From the Guidelines
Solu-medrol is contraindicated in patients with systemic fungal infections, hypersensitivity to methylprednisolone, and those receiving live or live-attenuated vaccines, as well as in patients with hepatitis B viral infection, tuberculosis, or other serious infectious diseases, as stated in the guidelines for the management of acute alcoholic hepatitis 1.
Key Contraindications
- Systemic fungal infections: Solu-medrol can worsen the infection by suppressing immune function.
- Hypersensitivity to methylprednisolone or any components of the formulation: Risk of allergic reactions.
- Live or live-attenuated vaccines: Contraindicated in patients receiving immunosuppressive doses of corticosteroids like Solu-medrol.
- Hepatitis B viral infection, tuberculosis, or other serious infectious diseases: As mentioned in the guidelines for the management of acute alcoholic hepatitis 1.
Important Considerations
- Caution is needed in patients with active tuberculosis, herpes simplex of the eye, recent myocardial infarction, heart failure, hypertension, diabetes mellitus, osteoporosis, peptic ulcer disease, and psychiatric disorders as Solu-medrol may exacerbate these conditions.
- Use with extreme caution during pregnancy (especially first trimester) and breastfeeding.
- Perform a thorough patient history and consider the risk-benefit ratio before administering Solu-medrol, as it can suppress inflammation and immune responses, potentially worsening infections and causing other systemic effects 1.
From the FDA Drug Label
WARNINGS ... Corticosteroids, including methylprednisolone, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens ... Fungal Infections Corticosteroids, including methylprednisolone, may exacerbate systemic fungal infections; therefore, avoid methylprednisolone use in the presence of such infections unless methylprednisolone is needed to control drug reactions ... Amebiasis Corticosteroids, including methylprednisolone, may activate latent amebiasis ... Strongyloides Infestation Corticosteroids, including methylprednisolone, should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation
The contraindications for Solu-medrol (methylprednisolone) include:
- Systemic fungal infections, unless needed to control drug reactions
- Latent amebiasis or active amebiasis in patients who have spent time in the tropics or have unexplained diarrhea
- Strongyloides (threadworm) infestation, use with great care in patients with known or suspected infestation 2
From the Research
Solu-medrol Contraindications
- Solu-medrol, also known as methylprednisolone, has several contraindications based on the available evidence 3
- One of the main contraindications is a history of allergic reactions to methylprednisolone, which can be mediated by IgE antibodies 3
- Patients who have experienced immediate allergic reactions to methylprednisolone should avoid using the medication to prevent potentially life-threatening reactions 3
- Additionally, the use of contaminated methylprednisolone injections has been linked to outbreaks of fungal infections, including Exserohilum rostratum 4, 5, 6, 7
- These infections can be severe and even fatal, highlighting the importance of ensuring the sterility and safety of injectable medications 4, 5, 6, 7
Fungal Infections Associated with Methylprednisolone
- The use of contaminated methylprednisolone injections has been linked to a range of fungal infections, including meningitis, spinal or paraspinal infections, and osteoarticular infections 4, 5, 6, 7
- Exserohilum rostratum is the primary pathogen associated with these infections, although other mold species have also been identified 6
- The clinical findings and outcomes of these infections can vary widely, with some patients experiencing persistent pain and disability, while others may develop life-threatening complications 4, 5, 6, 7
Allergic Reactions to Methylprednisolone
- Allergic reactions to methylprednisolone can be immediate and mediated by IgE antibodies 3
- Skin testing, ImmunoCAP, and the basophil activation test (BAT) can be used to confirm the diagnosis of an allergic reaction to methylprednisolone 3
- Patients who have experienced an allergic reaction to methylprednisolone should be advised to avoid using the medication in the future to prevent potentially life-threatening reactions 3