Intramuscular Solumedrol Dosing for Adults
For intramuscular administration of Solumedrol (methylprednisolone acetate) in adults, the typical dose ranges from 40 to 120 mg, with the specific dose depending on the clinical indication and severity of the condition being treated. 1
Standard Dosing Guidelines
The FDA-approved dosing for intramuscular methylprednisolone acetate varies by indication 1:
- Rheumatoid arthritis maintenance: 40 to 120 mg weekly 1
- Dermatologic conditions: 40 to 120 mg weekly for 1 to 4 weeks 1
- Acute severe dermatitis (poison ivy): Single dose of 80 to 120 mg 1
- Chronic contact dermatitis: Repeated injections of 40 to 120 mg at 5 to 10 day intervals 1
- Asthma/allergic conditions: 80 to 120 mg as a single dose 1
- Adrenogenital syndrome: 40 mg every two weeks 1
Clinical Context from Guidelines
Polymyalgia rheumatica: 120 mg intramuscular methylprednisolone every 3 weeks has been used as an alternative to oral glucocorticoids, with subsequent dose reductions over time 2
Acute low back pain: A single 160 mg intramuscular injection of methylprednisolone has been studied, though evidence shows no significant benefit over placebo 2
Rheumatoid arthritis induction: 120 mg intramuscular depot methylprednisolone at weeks 0,4, and 8 has been used successfully when initiating gold therapy 2, 3
Important Clinical Considerations
Avoid blanching during injection: Care must be taken to avoid injecting sufficient material to cause blanching, as this may result in tissue slough 1
Adrenal suppression risk: Even single low-dose (40 mg) intramuscular injections can significantly suppress serum cortisol levels for 24-72 hours, with some patients dropping below normal range 4
Bioavailability: Intramuscular methylprednisolone sodium phosphate produces approximately 20% higher plasma levels compared to methylprednisolone sodium succinate, though clinical effects are equivalent 5
Dosing frequency: When used as a temporary substitute for oral therapy, a single injection during each 24-hour period equal to the total daily oral dose is usually sufficient 1. For prolonged effect, the weekly dose may be calculated by multiplying the daily oral dose by 7 and given as a single intramuscular injection 1
Dose Equivalency Reference
For comparison purposes, 4 mg of methylprednisolone is equivalent to 1:
- 5 mg prednisone or prednisolone
- 20 mg hydrocortisone
- 0.75 mg dexamethasone or betamethasone
Note: These relationships apply primarily to oral or intravenous administration; relative properties may be greatly altered with intramuscular or intra-articular injection 1