Historical Use of Intramuscular Methylprednisolone in the 1960s
Yes, methylprednisolone acetate (Depo-Medrol) was administered intramuscularly beginning in 1960, initially for intraspinal (epidural and intrathecal) injections to treat disk disease and multiple sclerosis, though the intramuscular route itself was part of the broader clinical introduction of this formulation during that decade. 1, 2
Timeline of Methylprednisolone Acetate Introduction
Clinical trials with methylprednisolone acetate (Depo-Medrol) first began in 1960, when it was initially administered via the epidural route to treat low-back syndromes. 1, 2
By 1961, the intrathecal route became more widely used to treat arachnoiditis and multiple sclerosis, expanding the clinical applications of this depot formulation. 2
The formulation itself—methylprednisolone acetate suspended with polyethylene glycol as a vehicle—was designed as a depot preparation that could be administered by various parenteral routes, including intramuscular injection, to provide sustained corticosteroid release. 1, 3
Formulation Characteristics Relevant to 1960s Use
Methylprednisolone acetate contains approximately 30 mg of polyethylene glycol per milliliter, which serves as both a solvent and preservative in the depot formulation. This excipient was present from the original 1960s formulation. 1, 3
The depot nature of the acetate ester allows for prolonged release after intramuscular injection, distinguishing it from the water-soluble methylprednisolone sodium succinate formulation that was developed for intravenous use. 3
Evolution of Clinical Practice
Epidural steroid therapy came back into general use in 1980 for treating failed-back syndrome, after intrathecal therapy was largely abandoned following a decade of scientific controversy over complications. 2
Modern guidelines now recommend intramuscular methylprednisolone (typically the sodium succinate formulation rather than the acetate depot) at doses of 0.5–2.0 mg/kg for acute conditions like gout flares, particularly in NPO patients. 4, 5
Intramuscular triamcinolone acetonide 60 mg has become the specifically recommended depot corticosteroid for acute gout in contemporary practice, rather than methylprednisolone acetate. 4, 5
Important Historical Context
For ten years prior to 1960, basic scientists had already published warnings about the risks of using polyethylene glycol-containing preparations near the central nervous system, noting that this glycol acts as both an alcohol and detergent that can cause sterile meningitis, arachnoiditis, or pachymeningitis when injected intraspinally. 1
The intraspinal use of methylprednisolone acetate generated heated scientific controversy from 1960 through the 1980s, with reports of both efficacy and serious complications emerging throughout this period. 1, 2, 3