Universal reference book for medicines
Name of the drug: DEPO-MEDROL ® (DEPO-MEDROL ® )

Active substance: methylprednisolone

Type: GCS for injection - depot form

Manufacturer: PFIZER MFG.
BELGIUM (Belgium)
Composition, form of production and packaging
Suspension for injection of
white color.

1 ml

methylprednisolone acetate 40 mg

Excipients: macrogol 3350 29 mg / ml, sodium chloride 8.7 mg / ml, myristyl -? - picolinium chloride 200 μg / ml, sodium hydroxide (to adjust the pH to 3.5-7), hydrochloric acid (to adjust the pH to 3.5-7 ), water d / and up to 1 ml.

1 ml - bottles (1) - packs of cardboard.

Suspension for injection of white color.

1 ml of 1 amp.

methylprednisolone acetate 40 mg 80 mg

Excipients: macrogol 3350 29 mg / ml, sodium chloride 8.7 mg / ml, myristyl -? - picolinium chloride 200 μg / ml, sodium hydroxide (to adjust the pH to 3.5-7), hydrochloric acid (to adjust the pH to 3.5-7 ), water d / and up to 1 ml.

2 ml - bottles (1) - packs of cardboard.

INSTRUCTION FOR THE SPECIALIST.

Description of the drug approved by the manufacturer for the printed edition of 2011.

PHARMACHOLOGIC EFFECT

Methylprednisolone acetate has the same properties as methylprednisolone, but is less soluble and less metabolized, which explains the longer duration of its action.

SCS, penetrating through cell membranes, form complexes with specific cytoplasmic receptors.
Then these complexes penetrate into the cell nucleus, bind to DNA (chromatin) and stimulate the transcription of mRNA and the subsequent synthesis of various proteins (including enzymes), which explains the effect of GCS in systemic application. SCS not only have a significant effect on the inflammatory process and immune response, but also affect carbohydrate, protein and fat metabolism. They also have an effect on the cardiovascular system, skeletal muscles and the central nervous system.
Influence on the inflammatory process and immune response

Most indications for the use of GCS are due to their anti-inflammatory, immunosuppressive and anti-allergic properties.
Due to these properties, the following therapeutic effects are achieved:
- decrease in the number of immunoactive cells in the inflammatory focus;

- Reduction of vasodilation;

- stabilization of lysosomal membranes;

- inhibition of phagocytosis;

- a decrease in the production of prostaglandins and related compounds.

The dose in 4.4 mg of methylprednisolone acetate (4 mg of methylprednisolone) has the same anti-inflammatory effect as 20 mg of hydrocortisone.

Methylprednisolone has only a minor mineralocorticoid activity (200 mg of methylprednisolone is equivalent to 1 mg of deoxycorticosterone).

Influence on carbohydrate and protein metabolism

GKC have a catabolic effect on proteins.
The releasing amino acids are converted in the process of gluconeogenesis in the liver into glucose and glycogen.Consumption of glucose in peripheral tissues is reduced, which can lead to hyperglycemia and glucosuria, especially in patients at risk of developing diabetes.
Effect on fat metabolism

GCS have a lipolytic effect, which is primarily manifested in the limb region.
SCS also increases lipogenesis, which is most pronounced in the region of the chest, neck and head. All this leads to redistribution of fatty deposits.
The maximum pharmacological activity of GCS is manifested not at the peak concentration in the plasma, but after it, therefore, their effect is primarily due to the effect on enzyme activity.

PHARMACOKINETICS

Methylprednisolone acetate is hydrolyzed by the action of serum cholinesterases with the formation of an active metabolite.
In the human body, methylprednisolone forms a weak, dissociating bond with albumin and transcortin. About 40-90% of methylprednisolone is in the bound state. Due to the intracellular activity of GCS, a pronounced difference between plasma T 1/2 and pharmacological T 1/2 is revealed. Pharmacological activity persists even when the concentration of methylprednisolone in the blood is no longer determined.
The duration of anti-inflammatory activity of GCS is approximately equal to the duration of suppression of the hypothalamic-pituitary-adrenal (HHG) system.

