From the FDA Drug Label
In treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of methylprednisolone for a week followed by 64 mg every other day for 1 month have been shown to be effective
The recommended dose of Solumedrol (methylprednisolone) for an acute Multiple Sclerosis (MS) flare-up is 160 mg daily for a week, followed by 64 mg every other day for 1 month 1.
From the Research
The recommended dose of Solumedrol (methylprednisolone) for an acute Multiple Sclerosis flare-up in the Emergency Department is typically 1,000 mg administered intravenously daily for 3-5 days, as supported by the most recent and highest quality study 2. This high-dose steroid therapy should be given as an infusion over at least 30-60 minutes to minimize side effects. The medication is usually diluted in 100-250 mL of normal saline or D5W. Some key points to consider when administering Solumedrol for an acute MS flare-up include:
- Monitoring for common side effects such as elevated blood glucose, insomnia, mood changes, increased appetite, and metallic taste
- Providing gastrointestinal prophylaxis with a proton pump inhibitor or H2 blocker during treatment
- Considering an oral prednisone taper after the IV course is completed, although this is not always necessary
- Being aware of the potential for cardiac arrhythmias, particularly in patients with a history of smoking or autonomic disturbances 3 The goal of this high-dose corticosteroid therapy is to reduce inflammation and suppress immune responses in the central nervous system, which helps to shorten the duration and severity of MS exacerbations by decreasing edema and stabilizing the blood-brain barrier. It's also worth noting that oral methylprednisolone may be a viable alternative to intravenous administration, with studies suggesting that oral doses of 1250 mg/day for 3 days may be effective in treating MS relapses 4. However, the most recent and highest quality study 2 supports the use of high-dose intravenous methylprednisolone.