Methylprednisolone Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• Check the approved route of administration on product packaging carefully (intravenous and depot intramuscular steroid preparations could be easily confused)

Available preparations

Solumedrone 40mg Act-O-Vial

Solumedrone 125mg Act-O-Vial

Solumedrone 500mg vial

Solumedrone 1g vial

Reconstitution

500mg and 1000mg vial

• Water for Injections
• 7.8ml per 500mg vial
• 15.6ml per 1000mg vial

40mg and 125mg Act-O-Vial reconstitution

• Press down on plastic activator to force diluent into the lower compartment
• Gently agitate to effect dissolution
• Remove plastic tab covering centre of stopper - sterilise top of stopper with suitable germicide
• Insert needle squarely through centre of plunger-stopper until tip is just visible. Invert vial and withdraw dose

Infusion fluids

Sodium Chloride 0.9% or Glucose 5%

• Consider favouring sodium chloride 0.9% as the infusion fluid for high doses as administration glucose 5% may cause or aggravate hyperglycaemia

Methods of intravenous administration

Slow intravenous injection (doses of 250mg or less)

• Administer dose over at least five minutes (see below re adverse effects with rapid administration)

Intermittent intravenous infusion (may be used for all doses)

• Administer required doses over at least 30 minutes
• Rapid infusion may be associated with arrhythmias, cardiac arrest and circulatory collapse
• The infusion volume is not critical - any infusion volume may be used
• An infusion volume of as little as 50ml may be used if required (eg fluid restriction) but the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing

Dose in adults

Doses vary hugely depending on indication

Pulse therapy

• Regimens vary: examples of regimens used: 1g daily for three to five days

Exacerbation of COPD

• Give 125mg every six hours for 72 hours, then switch to oral therapy
• Alternatively a dose of 0.5mg/kg every six hours for 72 hours, then switch to oral therapy

Acute spinal cord injury (within three hours of injury - but see below also)

• Loading: 30mg/kg over 15 minutes
• Maintenance: Wait 45 minutes after loading dose has been given, then start a continuous infusion of 5.4mg/kg/hour for 23 hours (multiple bags of 500ml required)
• For patients who are initiated on treatment within 3 to 8 hours of injury, give loading dose and maintenance dose above, but continue maintenance infusion for 47 hours (rather than 23 hours)

For other indications: see SPC

Further information

• Because rare instances of skin reactions and anaphylactic reactions have occurred in patients receiving corticosteroid therapy, appropriate precautionary measures should be taken prior to administration, especially when the patient has a history of drug allergy
• Solumedrone is supplied as methylprednisolone sodium succinate (doses expressed in mg of methylprednisolone)
• The 40mg vial used to contain lactose as an excipient- however this product has been reformulated to remove the lactose constituent since 2021

Storage

• Store below 25⁰C

References

SPC September 2021

Therapeutic classification

Corticosteroid