After intravenous administration of the drug at a dose of 40 mg / ml, C max in the blood serum was achieved on average 7.3 ± 1 h (T max ) and averaged 1.48 ± 0.86 μg / 100 ml (T 1/2 = 69.3 h).
After a single intravenous injection of 40-80 mg of methylprednisolone acetate, the duration of suppression of the HGH system was 4 to 8 days.
After intra-articular administration of 40 mg to each knee joint (total dose = 80 mg), the C max in the blood serum was achieved after 4-8 hours and was approximately 21.5 μg / 100 ml.
The intake of methylprednisolone in the systemic bloodstream from the joint cavity was maintained for approximately 7 days, which is confirmed by the duration of suppression of the HGH system and the results of determination of methylprednisolone concentrations in the serum.
Metabolism of methylprednisolone is carried out in the liver, and this process is qualitatively similar to that of cortisol.
The main metabolites are 20 -? - hydroxymethylprednisolone and 20 -? - hydroxy-6 -? - methylprednisone. Metabolites are excreted into the urine in the form of glucuronides, sulfates and unconjugated compounds. These conjugation reactions occur mainly in the liver and partially in the kidneys.
INDICATIONS

GCS should be used only as a symptomatic treatment, with the exception of some endocrine disorders, in which they are used as substitution therapy.

A. V / M APPLICATION

Methylprednisolone acetate (Depo-MEDROL ® ) is not used to treat acute life-threatening conditions.
If a rapid hormonal effect of maximum intensity is required, I / in the well-soluble methylprednisolone sodium succinate (SOLO-MEDROL®).
If there is no possibility to perform oral therapy with GCS, then the use of the drug in / m is indicated in the following diseases:

1. Endocrine diseases

- Primary and secondary adrenal insufficiency (preparations of choice - hydrocortisone or cortisone, if necessary in combination with mineralocorticoids, especially in pediatric practice);

- acute adrenal insufficiency (preparations of choice - hydrocortisone or cortisone, there may be a need to add mineralocorticoids);

- congenital adrenal hyperplasia;

- hypercalcemia on the background of cancer;

- subacute thyroiditis.

2. Rheumatic diseases

As an additional tool for maintenance therapy (nonsteroidal anti-inflammatory drugs, kinesiotherapy, physiotherapy, etc.) and for short-term use (for removing the patient from an acute condition or exacerbating the process) with the following diseases:

- psoriatic arthritis;

ankylosing spondylitis.

In the following cases, the drug should be used in situ:

- Posttraumatic osteoarthritis;

- synovitis in osteoarthritis;

- rheumatoid arthritis, including juvenile rheumatoid arthritis (in some cases, maintenance therapy with low doses may be required);

- Acute and subacute bursitis;

- epicondylitis;

acute non-specific tenosynovitis;

- Acute gouty arthritis.

3. Collagenoses

During an exacerbation or in some cases as a maintenance therapy for the following diseases:

- systemic lupus erythematosus;

- systemic dermatomyositis (polymyositis);

acute rheumatic myocarditis.

4. Skin diseases

- Pemphigus;

- malignant exudative erythema (Stevens-Johnson syndrome);

- exfoliative dermatitis;

- mushroom mycosis;

- Bullous herpetiform dermatitis (the drug of choice - sulfone, systemic application of GCS is adjuvant).

5. Allergic conditions

To control the following severe and disabling allergic conditions, which can not be cured by the usual methods:

- asthmatic status;

contact dermatitis;

- atopic dermatitis;

- serum sickness;

- seasonal or all-the-year-round allergic rhinitis;

- drug allergy;

- reactions to transfusion and the introduction of drugs by type of urticaria;

- Acute non-infectious edema of the larynx (the drug of choice is epinephrine).

6. Ophthalmic diseases

Severe acute and chronic allergic and inflammatory processes with eye damage, such as:

- uveitis and inflammatory eye diseases that do not respond to the use of local corticosteroids.

