Methylprednisolone (Solumedrol) Dosing for Wheezing
For wheezing, methylprednisolone should be administered at 40-60 mg/day as a single or 2 divided doses for 3-10 days in adults, or 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days in children. 1
Dosing Recommendations by Age Group
Adults
- Initial dosing: 40-60 mg daily (single or divided doses)
- Duration: 3-10 days
- Administration route: Oral or intravenous
Children
- Initial dosing: 1-2 mg/kg/day (maximum 60 mg/day)
- Duration: 3-10 days
- Administration route: Oral or intravenous
Intravenous Administration Guidelines
When administering methylprednisolone intravenously:
- For emergency use, the preferred method is intravenous injection
- For high-dose therapy, administer 30 mg/kg IV over at least 30 minutes
- This dose may be repeated every 4-6 hours for up to 48 hours
- High-dose therapy should generally not continue beyond 48-72 hours 2
Special Considerations
Asthma Exacerbations
- For acute asthma exacerbations requiring hospitalization, use methylprednisolone 30 mg every 12 hours intravenously 1
- Upon discharge, switch to oral prednisolone 30 mg daily for 1-3 weeks 1
- The National Heart, Lung, and Blood Institute recommends 1-2 mg/kg/day in pediatric patients with uncontrolled asthma 2
Administration Precautions
- Avoid rapid administration of large doses (>0.5g over <10 minutes) due to risk of cardiac arrhythmias 2
- Monitor for side effects, including:
- Short-term: behavioral changes, gastrointestinal upset, sleep disturbances
- Long-term (with repeated courses): growth suppression, adrenal suppression, decreased bone mineral density 1
Monitoring and Follow-up
- Measure peak expiratory flow 15-30 minutes after starting treatment
- Monitor vital signs, blood glucose, blood pressure, and electrolytes
- Arrange follow-up within 1-2 weeks of an exacerbation to assess recovery 1
Discharge Planning
- Patients should be on discharge medication for 24 hours before leaving
- PEF should be >75% of predicted or personal best
- Treatment plan should include bronchodilators and inhaled steroids
- Follow-up should be arranged within 1 week 1
While some clinicians use higher doses based on clinical experience (66% of pediatric intensivists use 4 mg/kg/day) 3, the evidence-based recommendation remains 1-2 mg/kg/day for children and 40-60 mg/day for adults with moderate to severe wheezing, particularly in asthma exacerbations.