What are the uses of methylprednisolone (corticosteroid)?

Methylprednisolone Uses

Methylprednisolone is a systemic corticosteroid indicated for a broad range of inflammatory, autoimmune, allergic, and neoplastic conditions where immunosuppression or anti-inflammatory effects are needed. 1

Primary Indications by Organ System

Respiratory Conditions

• Acute severe asthma exacerbations: IV methylprednisolone 40-60 mg/day (or 125 mg as initial dose, range 40-250 mg) is preferred in severe cases requiring hospitalization, with evaluation for response within 1 week 2
• Chronic asthma management: Oral methylprednisolone 0.25-2 mg/kg daily for children, 7.5-60 mg daily for adults, administered as single morning dose 2
• Short-course burst therapy: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days to establish control during exacerbations 2
• Symptomatic sarcoidosis, berylliosis, Loeffler's syndrome, and aspiration pneumonitis 1

Rheumatologic and Autoimmune Disorders

• Rheumatoid arthritis: Used as adjunctive therapy for acute episodes or exacerbations, including juvenile rheumatoid arthritis 1
• Systemic lupus erythematosus: IV methylprednisolone pulses (up to 3 daily doses of 0.5-1 g each) followed by oral taper for active lupus nephritis (Class III/IV) 2
• Other rheumatic conditions: Ankylosing spondylitis, acute/subacute bursitis, acute gouty arthritis, psoriatic arthritis, post-traumatic osteoarthritis 1
• Systemic dermatomyositis/polymyositis and acute rheumatic carditis during exacerbations 1

Gastrointestinal Diseases

• Crohn's disease: IV methylprednisolone 40-60 mg/day for hospitalized patients with severe disease, with evaluation for response within 1 week 2
• Ulcerative colitis and regional enteritis to manage critical periods 1
• Autoimmune hepatitis: Part of combination therapy regimens 3

Dermatologic Conditions

• Severe skin diseases: Pemphigus (including pulsed IV methylprednisolone 250-1000 mg for 2-5 consecutive days), bullous dermatitis herpetiformis, Stevens-Johnson syndrome, exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis 3, 1

Hematologic Disorders

• Immune thrombocytopenia: High-dose parenteral methylprednisolone for patients failing first-line therapies (response rates ~80%) 3
• Idiopathic thrombocytopenic purpura in adults, secondary thrombocytopenia, acquired hemolytic anemia, erythroblastopenia 1

Allergic Conditions

• Severe or incapacitating allergic states: Seasonal/perennial allergic rhinitis, drug hypersensitivity reactions, serum sickness, contact dermatitis, bronchial asthma, atopic dermatitis when intractable to conventional treatment 1

Ophthalmic Diseases

• Severe inflammatory eye conditions: Allergic corneal marginal ulcers, herpes zoster ophthalmicus, anterior segment inflammation, diffuse posterior uveitis and choroiditis, sympathetic ophthalmia, keratitis, optic neuritis, allergic conjunctivitis, chorioretinitis, iritis and iridocyclitis 1

Endocrine Disorders

• Adrenocortical insufficiency: Primary or secondary (hydrocortisone/cortisone preferred, but methylprednisolone used as synthetic analog with mineralocorticoid supplementation where applicable) 1
• Congenital adrenal hyperplasia, nonsuppurative thyroiditis, hypercalcemia associated with cancer 1

Neurologic Conditions

• Acute multiple sclerosis exacerbations 1
• Tuberculous meningitis with subarachnoid block (with concurrent antituberculous chemotherapy) 1

Critical Care Applications

• Acute respiratory distress syndrome (ARDS): 1 mg/kg/day with slow tapering over 6-14 days for early ARDS; 2 mg/kg/day with slow tapering over 13 days for late persistent ARDS 3
• Acute graft-versus-host disease (GVHD): 0.5-1 mg/kg/day for grade II; 1-2 mg/kg/day for grades III-IV (never exceed 2 mg/kg/day) 2

Oncologic Indications

• Palliative management: Leukemias and lymphomas in adults, acute leukemia of childhood 1

Renal Conditions

• Nephrotic syndrome: To induce diuresis or remission of proteinuria in idiopathic type or lupus-related nephrotic syndrome without uremia 1

Infectious Disease

• Severe leptospirosis: For immunologically-mediated severe disease, with monitoring for hyperglycemia within 36 hours and infection surveillance 4
• Trichinosis with neurologic or myocardial involvement 1

Important Clinical Considerations

Route Selection

• IV route is preferred in severe disease, hospitalized patients, or those unable to tolerate oral medications 2
• Oral administration is equally effective for most conditions and avoids IV-related complications; bioavailability is approximately 69% 5
• IM depot formulations (methylprednisolone acetate 240 mg IM once) may be used when adherence is problematic or in vomiting patients 2

Critical Monitoring

• Hyperglycemia surveillance especially within 36 hours of initial bolus 4, 3
• Infection monitoring as glucocorticoids blunt febrile response 4, 3
• GI prophylaxis with proton pump inhibitors should be considered 4

Duration and Tapering

• Short courses (3-10 days) are effective for acute exacerbations without need for tapering 2
• Longer courses require slow tapering (6-14 days) to avoid inflammatory rebound 3
• Never use for long-term maintenance in asthma or Crohn's disease due to adverse effects without sustained benefit 2

Common Pitfalls

• Do not exceed 2 mg/kg/day in GVHD as higher doses provide no additional benefit 2
• Evaluate response early: within 1 week for severe disease, 2-4 weeks for moderate disease to determine need for therapy modification 2
• Avoid abrupt discontinuation after prolonged use (>2 weeks) due to adrenal suppression risk 2