Medrol Dose Pack Prescription Instructions
The standard Medrol dose pack contains 21 tablets of 4 mg methylprednisolone each (84 mg total), administered over 6 days with a tapering schedule: Day 1 take 6 tablets (24 mg), Day 2 take 5 tablets (20 mg), Day 3 take 4 tablets (16 mg), Day 4 take 3 tablets (12 mg), Day 5 take 2 tablets (8 mg), and Day 6 take 1 tablet (4 mg). 1, 2
Standard Prescription Format
Write the prescription as follows:
- Medication: Methylprednisolone 4 mg tablets (Medrol Dose Pack)
- Quantity: 21 tablets
- Directions: "Take 6 tablets by mouth on Day 1, then 5 tablets on Day 2, then 4 tablets on Day 3, then 3 tablets on Day 4, then 2 tablets on Day 5, then 1 tablet on Day 6. Take all tablets in the morning with food." 1, 2
Critical Dosing Limitations to Consider
Before prescribing the standard dose pack, recognize that it provides only 84 mg total methylprednisolone (approximately 105 mg prednisone equivalent), which is often inadequate for many inflammatory conditions. 1, 3
When the Dose Pack is Insufficient:
For conditions requiring robust anti-inflammatory effect (such as asthma exacerbations, severe allergic reactions, or inflammatory conditions):
- Guidelines recommend the equivalent of prednisone 40-80 mg/day for 5-10 days in adults, which translates to methylprednisolone 32-64 mg daily. 1, 3
- For a 60 kg adult requiring 1 mg/kg/day dosing, this equals approximately 48 mg methylprednisolone daily—double what the dose pack provides on Day 1. 1, 2
- The dose pack provides only 105 mg prednisone equivalent over 6 days, compared to 300-600 mg total with standard burst therapy. 1
Alternative Prescription for Adequate Dosing:
Instead of the dose pack, prescribe:
- Methylprednisolone 4 mg tablets
- Quantity: 60-80 tablets
- Directions: "Take 8-12 tablets (32-48 mg) by mouth once daily in the morning with food for 5-7 days, then stop." 1, 3
- No taper is needed for courses under 10 days. 3
Administration Recommendations
- Administer as a single daily morning dose rather than divided doses for better compliance and potentially reduced adrenal suppression. 1, 2, 4
- Take with food to minimize gastrointestinal upset. 5
- For courses lasting less than 10 days, no taper is necessary and the medication can be stopped abruptly. 3
Common Pitfalls to Avoid
- Don't assume the dose pack is adequate for serious inflammatory conditions—it was designed for convenience, not optimal therapeutic dosing. 1
- Don't use the dose pack for asthma exacerbations requiring hospitalization or emergency department visits, where methylprednisolone 60-80 mg/day (or equivalent) is recommended. 6, 1
- Don't prescribe divided doses throughout the day—single morning dosing is preferred. 1, 4
Monitoring and Side Effects
Monitor for common adverse effects including:
- Hyperglycemia and elevated blood sugar 2, 3
- Weight gain and increased thirst 2, 3
- Sleep disturbances 2
For patients with high-risk comorbidities (diabetes, osteoporosis, glaucoma, hypertension, cardiovascular disease), consider lower doses and steroid-sparing alternatives rather than repeated courses. 3