What is methylprednisolone?
Methylprednisolone falls under a class of drugs called corticosteroids, which also includes prednisolone, fluticasone, and budesonide, among others. It is sold under several brand names, including Medrol, Depo-Medrol, Solu-Medrol, and A-Methapred, and is also available as a generic medication.
Corticosteroids are steroid hormones that occur naturally in your body, while synthetic versions (such as methylprednisolone) are used medicinally. Corticosteroids are involved in several processes, including your immune response, inflammation, and metabolism. Corticosteroids can be further categorized, with the main classes being glucocorticoids and mineralocorticoids. Glucocorticoids are the type of corticosteroids that influence your immune response and inflammation.
Methylprednisolone is a glucocorticoid and therefore has anti-inflammatory effects. This is why you may see it referred to as both a corticosteroid and glucocorticoid.
Methylprednisolone is, therefore, usually used to treat conditions that are characterized by inflammation, including different forms of arthritis, allergic conditions (including asthma), and chronic skin conditions (such as psoriasis). A more comprehensive list of conditions methylprednisolone is used to treat can be found in question 2: What is methylprednisolone used for?
Methylprednisolone can be taken orally or via injections, the latter of which is performed by a healthcare professional. The possibility to inject methylprednisolone may make it preferable to other drugs under certain circumstances; for example, if taking oral medications is not feasible. Methylprednisolone is also available as a topical treatment in some countries, coming in lotion, cream, or ointment form which is applied onto your skin.
What is methylprednisolone used for?
The anti-inflammatory characteristics of methylprednisolone make it a potential treatment option for a wide range of diseases that are characterized by inflammation.
The use of corticosteroids in treating allergic conditions, including asthma, allergic rhinitis (hay fever), and allergic reactions to other drugs, is usually reserved for severe cases and when conventional treatment has been ineffective.
Methylprednisolone can be used, in addition to long-term therapy, as a short-term treatment for acute episodes or ‘flare-ups’ of several rheumatic disorders. These include rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, among others.
Methylprednisolone may be used to treat endocrine disorders such as Addison’s disease, which is characterized by the adrenal glands not producing enough steroid hormones (primarily cortisol). Methylprednisolone can be used as a treatment, as it mimics cortisol (see question 3: How does methylprednisolone work).
Methylprednisolone can be used to treat autoimmune diseases related to collagen (the main protein in connective tissue), either during an exacerbation or as maintenance therapy. These include lupus, dermatomyositis, and acute rheumatic carditis.
Methylprednisolone can be used to treat several skin conditions, including psoriasis, seborrheic dermatitis, exfoliative dermatitis, bullous dermatitis herpetiformis, mycosis fungoides, pemphigus, and Stevens-Johnson syndrome. As methylprednisolone is one of the more potent corticosteroids, it may be used in particularly severe cases.
Other uses for methylprednisolone include a range of respiratory disorders, hematological disorders, neoplastic diseases, edematous states, gastrointestinal diseases, and nervous diseases. It may also be used ‘off-label’ (in a manner not approved by the FDA or other health agencies) at your doctor’s discretion.
For more details about which conditions methylprednisolone is used to treat and whether it may be a suitable option for you, you can read the FDA label (available in the sources at the bottom of this page) or speak to your doctor.
How does methylprednisolone work?
Corticosteroid drugs, such as methylprednisolone, work by mimicking the effects that natural corticosteroid hormones have on your body. In particular, they mimic cortisol, which is the most important glucocorticoid (see question 1: What is methylprednisolone? for a brief explanation of what glucocorticoids are).
One of the primary actions of methylprednisolone is to limit your immune system’s activity, particularly regarding inflammation. Inflammation is an important part of your immune system’s normal response; however, many diseases are characterized by the immune system being overactive or mistakenly attacking healthy parts of the body (such as the joints in people living with rheumatoid arthritis).
By limiting this response, methylprednisolone can reduce inflammation and ease symptoms.
