How to administer Solumedrol (methylprednisolone) 40 mg in powder form?

How to Administer Solumedrol (Methylprednisolone) 40 mg Powder Form

Reconstitute the 40 mg powder vial with Bacteriostatic Water for Injection containing benzyl alcohol, then administer intravenously over several minutes or by intramuscular injection. 1

Reconstitution Instructions

• Use only Bacteriostatic Water for Injection with Benzyl Alcohol when reconstituting methylprednisolone sodium succinate 40 mg powder 1
• The 40 mg single-dose vial, when properly mixed, provides a concentration of 40 mg methylprednisolone per mL 1
• After reconstitution, the solution must be used within 48 hours 1
• Inspect the reconstituted solution visually for particulate matter and discoloration before administration 1

Administration Routes (in order of preference)

Intravenous injection is the preferred method for initial emergency use, followed by intravenous infusion or intramuscular injection 1

Intravenous Injection (Preferred for Emergency)

• Administer the desired dose intravenously over a period of several minutes 1
• Critical safety warning: Cardiac arrhythmias and/or cardiac arrest have been reported following rapid administration of large IV doses (>0.5 gram over <10 minutes) 1
• For the 40 mg dose, this safety concern is less relevant, but still administer over several minutes rather than as a rapid bolus 1

Intravenous Infusion (Alternative)

• After reconstituting as directed, the solution may be further diluted by adding it to 5% dextrose in water, isotonic saline solution, or 5% dextrose in isotonic saline solution 1
• The diluted product should be used immediately, or stored below 25°C for up to 4 hours, or at 2-8°C for up to 24 hours 1

Intramuscular Injection (Alternative)

• The reconstituted solution may be administered by intramuscular injection if IV access is not available 1

Dosing Context for 40 mg

• The 40 mg dose falls within the initial dosage range of 10-40 mg for various disease entities 1
• For adrenal insufficiency specifically, the recommended dose is 2-3 mg/kg (maximum 100 mg) over 3-5 minutes, followed by maintenance dosing 2
• Dosage requirements are variable and must be individualized based on the disease being treated and patient response 1

Important Safety Considerations

• Never administer methylprednisolone acetate (Depo-Medrol) intrathecally or epidurally - this formulation contains polyethylene glycol and other excipients that are neurotoxic when injected near the neuraxis 3, 4
• The sodium succinate formulation (Solu-Medrol) is the appropriate form for IV/IM administration and is free from the neurotoxic excipients found in depot formulations 3
• Monitor for bradycardia during or after administration of large doses 1
• If administering high-dose therapy (30 mg/kg), infuse over at least 30 minutes and continue only until patient stabilization (usually not beyond 48-72 hours) 1