7. Diseases of the gastrointestinal tract

To excrete a patient from a critical condition with the following diseases:

- Ulcerative colitis (systemic therapy);

- Crohn's disease (systemic therapy).

8. Diseases of the respiratory system

- symptomatic sarcoidosis;

- berylliosis;

- focal or disseminated pulmonary tuberculosis (used in combination with appropriate anti-tuberculosis chemotherapy);

- Leffler's syndrome, not amenable to therapy by other methods;

aspiration pneumonitis.

9. Hematological diseases

- acquired (autoimmune) hemolytic anemia;

- secondary thrombocytopenia in adults;

erythroblastopenia (major thalassemia);

congenital (erythroid) hypoplastic anemia.

10. Oncological diseases

As a palliative therapy for the following diseases:

- leukemias and lymphomas in adults.

11. Edema Syndrome

For induction of diuresis or treatment of proteinuria in nephrotic syndrome, idiopathic type or due to systemic lupus erythematosus

12. The nervous system

- Multiple sclerosis in the phase of exacerbation.

13. Other indications for use

- tuberculous meningitis with a subarachnoid block or in case of a blockade, in combination with appropriate anti-tuberculosis chemotherapy.

- trichinosis with damage to the nervous system or myocardium.

B. INTERNAL, PERIARTICULAR, INTURBURSAL APPLICATION AND INTRODUCTION TO SOFT FABRICS.

As an auxiliary therapy for short-term use (for removing a patient from an acute condition or exacerbating a process) with the following diseases:

- synovitis in osteoarthritis;

- rheumatoid arthritis;

- Acute and subacute bursitis;

- acute gouty arthritis;

- eicondylitis;

acute non-specific tenosynovitis.

B. INTRODUCTION TO THE PATHOLOGICAL CENTER

Keloid scars and localized foci of inflammation with:

- red flat lichen (Wilson);

- psoriatic plaques;

- annular granulomas;

- simple chronic lichen (neurodermatitis);

- discoid lupus erythematosus;

- diabetic lipodystrophy;

- alopecia areata.

It is also effective in cystic tumors or tendon aponeurosis (tendon sheath cysts).

DOSING MODE

- in / m;

- intraarticular, periarticular, intra-bursal administration or introduction into soft tissues;

- An introduction to the pathological focus.

INTRODUCTION TO THE PATHOLOGICAL FOCUS FOR ACHIEVING A LOCAL EFFECT

Despite the fact that treatment with DEPO-MEDROL ® leads to a reduction in the symptoms of the disease, it does not affect the cause of the inflammatory process, so it is necessary to carry out the usual therapy for each specific disease.

Rheumatoid arthritis and osteoarthritis.
The dose for intraarticular administration depends on the size of the joint, as well as on the severity of the condition of the patient. In the case of chronic diseases, the number of injections can vary from one to five or more per week, depending on the degree of improvement achieved after the first injection. The following doses are given as general recommendations:
Joint size Joint name Dose range