The downside to this mechanism of action is that methylprednisolone can weaken your immune system and make you more susceptible to infections. Cortisol, the hormone methylprednisolone replicates, also plays a role in a variety of other functions within your body. Methylprednisolone can, therefore, cause several side effects related to these other functions, particularly when taken at high doses. You can read more about the side effects of methylprednisolone in question 7: What are the side effects of methylprednisolone?
The mechanisms of corticosteroids are markedly different from non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and meloxicam. NSAIDs block enzymes that promote pain and inflammation, rather than limiting the response of your immune system.
What is the difference between methylprednisolone, prednisolone, and prednisone?
Methylprednisolone, prednisolone, and prednisone all work in very similar ways and are generally used to treat the same conditions. However, there are some differences:
- Prednisone is a ‘prodrug’. This means it is biologically inactive until it is metabolized. Prednisone is metabolized in the liver, releasing prednisolone, which then acts on the body. Prednisone is taken orally.
- Prednisolone is, therefore, the active metabolite of prednisone. Unlike prednisone, it does not need to be metabolized before it starts having a biological effect. It can be taken orally, by injection, or topically (creams/ointments applied on the skin). Prednisolone and prednisone have been found to have similar potency.
- Methylprednisolone is the most potent of the three; 4mg of methylprednisolone is equivalent to 5mg of prednisone or prednisolone. It can be taken orally, with injections, or topically.
Your doctor will consider the differences between methylprednisolone, prednisone, prednisolone, another corticosteroid, and other treatment options (such as NSAIDs) when deciding the most suitable option.
How long does it take for methylprednisolone to work?
Although methylprednisolone begins working immediately, the length of time it takes before you notice an improvement in symptoms can vary significantly depending on your condition, the severity of your condition, and the form of methylprednisolone you are taking.
It is possible you will notice an improvement within a few days, but it can take several weeks for methylprednisolone to have its full effects.
You should speak to your doctor about your specific treatment and how long it should take to start working. If you have not noticed any improvement within a timeframe specified by your doctor (often a few weeks), an alternative treatment may be considered.
How do you take methylprednisolone?
There are several different ways of taking methylprednisolone.
Methylprednisolone is often prescribed in tablets that you take orally, in strengths ranging from 2 mg to 32 mg.
Dosage varies significantly depending on the condition being treated, its severity, and your response, but is usually between 4 mg and 48 mg per day. It is usually taken with food or milk. If you are prescribed methylprednisolone for long-term treatment, your doctor may decide to use Alternate Day Therapy (ADT), which means you take twice the usual daily dosage every other day. This is designed to limit side effects and keep your adrenal glands working.
Injectable variations of methylprednisolone are also available. Different formulas of injectable methylprednisolone exist; for example, the solution sold under the brand name Solu-Medrol is methylprednisolone sodium succinate while Depo-Medrol is methylprednisolone acetate.
They have widely similar uses and are often prescribed for conditions listed in question 2, What is methylprednisolone used for?, when oral treatment is not feasible.
However, they do differ somewhat when it comes to aspects such as the speed at which they work, the duration of their effectiveness, and side effects. There are also differences regarding the parts of the body into which they can be injected; methylprednisolone acetate (Depo-Medrol) can be injected into joints and soft tissue (which may make it the preferred option for certain rheumatic conditions), and lesions (in the treatment of alopecia areata and plaque psoriasis, among other conditions).
Should you require methylprednisolone injections, your doctor will consider these differences when deciding which formula to prescribe.
Topical treatments are applied directly onto the skin, in the form of creams, ointments, and lotions. Methylprednisolone is available as a topical treatment, although it is not available (or has been discontinued) in many markets worldwide. Where available, it is usually used to treat dermatological conditions such as acne, psoriasis, and seborrheic dermatitis.
It may also be combined with an antibiotic (such as neomycin) to help prevent the growth of bacteria that can lead to infections.
What are the side effects of methylprednisolone?
Methylprednisolone can cause a wide range of symptoms, some of which are specific to the form of methylprednisolone you are taking (tablets, injections, topical).
