How to Order a Medrol Dose Pack
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 (6 tablets), Day 2 = 20 mg (5 tablets), Day 3 = 16 mg (4 tablets), Day 4 = 12 mg (3 tablets), Day 5 = 8 mg (2 tablets), Day 6 = 4 mg (1 tablet). 1, 2, 3
Standard Ordering Information
- Write the prescription as: "Methylprednisolone 4 mg DOSEPAK™ (21 tablets), take as directed on package" 3
- The dose pack is available as NDC 59762-4440-2 (Unit of Use containing 21 tablets) 3
- Administer as a single morning dose or divided throughout the day 2
Critical Dosing Limitations
The standard Medrol dose pack delivers only 84 mg total methylprednisolone (equivalent to approximately 105 mg prednisone) over 6 days, which is substantially underdosed for many inflammatory conditions requiring full therapeutic effect. 1, 2
- For optimal anti-inflammatory response, therapeutic dosing typically requires prednisone equivalent of 1 mg/kg/day (maximum 60 mg daily), translating to approximately 48 mg methylprednisolone daily for a 60 kg adult 1, 4
- The dose pack provides only 105 mg prednisone equivalent over 6 days compared to 540 mg prednisone equivalent over 14 days for full therapeutic dosing in a 60 kg adult 1, 4
- For conditions like sudden sensorineural hearing loss, guidelines recommend methylprednisolone 48 mg/day for 7-14 days followed by taper—significantly higher than the dose pack regimen 1
Timing Between Courses
- Wait at least 1-2 weeks after completing a standard 6-day dose pack before administering another oral or injectable corticosteroid course 2, 4
- For patients with diabetes, hypertension, osteoporosis, or glaucoma, extend the waiting period to 3-4 weeks due to higher risk of cumulative steroid complications 2, 4
Mandatory Concurrent Prescriptions
- Prescribe calcium and vitamin D supplementation concurrently with all corticosteroid therapy 2, 4
- Perform bone DEXA scanning at 1-2 year intervals while on steroids 2, 4
- Actively treat osteopenia and osteoporosis when identified 2, 4
Monitoring Requirements
- Monitor for hyperglycemia, hypertension, and fluid retention during and after treatment 2, 4
- Common adverse effects include elevated blood sugar, increased thirst, sleep disturbances, and weight gain 1, 2
- In one survey of sports medicine physicians, glucose intolerance was the most frequent complication (37% of prescribers reported this) 5
Common Pitfalls to Avoid
- Do not assume the standard dose pack provides adequate dosing for moderate-to-severe inflammatory conditions—it may be insufficient 1, 2
- Do not prescribe repeated courses without appropriate waiting periods—this increases cumulative steroid exposure and complications 2, 4
- Do not forget bone protection measures—calcium and vitamin D should be prescribed with every corticosteroid course 2, 4