Large Knee Ankle Brachial 20-80 mg

Medium Elbow joint Wrist bandage 10-40 mg

Small Pseudo-phalanx Interphalangeus Breast-clavicular Acromioclavicular 4-10 mg

Procedure .
Before carrying out intraarticular injection, it is recommended to evaluate the anatomy of the affected joint. For a full-fledged anti-inflammatory action, it is important that the injection be carried out into the synovial cavity. It is necessary to follow the rules of aseptic and antiseptic as well as with lumbar puncture. Sterile needle 20-24 G (put on a dry syringe) is quickly inserted into the synovial cavity. The method of choice is infiltration anaesthesia procaine. To control the entry of the needle into the joint cavity, several drops of intraarticular fluid are aspirated. When choosing the site of the injection, which is individual for each joint, the proximity of the synovial cavity to the surface (as close as possible) is taken into account, as well as the path of passage of large vessels and nerves (as far as possible) . The needle remains in place, the syringe with aspirated liquid is removed and replaced with another syringe containing the required amount of DEPO-MEDROL ® . Then slowly pull the plunger toward yourself and aspirate the synovial fluid to make sure that the needle is still in the synovial cavity. After the injection, several light movements in the joint should be made, which helps to mix the suspension with the synovial fluid. Place the injection close a small sterile bandage.
The drug can be injected into the knee, ankle, elbow, shoulder, metacarpophalangeal, interphalangeal and hip joints.
Sometimes there are difficulties with the introduction of the hip joint, because you should avoid getting into large blood vessels. In the following joints, injections are not made: anatomically unattainable joints, for example, intervertebral articulations, including the sacroiliac joint, in which there is no synovial cavity. Inefficiency of therapy is most often the result of an unsuccessful attempt to penetrate the joint cavity. When the drug is injected into the surrounding tissues, the effect is insignificant or absent altogether. If the therapy did not give positive results in the case when getting into the synovial cavity was not in doubt, which was confirmed by the aspiration of the intraarticular fluid, repeated injections usually are useless.
Local therapy does not affect the process underlying the disease, therefore, complex therapy should be conducted, including basic anti-inflammatory therapy, physiotherapy and orthopedic correction.
After intra-articular injection of GCS, care should be taken not to overload the joints, in which symptomatic improvement is noted, in order to avoid stronger damage to the joint compared to what was before the start of SCS therapy. GKS can not be injected into unstable joints. In some cases, repeated intraarticular injections can lead to instability of the joint. In some cases it is recommended to perform X-ray inspection to detect damage. If a local anesthetic is used prior to the administration of DEPO-MEDROL ® , you should carefully read the instructions for use of this anesthetic to comply with all necessary precautions.
Bursitis.
After treating the area around the injection site with a suitable antiseptic, local infiltration anesthesia is performed with a 1% solution of procaine. On a dry syringe put on a needle 20-24 G, which is injected into the joint bag, and then aspirate the liquid. The needle is left in place, and the syringe with aspirated liquid is removed and a syringe containing the necessary dose of the drug is placed in its place. After the injection, the needle is removed and a bandage is applied.
Cyst of the tendon sheath, tendonitis, epicondylitis.
In the treatment of conditions such as tendonitis or tendosynovitis, care should be taken to ensure that the suspension is inserted into the tendon sheath and not into the tendon tissue. The tendon can easily be palpated if you hold your hand along it. In the treatment of conditions such as epicondylitis, the most painful area should be identified and the suspension should be introduced into it by the creeping infiltrate method. In the cysts of the tendon sheaths, the suspension is injected directly into the cyst. In many cases, it is possible to achieve a significant reduction in the size of the cystic tumor and even its disappearance after a single injection of the drug. Each injection should be done in accordance with the rules of aseptic and antiseptic treatment (skin treatment with a suitable antiseptic).
The dose is selected depending on the nature of the process and is 4-30 mg.
If the recurrence or chronic course of the process may require repeated injections.
Skin diseases.
After treating the skin with a suitable antiseptic, for example, 70% alcohol, 20-60 mg of the suspension is injected into the lesion. With a large lesion surface, a dose of 20-40 mg is divided into several parts and injected into various parts of the affected surface. With the introduction of the drug should be careful, since it is necessary to avoid whitening of the skin, which can in the future lead to peeling. Usually, 1-4 injections are given, the interval between injections depends on the type of pathological process and the length of the period of clinical improvement achieved after the first injection.
V / M INTRODUCTION TO ACHIEVE THE SYSTEM EFFECT

