequently Asked Questions About Solu-Medrol
Medical References
All information on this page is based on peer-reviewed medical literature, official regulatory agency documents, and international clinical guidelines. Evidence level: 1A (systematic reviews and randomized controlled trials where applicable).
- European Medicines Agency (EMA). Methylprednisolone – Summary of Product Characteristics. Available at: www.ema.europa.eu.
- U.S. Food and Drug Administration (FDA). Solu-Medrol (methylprednisolone sodium succinate) – Prescribing Information. Pfizer Inc. Available at: www.accessdata.fda.gov.
- World Health Organization (WHO). Model List of Essential Medicines – 23rd Edition (2023). Glucocorticoids section. Available at: www.who.int.
- British National Formulary (BNF). Methylprednisolone: Indications, Dosage, Cautions, Side Effects, and Interactions. National Institute for Health and Care Excellence (NICE). Available at: bnf.nice.org.uk.
- Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clinical Pharmacokinetics. 2005;44(1):61–98. doi:10.2165/00003088-200544010-00003.
- Buttgereit F, da Silva JAP, Boers M, et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens. Annals of the Rheumatic Diseases. 2002;61(8):718–722. doi:10.1136/ard.61.8.718.
- Rhen T, Cidlowski JA. Antiinflammatory Action of Glucocorticoids — New Mechanisms for Old Drugs. New England Journal of Medicine. 2005;353(16):1711–1723. doi:10.1056/NEJMra050541.
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2024). Systemic corticosteroids in acute asthma. Available at: ginasthma.org.
- Cardenas-Garcia J, Schaub KF, Engel JB, et al. Safety of pulse methylprednisolone therapy in severe COVID-19 pneumonia. Respiratory Medicine. 2021;185:106493. doi:10.1016/j.rmed.2021.106493.
- World Allergy Organization (WAO). WAO Anaphylaxis Guidance 2020. Role of corticosteroids in anaphylaxis management. Available at: www.worldallergyorganizationjournal.org.
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