What are the side effects of Solu-medrol (Methylprednisolone)?

From the Guidelines

Solu-Medrol can cause several serious side effects, including hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation or ulcer formation, glaucoma, myopathy, and osteoporosis, which necessitate close monitoring by the treating physician 1.

Common Side Effects

• Increased appetite
• Weight gain
• Fluid retention
• Mood changes (irritability, anxiety, euphoria)
• Insomnia
• Increased blood sugar
• Digestive issues like heartburn or nausea

Serious Side Effects

• Increased risk of infections
• High blood pressure
• Osteoporosis
• Muscle weakness
• Cataracts
• Glaucoma
• Adrenal suppression
• Facial swelling (moon face)
• Acne
• Easy bruising
• Delayed wound healing

Rare but Severe Side Effects

• Severe allergic reactions

Management and Prevention

• Patients should be closely monitored for potential corticosteroid side effects regardless of the duration or type of corticosteroid selected 1.
• The treating physician should assess health-related quality of life (HRQoL) while patients are receiving corticosteroids, including depression, fatigue, mental status, etc. 1.
• Patients should never stop taking Solu-Medrol suddenly, as this can cause withdrawal symptoms; instead, the medication should be tapered gradually under medical supervision.
• Anyone experiencing severe side effects like vision changes, unusual swelling, severe abdominal pain, or signs of infection should contact their healthcare provider immediately.
• Taking the medication with food and following prescribed dosing schedules can help minimize some side effects.

From the FDA Drug Label

The following adverse reactions have been reported with methylprednisolone sodium succinate or other corticosteroids: Allergic reactions: Allergic or hypersensitivity reactions, anaphylactoid reaction, anaphylaxis, angioedema. Blood and lymphatic system disorders: Leukocytosis Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis Dermatologic: Acne, allergic dermatitis, burning or tingling (especially in the perineal area after intravenous injection), cutaneous and subcutaneous atrophy, dry scaly skin, ecchymoses and petechiae, edema, erythema, hyperpigmentation, hypopigmentation, impaired wound healing, increased sweating, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients. Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention Gastrointestinal: Abdominal distention, bowel/bladder dysfunction (after intrathecal administration), elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis. Hepatobiliary: Hepatitis (see WARNINGS, Drug-Induced Liver Injury). Metabolic: Negative nitrogen balance due to protein catabolism Musculoskeletal: Aseptic necrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, postinjection flare (following intra-articular use), steroid myopathy, tendon rupture, vertebral compression fractures Neurologic/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation of treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychic disorders, vertigo Arachnoiditis, meningitis, paraparesis/paraplegia, and sensory disturbances have occurred after intrathecal administration (see WARNINGS, Neurologic). Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, rare instances of blindness associated with periocular injections Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, injection site infections following non-sterile administration (see WARNINGS), malaise, moon face, weight gain.

The side effects of Solu-medrol (methylprednisolone) include:

• Allergic reactions: anaphylaxis, angioedema
• Cardiovascular: bradycardia, cardiac arrest, congestive heart failure
• Dermatologic: acne, impaired wound healing, thin fragile skin
• Endocrine: decreased carbohydrate tolerance, development of cushingoid state
• Gastrointestinal: abdominal distention, nausea, pancreatitis
• Musculoskeletal: aseptic necrosis of femoral and humeral heads, osteoporosis
• Neurologic/Psychiatric: convulsions, depression, increased intracranial pressure
• Other: abnormal fat deposits, decreased resistance to infection, weight gain 2

From the Research

Solu-medrol Side Effects

• The studies provided do not directly address the side effects of Solu-medrol, but rather the efficacy and safety of methylprednisolone, which is the active ingredient in Solu-medrol, for various conditions such as Graves' ophthalmopathy and optic neuritis 3, 4, 5, 6, 7.
• According to the study by 3, major adverse events were slightly more frequent using the highest dose of methylprednisolone, but occurred also using the lowest dose.
• The study by 4 found that intravenous glucocorticoids (IVGC) resulted in an obvious reduction of clinical activity score (CAS) compared with oral glucocorticoids (OGC), with a weighted mean difference (WMD) of 0.86, and caused fewer adverse events.
• The review by 5 showed that oral methylprednisolone has a non-inferior efficacy and adverse effect profile in comparison to intravenous methylprednisolone for the treatment of acute optic neuritis.
• The study by 6 found that rapid administration of high-dose intravenous methylprednisolone improved visual outcomes after optic neuritis in patients with AQP4-IgG-positive NMOSD, but did not report on specific side effects.
• The study by 7 compared intravenous methylprednisolone therapy with oral methylprednisolone therapy in patients with Graves' ophthalmopathy and found that intravenous therapy was more effective and better tolerated, but did not provide a detailed list of side effects.

Common Side Effects

• Although the studies do not provide a comprehensive list of side effects, they suggest that methylprednisolone can cause adverse events, particularly at higher doses 3, 4.
• The specific side effects of Solu-medrol are not addressed in the provided studies, but it is known that corticosteroids like methylprednisolone can cause a range of side effects, including weight gain, mood changes, and increased risk of infections 3, 4, 5, 6, 7.