The dose of the drug for the / m administration depends on the disease to be treated.
To obtain a lasting effect, calculate the weekly dose, multiplying the daily dose for oral administration by 7, and injecting it as one intravenous injection.
The dose should be selected individually, taking into account the severity of the disease and the patient's response to therapy.
Children (including infants) are treated with a lower dose, which is chosen primarily taking into account the severity of the disease, rather than using permanent schemes based on age or body weight. The course of treatment should be as short as possible. Treatment is carried out under constant medical supervision.
Hormone therapy is a supplement to conventional therapy, but does not replace it. The dose should be reduced gradually, the abolition of the drug is also carried out gradually, if it is administered for longer than a few days. The main factors determining the dose range are severity of disease, prognosis, the estimated duration of the disease and the patient's response to therapy. If a chronic disease arose during spontaneous remission, treatment should be interrupted. Prolonged therapy routine laboratory tests, such as urinalysis, determining the concentration of blood glucose 2 hours after the meal, the determination of blood pressure, body weight, chest X-ray should be conducted at regular time intervals.Patients with gastric ulcer and duodenal ulcer history or severe dyspepsia, it is desirable to conduct X-ray examination of the upper gastrointestinal tract.
Patients with adrenogenital syndrome enough to enter / m to 40 mg once every 2 weeks. For maintenance therapy to patients with rheumatoid arthritis drug is administered once a week / m to 40-120 mg. The usual dose systemic glucocorticosteroids therapy in patients with skin diseases , allowing to achieve a good clinical effect is 40-120 mg / m 1 times a week for 1-4 weeks. In acute severe dermatitis caused by poison contained in the ivy, can eliminate manifestations within 8-12 hours after a single / m administration of 80-120 mg. In chronic contact dermatitis may be effective repeated injections with an interval of 5-10 days. In seborrheic dermatitis condition monitoring it suffices to introduce 1 to 80 mg once a week.
After the / m of 80-120 mg in patients with bronchial asthma symptoms disappearance occurs within 6-48 hours and the effect lasts for a few days or even 2 weeks. Patients with allergic rhinitis (hay fever) / m for the injection of 80-120 mg may also result in the elimination of symptoms coryza for 6 hours, the effect lasts from a few days up to 3 weeks.
If the disease targeted by the therapy, also develop symptoms of stress, a dose of suspension should be increased. For maximum effect rapid shown intravenous methylprednisolone sodium succinate, characterized by rapid dissolution.
SIDE EFFECT

The following side effects typical of corticosteroids with parenteral use. Inclusion in this list does not mean that these effects are specific to a given drug.
Intramuscular APPLICATION
disruption of water-electrolyte balance: sodium retention, chronic heart failure patients with a corresponding disposition, high blood pressure, fluid retention, hypokalemia, hypokalemic alkalosis.
When using synthetic derivatives such as methylprednisolone acetate, mineralocorticoid effects occur less frequently than with cortisone or hydrocortisone.
Musculoskeletal:"Steroid" myopathy, muscle weakness, osteoporosis, pathologic fractures, compression fractures of the vertebrae, aseptic necrosis of the femoral head and the humerus bone, tendon rupture, in particular Achilles tendons, loss of muscle mass.
Gastrointestinal / liver: peptic ulcer (possible perforation and hemorrhage), gastric hemorrhage, pancreatitis, ulcerative esophagitis, perforation of the intestine.
It may be a temporary and moderate increase in transaminases and alkaline phosphatase in the serum, but it is not associated with any clinical syndrome and reversible remove the drug.
For the skin: impaired wound healing, petechiae and ecchymosis, thinning and fragility of the skin.
metabolic:negative nitrogen balance due to protein catabolism.
Neurological: increased intracranial pressure, cerebral pseudotumor, mental illness, seizures.
Endocrine: menstrual irregularities, development of the syndrome of Cushing, suppression of hypothalamic-pituitary-adrenal axis (HPA), impaired glucose tolerance, manifestation of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents in patients with diabetes, growth retardation in children.
Ophthalmic: posterior subcapsular cataracts, increased intraocular pressure, exophthalmos.
The immune system:erased the clinical picture of infectious diseases, activation of latent infections, infections caused by opportunistic pathogens, hypersensitivity reactions, including anaphylaxis, may suppress reactions during skin tests.
ADDITIONAL reactions associated with parenteral corticosteroids therapy
- cases of blindness associated with local drug administration in pathological lesions located on the face and head;
- anaphylactic or allergic reactions;
- hyperpigmentation or hypopigmentation;
- atrophy of the skin and subcutaneous tissue;
- postinjection exacerbation after injection into the synovial fluid;
- Charcot arthropathy of the type;
- infection venue injection at non-observance of the rules of aseptic and antiseptic;
- sterile abscess.
CONTRAINDICATIONS

