How to write a prescription for a Medrol (methylprednisolone) dose pack?

From the Guidelines

To write a prescription for a Medrol Dose Pack (methylprednisolone), include the following information: "Medrol Dose Pack, Dispense #1 pack, Sig: Take as directed per package instructions" is not adequate, as the standard Medrol Dose Pack may not provide sufficient dosage for certain conditions, such as idiopathic sudden sensorineural hearing loss (ISSNHL), where a higher dose of 48 mg/d is recommended 1.

Key Considerations for Prescribing Medrol Dose Pack

• The standard Medrol Dose Pack contains 21 tablets of methylprednisolone in a tapered dosing schedule over 6 days, but this may not be sufficient for all conditions, and the dose may need to be adjusted based on the patient's condition and weight 1.
• For maximal treatment outcomes, recommended treatment doses of oral prednisone are given at 1 mg/kg/d in a single (not divided) dose, with the usual maximum dose of 60 mg daily, and treatment duration of 10 to 14 days 1.
• Methylprednisolone is 5 times more powerful than hydrocortisone, and the equivalent dose of prednisone 60 mg is 48 mg for methylprednisolone 1.
• The prescription should include patient instructions to take with food to reduce gastrointestinal irritation.
• The clinician should ensure that the patient is initially adequately dosed, as early treatment is important, and underdosage is a possibility if attention is not given to these ratios 1.

Example Prescription

• Medrol (methylprednisolone) 48 mg daily for 10-14 days, take with food.
• Alternatively, if using a Medrol Dose Pack, the prescription should be written as: Medrol Dose Pack, Dispense #1 pack, Sig: Take 6 tablets (24 mg) on day 1,5 tablets (20 mg) on day 2, and so on, to achieve a total dose of 48 mg/d.
• However, it's essential to note that the standard Medrol Dose Pack may not provide the required dose, and a custom dose pack or separate tablets may be needed to achieve the desired dosage 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The initial dosage of methylprednisolone tablets may vary from 4 mg to 48 mg of methylprednisolone per day, depending on the specific disease entity being treated. DOSEPAK™ Unit of Use (21 tablets) NDC 59762-4440-2

The prescription for a Medrol (methylprednisolone) dose pack should be written based on the individual patient's disease entity and response to treatment. The dose pack, also known as DOSEPAK™, contains 21 tablets, but the dosage requirements are variable and must be individualized. The initial dosage may vary from 4 mg to 48 mg per day, and the maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached 2.

From the Research

Methylprednisolone Dose Pack Prescription

To write a prescription for a Medrol (methylprednisolone) dose pack, consider the following:

• The dose pack typically contains 21 tablets of 4mg methylprednisolone, 15 tablets of 8mg methylprednisolone, and 13 tablets of 16mg methylprednisolone, or other combinations, to be taken over a period of 6 days, with the dose tapering down over time 3
• The prescription should specify the number of tablets to be taken each day, and the duration of treatment
• The patient should be instructed to take the tablets as directed, and not to stop taking them without consulting a doctor

Dosage Information

Some studies have investigated the use of methylprednisolone in various conditions, including:

• Rheumatoid arthritis: a dose of 1g intravenous methylprednisolone was administered on alternate days for 3 days, followed by a tapering dose of oral methylprednisolone 4
• Acute hepatic cellular rejection: a dose of 1,000mg intravenous methylprednisolone was administered, followed by a 6-day taper from 200 to 20mg/day 3
• COVID-19 pneumonia: a dose of 40mg bid intravenous methylprednisolone was administered for 3 days, followed by 20mg bid for 3 days 5

Administration Route

Methylprednisolone can be administered orally or intravenously, depending on the condition being treated and the severity of the disease:

• Oral administration: may be used for outpatient treatment of conditions such as rheumatoid arthritis 6
• Intravenous administration: may be used for more severe conditions, such as acute hepatic cellular rejection or COVID-19 pneumonia 3, 5