Skill Page - SOLUMEDROL INFUSION

17 JAN 2015

SOLUMEDROL INFUSION

Mr Binoy Micheal, EMN Staff

SOLUMEDROL
Methylprednisolone is a potent anti-inflammatory steroid.

Solu-Medrol - Clinical Pharmacology
Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that are readily absorbed from the gastrointestinal tract.
Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems.

Mechanism
Potent glucocorticoid with minimal to no mineralocorticoid activity.
Modulates carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis.

Metabolism & elimination -
Metabolism
Extensively metabolized in liver

Elimination
Half-life: 3-3.5 hr

Dialyzable: Hemodialysis, slightly
Total body clearance: 16-21 L/hr

Excretion: Urine (mainly, as metabolites), feces (minimally)

INDICATIONS -

1. Acute spinal cord injury
2. Asthma exacerbations
3. Anti-inflammatory or immunosuppressive
4. Lupus nephritis
5. Aplastic anemia
6. Pneumocystis pneumonia in AIDS patients

CONTRAINDICATIONS -

1. Untreated serious infections.
2. Documented hypersensitivity.
3. Methylprednisolone must not be administered intrathecally.
4. IM route is contraindicated in idiopathic thrombocytopenic purpura

Cautions -

1. Use with caution in cirrhosis,  herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, thromboembolic disorders. Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated.
2. Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored).
3. Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy .
4. May cause hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, or hyperglycemia.
5. Prolonged corticosteroid use may result in elevated IOP, glaucoma, or cataracts.

Side Effects -

1. Nausea, vomiting, heartburn, headache, dizziness, trouble  sleeping, appetite changes, increased sweating, acne, or pain/redness/swelling at the injection site may occur.
2. Adrenal suppression .
3. Amenorrhea.
4. Psychosis
5. Sodium and water retention
6. Seizure
7. Tachycardia
8. Ulcerative esophagitis
9. Urticaria
10. Vasculitis
11. Delirium
12. Diabetes mellitus
13. Edema
14. Emotional instability
15. Vertigo
16. Weight gain

SOLUMEDROL INFUSION -
Acute Spinal Cord Injury

1st hour: 30 mg/kg IV in 100ml NS over 15 minutes
Next 23 hours: 5.4 mg/kg/hr IV by continuous infusion
by an infusion of 5.4 mg/kg/hour for 23 hours.

Preparation -

- Available in 40mg,125mg,500mg,1gm.
- Take 2 vials of 1gm
- Dilute with 34ml NS.
- 50 ml=2gm (2000mg)
- 1ml = 40mg

Eg. 60kg pt
       5.4 x 60 =324mg / hr.
       1ml =40mg
        Infusion rate 324/40 = 8.1 ml /hr