- intrathecal;
- / in the introduction;
- Systemic fungal infections;
- established hypersensitivity to any component of the drug.
Precautions: in lesions of the eye caused by the herpes simplex virus; as this may lead to perforation of the cornea; ulcerative colitis, if there is a threat of perforation, abscess or other development of purulent infection, as well as diverticulitis; in the presence of fresh intestinal anastomoses; with active or latent peptic ulcer; renal failure; diabetes; hypertension; osteoporosis; myasthenia gravis, when corticosteroids are used as primary or adjunctive therapy; for mental disorders in history; in children.
PREGNANCY AND LACTATION

Several animal studies showed that administration of female corticosteroids at high doses can lead to a teratogenic effect. There are no adequate studies of the effect of corticosteroids on the reproductive function in humans has not been so in the decision on the appointment of corticosteroids to pregnant women, nursing mothers, or women who may become pregnant, should be weighed the potential benefits of the drug to the mother (the expectant mother) and the potential risk to the fetus or child. Corticosteroids should be used during pregnancy is strictly on the testimony.
GCS is easy to cross the placenta. Children born to mothers who received relatively high doses of corticosteroids during pregnancy should be monitored carefully, so that you can quickly identify the signs of adrenal insufficiency. Effect of corticosteroids on the course and outcome of unknown genera. GCS allocated into breast milk.
APPLICATION FOR FUNCTIONS OF THE LIVER

