From the FDA Drug Label
When high dose therapy is desired, the recommended dose of methylprednisolone sodium succinate for injection is 30 mg/kg administered intravenously over at least 30 minutes. This dose may be repeated every 4 to 6 hours for 48 hours.
The recommended dose of methylprednisolone (Solumedrol) for autoimmune encephalitis is 30 mg/kg administered intravenously over at least 30 minutes, which may be repeated every 4 to 6 hours for 48 hours 1.
From the Research
Methylprednisolone (Solumedrol) for autoimmune encephalitis is typically administered at a dose of 1 gram (1000 mg) intravenously daily for 3-5 days. This high-dose pulse therapy is usually the first-line immunotherapy for autoimmune encephalitis, often initiated after diagnosis is suspected and appropriate samples are collected 2. Following the IV pulse therapy, patients are generally transitioned to oral prednisone at 1 mg/kg/day (maximum 60-80 mg daily), which is then gradually tapered over 2-6 months depending on clinical response. The high-dose steroid therapy works by rapidly suppressing the inflammatory response and reducing immune-mediated damage to neuronal tissues.
Some key points to consider when administering Solumedrol for autoimmune encephalitis include:
- Patients should receive gastric protection (such as a proton pump inhibitor) during treatment and be monitored for common steroid side effects including hyperglycemia, hypertension, mood changes, and increased infection risk 3.
- Blood glucose levels should be checked regularly during the IV treatment phase.
- In cases with inadequate response to steroids, additional immunotherapies such as IVIG, plasma exchange, or rituximab may be considered as part of the treatment regimen 4, 2.
- Early clinical suspicion is key, as the outcome depends on early initiation of immunotherapy, including corticosteroids, intravenous immunoglobulin, and/or plasmapheresis 2.
It's worth noting that while the provided evidence does not explicitly state the optimal dose of Solumedrol, the most recent and highest quality study 2 supports the use of high-dose pulse therapy as the first-line treatment for autoimmune encephalitis. Therefore, the recommended dose of 1 gram (1000 mg) intravenously daily for 3-5 days is based on this study and general clinical practice.