Side effects of methylprednisolone that require medical attention
Some side effects can occur when methylprednisolone is taken orally or via injections and require medical attention. They include:
- Blurred vision
- Decreased amount of urine
- Mood changes, aggression, or irritability
- Slow, fast, or irregular heartbeat
- Difficulty swallowing
- Trouble breathing
- Numbness or tingling in your arms or legs
- Itching or skin rashes
- Eye pain or tearing
- Loss of appetite
- Yellow eyes or skin
- Unexplained weight gain or loss
- Pain in your stomach or abdomen
Should you experience any of these side effects, you should contact your doctor immediately.
Side effects of methylprednisolone that do not usually require medical attention
Other side effects of methylprednisolone are not considered as serious and may go away once your body adapts to the drug. Some side effects can occur when methylprednisolone is taken orally or by injection include:
- Dry scalp
- Thinning of hair
- Swelling of the stomach area
- Lightening skin color
- Red face
- Red or purple lines on your arm, face, legs, or groin
Side effects that are more likely to occur when methylprednisolone is taken orally include:
- Increased sweating
- Thin or fragile skin
- Menstrual changes
Side effects that can occur when methylprednisolone is taken by injection include:
- Pain, redness, or hard skin at the injection site
- Pitting or depression at the injection site
These side effects will often ease or go away as your body gets used to methylprednisolone. However, if they are severe, persistent, or worsen, you should speak to your doctor.
Side effects of topical methylprednisolone
Topical methylprednisolone, most commonly sold under the brand name Advantan, can produce different side effects to oral and injectable forms of methylprednisolone. Common side effects include:
Less common side effects include:
- Skin infection at the site of application
- Swelling at the site of application
- Irritation at the site of application
- Bacterial skin infection
- Cracks on the skin
- Thinning of the skin
- Skin discoloration
Although serious side effects to topical methylprednisolone are rare, you should speak to your doctor if you are concerned about any side effects that you (or your child) experience.
Allergic reactions to methylprednisolone
Allergic reactions to methylprednisolone are rare but can occur. Signs of a serious allergic reaction should be treated as a medical emergency. They include:
- Skin rash – for example itchy, red, or swollen skin
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
Effects of methylprednisolone on the immune system
The way that methylprednisolone works means it may reduce your immune system’s ability to fight infections. You should, therefore, be aware of any signs of infection and speak to your doctor if you experience symptoms such as fever, chills, a bad cough, or persistent sore throat. You should also speak to your doctor immediately if you are exposed to chickenpox or measles.
Speak to your doctor & read the label
This is not a comprehensive list of side effects that can occur when you take methylprednisolone. Because methylprednisolone comes in different forms and is prescribed at different strengths and for different lengths of time, it is important to both speak to your doctor about which side effects that you should be aware of. You should also read the leaflet that comes with your medication.
How long do the side effects of methylprednisolone last?
Given the wide-ranging use of methylprednisolone, the different forms and strengths, and the varied side effects that can occur, there is no single length of time you can expect side effects to last. As discussed in the previous question, What are the side effects of methylprednisolone, you should speak to your doctor immediately if serious side effects occur.
Less serious side effects should begin easing off as your body adapts to methylprednisolone. This will often happen within a week but can take longer. If side effects do not ease off (or if they worsen), you should speak to your doctor.
Can I take painkillers with methylprednisolone?
You should not take non-steroidal anti-inflammatory painkillers (NSAIDs), such as ibuprofen, aspirin, meloxicam, or naproxen while taking methylprednisolone unless explicitly told to do so by your doctor.
The combination can increase your risk of problems in your gut, including gastrointestinal bleeding, stomach ulcers, and inflammation. In rare cases, it can lead to gastrointestinal perforation – a hole right through the stomach or intestine – which can be fatal.
Doctors may, in some circumstances, prescribe methylprednisolone with an NSAID such as ibuprofen if the benefits are deemed to outweigh the risks.
Acetaminophen (also known as paracetamol) is not believed to interact with methylprednisolone, so they can be taken together.
A number of other substances can interact with methylprednisolone. It is important to tell your doctor about prescription medications, over-the-counter medications, and supplements that you take.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.