From the Guidelines
For patients already on prednisone who need intravenous corticosteroids, Solu-Medrol (methylprednisolone) is generally preferred over Solu-Cortef (hydrocortisone) due to its stronger anti-inflammatory effects and lower risk of hypokalaemia 1. When converting from oral prednisone to IV steroids, use methylprednisolone at approximately 80% of the prednisone dose (e.g., 40mg prednisone converts to about 32mg methylprednisolone) due to its higher potency. Some key points to consider when choosing between Solu-Medrol and Solu-Cortef include:
- Clinical situation: Solu-Medrol is preferred for conditions like asthma exacerbations or MS flares, while Solu-Cortef provides better mineralocorticoid effects for conditions requiring blood pressure support like adrenal insufficiency.
- Potency: Methylprednisolone is more potent than hydrocortisone, with a conversion ratio of approximately 1:4 (e.g., 40mg prednisone equals about 32mg methylprednisolone or 160mg hydrocortisone).
- Side effects: Methylprednisolone causes significantly less hypokalaemia than hydrocortisone at equivalent doses 1. When transitioning back to oral prednisone, taper according to the patient's condition and duration of steroid use to prevent adrenal suppression. It is also essential to monitor for hyperglycemia, electrolyte abnormalities, and psychiatric effects during IV steroid administration. The most recent and highest quality study supports the use of methylprednisolone as the preferred intravenous corticosteroid for patients already on prednisone 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that are readily absorbed from the gastrointestinal tract. Methylprednisolone is a potent anti-inflammatory steroid with greater anti-inflammatory potency than prednisolone and even less tendency than prednisolone to induce sodium and water retention. When high dose hydrocortisone therapy must be continued beyond 48–72 hours, hypernatremia may occur Under such circumstances, it may be desirable to replace SOLU-CORTEF with a corticoid such as methylprednisolone sodium succinate which causes little or no sodium retention.
For patients on prednisone, methylprednisolone (Solumedrol) may be a suitable alternative to hydrocortisone (Solucortef), especially when high-dose therapy is required for an extended period, due to its lower tendency to cause sodium and water retention.
- Key points:
- Methylprednisolone has greater anti-inflammatory potency than prednisolone.
- Methylprednisolone causes less sodium and water retention than prednisolone.
- Hydrocortisone may be replaced with methylprednisolone sodium succinate to avoid hypernatremia when high-dose therapy is continued beyond 48-72 hours 2 3.
From the Research
Corticosteroid Options for Patients on Prednisone
- Solumedrol (methylprednisolone) and Solucortef (hydrocortisone) are two corticosteroid options that can be considered for patients on prednisone 4.
- The choice between Solumedrol and Solucortef depends on various factors, including the patient's medical condition, the severity of their symptoms, and their individual response to different corticosteroids.
Potency and Efficacy of Corticosteroids
- Studies have shown that methylprednisolone (Solumedrol) is a more potent corticosteroid than hydrocortisone (Solucortef) 4.
- Methylprednisolone has been shown to be more effective in suppressing lymphocyte activity in vitro, indicating its higher immunosuppressive potency 4.
- However, the use of methylprednisolone has also been associated with greater hyperglycemia compared to hydrocortisone, particularly in hospitalized patients 5.
Considerations for Patients on Prednisone
- Patients on prednisone who require additional corticosteroid therapy should be carefully evaluated to determine the best course of treatment 6.
- The use of stress doses of corticosteroids in patients on prednisone undergoing surgery is not always necessary, and the decision to use stress doses should be made on a case-by-case basis 6.
- The metabolism of systemically administered corticosteroids, including prednisone, can vary depending on the specific corticosteroid used and the individual patient's characteristics 7.