Medrol Dose Pack Dosing Instructions
The standard Medrol Dose Pack provides 21 tablets of 4 mg methylprednisolone each (84 mg total), administered over 6 days with a tapering schedule: Day 1 takes 6 tablets (24 mg), Day 2 takes 5 tablets (20 mg), Day 3 takes 4 tablets (16 mg), Day 4 takes 3 tablets (12 mg), Day 5 takes 2 tablets (8 mg), and Day 6 takes 1 tablet (4 mg), with tablets divided throughout each day (typically at breakfast, lunch, dinner, and bedtime). 1, 2, 3
Standard Administration Schedule
The FDA-approved dosing pattern distributes tablets throughout each day as follows: 4
- Day 1 (24 mg): 2 tablets before breakfast, 1 after lunch, 1 after dinner, 2 at bedtime
- Day 2 (20 mg): 1 tablet before breakfast, 1 after lunch, 1 after dinner, 2 at bedtime
- Day 3 (16 mg): 1 tablet before breakfast, 1 after lunch, 1 after dinner, 1 at bedtime
- Day 4 (12 mg): 1 tablet before breakfast, 1 after lunch, 1 at bedtime
- Day 5 (8 mg): 1 tablet before breakfast, 1 at bedtime
- Day 6 (4 mg): 1 tablet before breakfast 1, 3
Important Clinical Considerations
The standard Medrol Dose Pack is frequently underdosed for many inflammatory conditions. The pack provides only 84 mg methylprednisolone (equivalent to approximately 105 mg prednisone) over 6 days, whereas optimal anti-inflammatory dosing for moderate-to-severe conditions typically requires 1 mg/kg/day prednisone equivalent (48 mg methylprednisolone daily for a 60 kg adult), totaling 540 mg prednisone equivalent over 14 days. 1, 2
For specific conditions requiring higher doses: 5, 3
- Immune checkpoint inhibitor colitis (Grade 2-3): Requires prednisone 1-2 mg/kg/day or equivalent methylprednisolone, far exceeding the dose pack 5
- Severe polyarteritis nodosa: Requires high-dose glucocorticoids at 1 mg/kg/day prednisone equivalent 5
- Sudden sensorineural hearing loss: Guidelines recommend 48 mg/day methylprednisolone for 7-14 days followed by taper 2
Monitoring and Side Effects
Common adverse effects to monitor include: 2, 3
- Hyperglycemia (most frequent complication) - diabetic patients must monitor blood glucose more frequently 3
- Sleep disturbances - particularly when evening doses are taken 1
- Increased appetite and weight gain 3
- Facial flushing and increased thirst 3
Serious but rare complications: 1, 6
- Adrenal suppression (rare with 6-day course) 1
- Osteonecrosis (primarily reported with repeated courses, most commonly affecting the hip) 6
- Increased infection risk 1
Critical Warnings
The short 6-day duration minimizes risk of serious chronic steroid complications, but the dose pack should not be used for maintenance therapy in chronic inflammatory conditions. 3 If long-term corticosteroid therapy beyond 6 days is required, transition to individualized dosing with appropriate bone protection (calcium and vitamin D supplementation). 3
For conditions requiring more aggressive treatment, prescribe higher-dose methylprednisolone (40-60 mg daily) or prednisone (1 mg/kg/day) with appropriate taper duration rather than relying on the standard dose pack. 5, 2, 3