Can Solumedrol (methylprednisolone) be administered intravenously (IV)?

From the Guidelines

Yes, Solumedrol (methylprednisolone) can be administered intravenously (IV). This corticosteroid medication is commonly given through IV routes in hospital settings for conditions requiring rapid anti-inflammatory or immunosuppressive effects.

Key Points to Consider

• Typical IV dosing ranges from 40-125 mg every 6 hours for acute conditions, though higher doses (500-1000 mg daily for 3-5 days) may be used for severe inflammatory conditions like acute exacerbations of multiple sclerosis or severe asthma attacks, as seen in the study by 1.
• When administering IV Solumedrol, it should be reconstituted according to manufacturer guidelines and can be given as a direct IV push (over 3-15 minutes depending on dose) or as an infusion diluted in compatible solutions like normal saline or D5W.
• Healthcare providers should monitor patients for potential adverse effects including hyperglycemia, fluid retention, mood changes, and increased infection risk, as noted in the guidelines by 1.
• The IV route allows for rapid onset of action compared to oral administration, making it particularly valuable in emergency situations where quick control of inflammation is needed, as highlighted in the study by 1.

Administration and Monitoring

• The dose of IV methylprednisolone can range from 0.5-1 mg/kg and should be converted to oral corticosteroids on response, with a tapering period of at least 4 weeks, as recommended by 1.
• In cases of severe cutaneous adverse reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, IV methylprednisolone may be administered at a dose of 1-2 mg/kg, with tapering when toxicity resolves to normal, as suggested by 1.
• It is essential to consider the potential for immune-related adverse events when using IV Solumedrol, particularly in patients treated with immune checkpoint inhibitor therapy, as discussed in the guidelines by 1.

From the FDA Drug Label

This preparation may be administered by intravenous injection, by intravenous infusion, or by intramuscular injection, the preferred method for initial emergency use being intravenous injection. Methylprednisolone sodium succinate for injection may be administered by intravenous or intramuscular injection or by intravenous infusion, the preferred method for initial emergency use being intravenous injection. To administer by intravenous (or intramuscular) injection, prepare solution as directed. The desired dose may be administered intravenously over a period of several minutes

Yes, Solumedrol (methylprednisolone) can be administered intravenously (IV) 2. The drug label explicitly states that it can be administered by intravenous injection or infusion.

From the Research

Administration of Solumedrol IV

• Solumedrol, also known as methylprednisolone, can be administered intravenously (IV) as indicated in a study published in 1990 3.
• The study compared the use of methylprednisolone pulse therapy (1 g of methylprednisolone intravenously) with a short course of oral prednisolone in patients with acute severe asthma.
• The results showed that both treatments were effective in relieving the acute attack of asthma, although the IV methylprednisolone group did not show a faster resolution than the orally treated group.

Safety and Efficacy

• A pilot study published in 2019 evaluated the safety of a single intramuscular methylprednisolone injection at the time of discharge as a replacement for oral steroid therapy for patients with asthma or chronic obstructive pulmonary disease (COPD) 4.
• The study found that a single dose of methylprednisolone injection was safe and effective, with no unscheduled emergency room visits reported at one month follow-up.
• However, another study published in 2011 reported a case of acute urticaria caused by oral methylprednisolone in a patient with aspirin-exacerbated respiratory disease (AERD) 5.

Clinical Pharmacology of Corticosteroids

• A review published in 2018 discussed the clinical pharmacology of corticosteroids, including their anti-inflammatory and immunosuppressive effects 6.
• The review noted that corticosteroids can cause numerous adverse effects associated with an excess of glucocorticoid activity, and that dosing strategies are designed to minimize the risk for hypothalamic-pituitary-adrenal axis suppression.
• The review also highlighted the importance of inhaled corticosteroids in the treatment of asthma and COPD, and their potential for systemic effects based on several factors that influence systemic bioavailability.