Use with caution in patients with renal insufficiency.
APPLICATION FOR CHILDREN

Used in children with caution.
SPECIAL INSTRUCTIONS

Apply strictly prescribed by a doctor to avoid complications.
- preparations for parenteral administration before use should be visually inspected to detect foreign particles and discoloration of the formulation;
- vials should not be stored upside down! Shake well before using;
- one vial can not be used for administration of multiple doses; after administration of the required dose vial residues suspension to be destroyed;
- DEPO-Medrol ®should not be given in any other way. The introduction of the drug in any way not approved by the developer, is associated with the occurrence of serious adverse events including: arachnoiditis, meningitis, paraparesis / paraplegia, disorders of the sense organs, disorders of bowel and bladder function, seizures, visual impairment, including blindness, eye inflammation and its appendages, residual effects of rejection or foci of necrotic tissue at the injection site;
- since the crystals corticosteroids suppress inflammation reactions, their presence can cause degradation of cellular and extracellular connective tissue cells that rarely appears as a deformation of the skin at the injection site. The extent of these changes depends on the amount of injected corticosteroids. After complete absorption of the drug (usually after several months) there is a complete regeneration of the skin at the injection site;
- to minimize the likelihood of development of atrophy of the skin or subcutaneous tissue, care should be taken not to exceed the recommended dose for parenteral administration. If possible, the affected area should be mentally divided into several sections and each one of them to enter a part of the total dose. In carrying out intra-articular and intramuscular injection must be ensured, so as not to introduce the drug into the skin, or that there was no contact with the drug in the skin, as well as not to accidentally introduce the drug into the deltoid muscle, as this can lead to atrophy of the subcutaneous tissue;
- if patients receiving corticosteroids therapy may undergo or has already been exposed to severe stress, higher doses should be administered corticosteroids speed before, during and after impact;
- GCS can erase the clinical picture of infectious diseases, in their application can develop a new infection. Against the background of SCS therapy may reduce the body's resistance to infection, and impaired body's ability to localize the infection process. The development of infections caused by various pathogenic organisms such as viruses, bacteria, fungi, protozoa or helminths which are located in the various systems of the human body, can be associated with the use of corticosteroids, both as monotherapy and in combination with other drugs - immunosuppressive acting on the cellular immunity, humoral immunity, or neutrophil function. These infections can occur not heavy, but in some cases it is possible for the heavy and even death. Moreover, the higher dose of corticosteroids are applied,the higher the probability of infectious complications. In acute infections should not be administered intra-articularly drug in the joint capsule and tendon sheath muscles; / m introduction is possible after selecting a suitable antimicrobial / antiparasitic therapy;
- long-term use of corticosteroids may develop posterior subcapsular cataract, glaucoma possible lesion of the optic nerve; It increases the likelihood of developing secondary infections caused by fungi and viruses;
- in children receiving corticosteroids therapy for a long time every day, there may be a slowdown in growth. Such administration mode should only be used under the most severe conditions;
- patients receiving treatment with corticosteroids in dosages that provide immunosuppressive effect, contraindicated administering live or live attenuated vaccines. However, patients receiving treatment with corticosteroids at doses that have immunosuppressive action, can be administered to killed or inactivated vaccine; however, the response to the administration of such vaccines can be reduced. Patients receiving treatment with corticosteroids at doses that do not produce an immunosuppressive actions relevant indications of immunization can be conducted;
- use of the drug depot-Medrol ®with active tuberculosis is shown only in cases of focal or disseminated tuberculosis when corticosteroids are administered in combination with an appropriate anti-tuberculosis chemotherapy. If corticosteroids are appointed with latent tuberculosis patients, or in the period of turn tuberculin tests, the dose should be chosen carefully, because reactivation of the disease may occur. During long-term GCS therapy, these patients should receive chemoprophylaxis of TB;
- as in patients receiving corticosteroids therapy, in rare cases of anaphylactic reaction, appropriate precautions should be taken prior to administration, especially if the patient had a history of allergic reactions to any drug. Observed allergic skin reactions were apparently due to inactive components. In rare cases skin tests during the reaction itself at identified methylprednisolone;
- on therapy with corticosteroids may develop a variety of mental disorders: from euphoria, insomnia, mood swings, personality disorders and severe depression to acute psychotic symptoms.
By parenteral administration of corticosteroids should observe the following additional precautions
- when administered intraarticular corticosteroids may occur as systemic and local side effects;
- it is necessary to conduct a study of aspirated joint fluid, to exclude a septic process;
- a significant increase in pain accompanied by local swelling, further restriction of joint movement, fever and tenderness are signs of septic arthritis. When developing this complication, and the diagnosis of sepsis confirmed, topical administration of corticosteroids should be discontinued and appoint adequate antimicrobial therapy;
- should not be administered corticosteroids into the joint, which was once the infectious process;
- corticosteroids should not be administered in unstable joints;
- is necessary to observe the rules of aseptic and antiseptic to prevent infection and contamination;
- it should be noted that the absorption of methylprednisolone with the / m introduction is slower;
- at controlled clinical trials have shown that GCS effectively accelerate the healing process during exacerbation of multiple sclerosis, it is determined that SCS affect the outcome and the pathogenesis of this disease. Studies have also shown that in order to achieve significant effects must be entered sufficiently high doses of corticosteroids;
- as the severity of complications in the treatment of corticosteroids is dependent on the dose and duration of therapy in each case be weighed potential risk and putative positive effect when choosing the dose and duration of treatment, and the choice between the daily administration and intermittent administration rate;
- it is reported that in patients treated with corticosteroids, Kaposi's sarcoma observed. However, clinical remission may occur when you cancel GCS;
- there is no evidence that corticosteroids are carcinogenic or mutagenic effect or impact on reproductive function.
Influence on the ability to drive and drive machinery

Although the employment drug impairment are rare, patients taking DEPO-Medrol ® , caution should be exercised when driving or operating other mechanisms.
OVERDOSE

Clinical syndrome of acute overdose of methylprednisolone acetate does not exist. Repeated frequent application of drug (daily or several times a week) for a long period may lead to development of Cushing's syndrome. It should stop using the product; but be aware that his abrupt withdrawal may lead to "rebound" adrenal insufficiency. Specific treatment is required.
DRUG INTERACTION

Due to the possibility of incompatibility pharmaceutical preparation DEPO-Medrol ® not be diluted or mixed with other solutions.
The following examples of interaction
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