What is the dose of methylprednisolone?

Methylprednisolone Dosing Guidelines

The dose of methylprednisolone varies by indication, route of administration, and severity of condition, with intravenous doses typically ranging from 1-2 mg/kg every 12 hours for moderate conditions to 1000 mg daily for 3-5 days for severe conditions.

Intravenous Methylprednisolone Dosing

Standard Dosing

• For most indications, initial IV dosage ranges from 10-40 mg depending on the specific disease entity being treated 1
• When high-dose therapy is desired, the recommended dose is 30 mg/kg administered intravenously over at least 30 minutes, which may be repeated every 4-6 hours for 48 hours 1
• For moderate conditions (e.g., grade 3 neurotoxicity), methylprednisolone 1 mg/kg IV every 12 hours is recommended 2

High-Dose/Pulse Therapy

• For severe conditions (e.g., grade 4 neurotoxicity), high-dose methylprednisolone at 1000 mg/day for 3-5 days is recommended, followed by a rapid taper 2
• For autoimmune conditions requiring pulse therapy, IV methylprednisolone is typically administered as 250-1000 mg daily for 1-3 days 3
• For lupus nephritis, IV methylprednisolone is administered as 500-2500 mg total dose depending on disease severity 3
• For acute severe ulcerative colitis, methylprednisolone 60 mg daily IV is recommended 2

Pediatric Dosing

• In pediatric patients, the initial dose ranges from 0.11-1.6 mg/kg/day in three or four divided doses (3.2-48 mg/m² BSA/day) 1
• For specific conditions like Kawasaki disease, IV methylprednisolone is administered at 30 mg/kg daily for 3 consecutive days 3
• For multisystem inflammatory syndrome in children (MIS-C), IV methylprednisolone 1-2 mg/kg/day is recommended as first-line therapy, with intensification to 10-30 mg/kg/day if needed 2

Administration Considerations

Duration of Treatment

• In general, high-dose corticosteroid therapy should be continued only until the patient's condition has stabilized, usually not beyond 48-72 hours 1
• For acute spinal cord injury, patients who receive methylprednisolone within 3 hours of injury should be maintained on treatment for 24 hours, while those who start treatment 3-8 hours after injury should continue for 48 hours 4

Administration Rate

• Rapid administration of large IV doses (>0.5 gram over <10 minutes) has been associated with cardiac arrhythmias and cardiac arrest 1
• High-dose methylprednisolone should be administered over at least 30 minutes 1

Route Conversion

• Methylprednisolone is approximately 1.25 times more potent than prednisone 3
• After IV pulse therapy is completed, transition to oral prednisone (0.3-0.5 mg/kg/day) is recommended for maintenance therapy 3

Special Considerations

• Dosage requirements are variable and must be individualized based on the disease being treated and the patient's response 1
• Monitor for potential adverse effects including hyperglycemia, hypertension, and mood disturbances when administering high-dose IV methylprednisolone 3
• Antifungal prophylaxis should be strongly considered in patients receiving steroids for treatment of conditions like CRS or neurotoxicity 2
• For pemphigus vulgaris, pulsed IV methylprednisolone (250-1000 mg per day for 2-5 days) has been shown to result in increased complete remission rates and lower mean maintenance oral corticosteroid doses in recalcitrant cases 2