How do I order a Medrol (methylprednisolone) pack?

Medrol Dose Pack Ordering and Administration

The standard Medrol Dose Pack contains 21 tablets of 4 mg methylprednisolone each, administered over 6 days with a tapering schedule: Day 1 (24 mg), Day 2 (20 mg), Day 3 (16 mg), Day 4 (12 mg), Day 5 (8 mg), and Day 6 (4 mg), taken as divided doses throughout each day. 1, 2

Standard Prescription Details

• The FDA-approved formulation is available as a DOSEPAK™ Unit of Use containing 21 tablets (NDC 59762-4440-2), with each tablet containing 4 mg methylprednisolone 3
• The pack provides a total of 84 mg methylprednisolone over 6 days, equivalent to approximately 105 mg of prednisone 1, 2
• Tablets should be stored at controlled room temperature 20° to 25°C (68° to 77°F) 3

Dosing Schedule

• Day 1: 24 mg (6 tablets) - typically divided as 2 tablets before breakfast, 1 after lunch, 1 after dinner, and 2 at bedtime 2
• Day 2: 20 mg (5 tablets) - divided throughout the day
• Day 3: 16 mg (4 tablets) - divided throughout the day 2
• Day 4: 12 mg (3 tablets) - divided throughout the day 2
• Day 5: 8 mg (2 tablets) - divided throughout the day
• Day 6: 4 mg (1 tablet) - single dose

Critical Clinical Limitations

The standard Medrol Dose Pack is frequently underdosed for many inflammatory conditions and should not be reflexively ordered without considering whether higher doses are clinically indicated. 1, 2

• Maximum therapeutic effect in severe inflammatory conditions often requires prednisone equivalent of 1 mg/kg/day (usual maximum 60 mg daily), which significantly exceeds the dose pack's provision 1, 2
• For a 60 kg adult requiring full therapeutic dosing, this would equate to approximately 48 mg methylprednisolone daily - the dose pack provides only 24 mg on Day 1 and rapidly tapers thereafter 2
• Specific conditions requiring higher doses include: 40-60 mg methylprednisolone daily for moderate to severe Crohn's disease, 40-80 mg daily for severe asthma exacerbations, and 1-2 mg/kg prednisone equivalent daily for immune checkpoint inhibitor toxicity 1

Patient Monitoring Requirements

• Hyperglycemia is the most common adverse effect - patients with diabetes must monitor blood glucose more frequently during treatment 1
• Monitor for elevated blood glucose levels, increased appetite and weight gain, increased thirst, facial flushing, and sleep disturbances 1, 2
• The dose pack should not be used for maintenance therapy in chronic inflammatory conditions, as it is designed only for short-term treatment of acute exacerbations 1

Special Populations

• For patients requiring longer-term steroid therapy beyond the dose pack, initiate calcium and vitamin D supplementation to prevent bone loss, and perform DEXA scanning at 1-2 year intervals 1
• Methylprednisolone is typically administered as a single daily dose rather than divided doses for better compliance and potentially reduced adrenal suppression 2

When to Consider Alternative Dosing

If the clinical scenario requires more aggressive steroid therapy, prescribe individual methylprednisolone tablets at appropriate doses rather than defaulting to the pre-packaged dose pack. 1, 2

• For severe asthma exacerbations, consider 125 mg methylprednisolone IV every 6 hours for 72 hours, then oral prednisone 40 mg for 7 days 4
• For conditions like sudden sensorineural hearing loss, guidelines recommend methylprednisolone at 48 mg/day for 7-14 days followed by a taper 2