What is the recommended dosage of Medrol Pak (methylprednisolone) and number of puffs for Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol) for a patient with a respiratory condition, such as Chronic Obstructive Pulmonary Disease (COPD) or asthma?

Medrol Pak and Trelegy Ellipta Dosing

For Medrol Pak (methylprednisolone), the standard dose pack contains 21 tablets of 4 mg each, taken over 6 days with a tapering schedule (6 tablets day 1,5 tablets day 2,4 tablets day 3 tablets day 4,2 tablets day 5,1 tablet day 6), and for Trelegy Ellipta, the correct dose is ONE puff once daily—never more. 1, 2, 3

Medrol Pak (Methylprednisolone) Dosing

The standard Medrol Dose Pack provides a pre-packaged tapering regimen:

• Total duration: 6 days
• Tablet strength: 4 mg per tablet
• Tapering schedule: Starting with 6 tablets on day 1, decreasing by one tablet each subsequent day until completion 1

For respiratory exacerbations requiring longer courses, alternative dosing exists:

• Acute exacerbations: 60-80 mg/day for 3-10 days (equivalent to 15-20 tablets of 4 mg daily) 1
• Severe cases: 120-180 mg/day in 3-4 divided doses for 48 hours, then 60-80 mg/day until recovery 1

Critical caveat: The standard 6-day Medrol Pak may be insufficient for moderate-to-severe COPD or asthma exacerbations, where 3-10 days of therapy at higher doses is typically needed. 1

Trelegy Ellipta Dosing

Trelegy Ellipta is administered as ONE inhalation once daily—this is non-negotiable. 2, 3, 4

Key dosing points:

• Dose: ONE puff of 100/62.5/25 mcg (fluticasone furoate/umeclidinium/vilanterol) once daily 3, 4
• Timing: Same time each day, typically morning 4
• Device: ELLIPTA dry powder inhaler delivers a single pre-metered dose per actuation 2

Common pitfall to avoid: Unlike some inhalers that require multiple puffs, Trelegy Ellipta is designed as a single-inhalation device. The ELLIPTA contains only one dose per blister, making it impossible to accidentally take multiple puffs from the same dose. 2, 4

Clinical Context for These Medications

For COPD patients with FEV1 <60% predicted:

• Inhaled bronchodilators (like those in Trelegy) are strongly recommended as first-line maintenance therapy 1
• Triple therapy (ICS/LABA/LAMA combination like Trelegy) is appropriate for symptomatic patients with frequent exacerbations 3, 5
• Systemic corticosteroids (like Medrol Pak) are reserved for acute exacerbations, not maintenance therapy 1

For acute exacerbations requiring systemic steroids:

• The standard 6-day Medrol Pak provides only 24 mg total methylprednisolone equivalent on day 1, which may be subtherapeutic
• Guidelines recommend 60-80 mg methylprednisolone daily for 3-10 days for exacerbations 1
• Consider prescribing individual methylprednisolone tablets rather than the pre-packaged dose pack for adequate dosing in moderate-to-severe exacerbations

Device Technique Considerations

For Trelegy Ellipta:

• The ELLIPTA device has proven superior ease of use compared to metered-dose inhalers, with only 10-40% of patients making technique errors versus 76% with MDIs 1, 2
• Single daily dosing improves adherence compared to multiple-daily-dose regimens 2, 3
• The device delivers consistent doses across a range of inspiratory flow rates, making it suitable for patients with severe airflow limitation 2

Verify inhaler technique at every visit—improper technique is the most common cause of apparent treatment failure with any inhaled medication. 1