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METHYLPREDNISOLONE SODIUM SUCCINATE
Note: For more information refer to the monograph: Glucocorticoids, General Information or to the manufacturer’s product information.
Chemistry – Also known as 6-alpha-methylprednislone , methylprednisolone is a synthetically produced glucocorticoid. Both the free alcohol and the acetate ester occur as odorless, white or practically white, crystalline powder. They are practically insoluble in water and sparingly soluble in alcohol.
Methylprednisolone sodium succinate occurs as an odorless, white or nearly white, hygroscopic, amorphous solid. It is very soluble in both water and alcohol.
Storage/Stability/Compatibility – Commercially available products of methylprednisolone should be stored at room temperature (15-30°C); avoid freezing the acetate injection. After reconstituting the sodium succinate injection, store at room temperature and use within 48 hours; only use solutions that are clear.
Methylprednisolone sodium succinate injection is reportedly compatible with the following fluids and drugs: amino acids 4.25%/dextrose 25%, amphotericin B (limited amounts), chloramphenicol sodium succinate, cimetidine HCl, clindamycin phosphate, dopamine HCl, heparin sodium, metoclopramide, norepinephrine bitartrate, penicillin G potassium, sodium iodide/aminophylline, and verapamil.
The following drugs and fluids have either been reported to be incompatible with methylprednisolone sodium succinate, compatible dependent upon concentration, or data conflicts: D5/half normal saline, D5 normal saline (80 mg/l reported compatible), D5W (up to 5 grams/L reported compatible), Lactated Ringer’s (up to 80 mg/L reported compatible), normal saline (data conflicts; some reports of up to 60 grams/liter compatible), calcium gluconate, cephalothin sodium (up to 500 mg/L in D5W or NS compatible), glycopyrrolate, insulin, metaraminol bitartrate, nafcillin sodium, penicillin G sodium and tetracycline HCl. Compatibility is dependent upon factors such as pH, concentration, temperature and diluents used. It is suggested to consult specialized references for more specific information (e.g., Handbook on Injectable Drugs by Trissel; see bibliography).
Contraindications/Precautions – The manufacturer (Upjohn Veterinary) states that the drug (tablets) should not be used in dogs or cats “in viral infections, …animals with arrested tuberculosis, peptic ulcer, acute psychoses, corneal ulcer, and Cushinoid syndrome. The presence of diabetes, osteoporosis, chronic psychotic reactions, predisposition to thrombophlebitis, hypertension, CHF, renal insufficiency, and active tuberculosis necessitates carefully controlled use.”
The injectable acetate product is contraindicated as outlined above when used systemically. When injected intrasynovially, intratendinously, or by other local means, it is contraindicated in the “presence of acute local infections.”
As an antiinflammatory (glucocorticoid effects):
a) Methylprednisolone: 0.5 mg/kg PO; Methylprednisolone sodium succinate: 0.5 mg/kg IV or IM (Robinson 1987)
b) For labeled uses: Methylprednisolone acetate 200 mg IM repeated as necessary (Package insert; Depo-Medrol®—Upjohn) The manufacturer has specific directions for use of the drug intrasynovially. It is recommended to refer directly to the package insert for more information.
a) Methylprednisolone sodium succinate: 10 – 20 mg/kg IV (Robinson 1987)
Dosage Forms/Preparations/Approval Status/Withdrawal Times–
Veterinary-Approved Products: A 10 ppb tolerance has been established for methylprednisolone in milk.
Methylprednisolone Tablets 1 mg, 2 mg
Medrol® (Upjohn), generic; (Rx) Approved for use in dogs and cats.
Methylprednisolone Acetate Injection 20 mg/ml, 40 mg/ml
Depo-Medrol® (Upjohn), generic; (Rx) Approved for use in dogs, cats and horses.
Methylprednisolone Tablets 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg; Medrol® (Upjohn), generic; (Rx)
Methylprednisolone Acetate for Injection 20 mg/ml, 40 mg/ml, 80 mg/ml in 1, 5 & 10 ml vials; Depo-Medrol® (Upjohn) many other trade names and generically-labeled products are available; (Rx)
Methylprednisolone Sodium Succinate Powder for Injection: 40 mg/vial; 125 mg/vial; 500 mg/vial; 1000 mg/vial (62.5 mg/ml after reconstitution), 2000 mg/vial; Solu-Medrol® (Upjohn), A-methaPred® (Abbott), generic; (Rx)