Section 04 · Monograph
Methylprednisolone
Reviewed Nov 2026FDA label
Solu-MedrolCorticosteroid
- Forms
- IV: 40, 125, 500, 1000mg vials
- Dose
- 500-1000mg/day x3-5d (relapse)
- MOA
- Broad anti-inflammatory/immunosuppressive
Indications
- Treatment of acute exacerbations (relapses) of multiple sclerosisFDA-labeled
- Broad anti-inflammatory and immunosuppressive indications across many specialtiesFDA-labeled
Mechanism of Action
- Synthetic glucocorticoid
- Binds intracellular glucocorticoid receptors, modulating gene transcription to suppress inflammatory cytokine production, reduce leukocyte migration, and stabilize the blood-brain barrier during acute relapses
Full Dosing
Adult / usual
- MS relapse: 500-1000 mg IV once daily for 3-5 days, sometimes followed by an oral prednisone taper
- Oral dosing highly variable by indication
Contraindications
- Systemic fungal infections
- Known hypersensitivity to methylprednisolone or components
Drug Interactions
- CYP3A4 inducers (e.g., rifampin, phenytoin) may decrease effect
- CYP3A4 inhibitors may increase effect
- NSAIDs increase GI ulceration risk
- May reduce efficacy of vaccines
Adverse Effects
- Insomnia
- Mood changes/irritability
- Hyperglycemia
- Increased appetite
- GI upset
- Fluid retention
- Hypertension
- Increased infection risk with prolonged use
- Osteoporosis with long-term use
- Adrenal suppression with prolonged use
Monitoring Parameters
- Blood glucose during treatment, especially in diabetics
- Blood pressure
- Signs of infection
- Mood/behavioral changes
- Bone density with long-term repeated courses
Pregnancy & Lactation
- Crosses placenta in small amounts; short courses generally considered lower risk
- Present in breast milk in small amounts; generally compatible with breastfeeding at low-to-moderate doses