Medrol 4mg Pfizer anti -inflammatory, treat hormonal disorders, thyroiditis (3 blisters x 10 tablets)

Used in serious phase or for maintenance treatment in selective cases of:

Serious and acute chronic and acute allergies in the eyes and appendages of the eye such as:

Temporary treatment in:

To help the urinary tract and reduce protein in the nephrotic syndrome, there is no balance with high blood urea, or nephrotic syndrome caused by scattered lupus erythematosus.

Gastrointestinal disease:

Used to bring patients over the crisis of the disease in:

Serious acute cases of multiple sclerosis.

Cases suitable for brain tumors.

Tripit transplant

Other indications:

Meningococcal tuberculosis has clogged subarachia cavity or threatening to simultaneously use appropriate tuberculosis chemotherapy.

Twisted worms related to myocardial and nerves.

Pharmacokic

methylprednisolon is a steroid that has anti -inflammatory effects. Its anti -inflammatory effect is better than prednisolon and tends to cause less sodium and water. The relative effect of methylprednisolon is at least 4 times the hydrocortisone.

pharmacokinetic pharmacokinetics

Metabolic pharmacokinetics of linear methylprednisolon, regardless of the line.

absorption

Methylprednisolon is quickly absorbed and reaches a peak concentration in plasma about 1.5 - 2.3 hours in all doses after drinking in normal healthy adults. The absolute bioavailability of methlyprednisolon on normal, healthy people is generally high (82 - 89%) after drinking.

Distribution

Methylprednisolon is widely distributed in tissues, through the bloodstream barrier and secreted into the milk. The apparent distribution of the drug is about 1.4L/kg. Methylprednisolon is attached to human plasma proteins at about 77%.

Metabolism

In humans, methylprednisolon is metabolized in the liver into inactivated metabolites, the main metabolites are 20α-hydroxymethylprednisolon and 20β-hydroxy-a-methylprednisolon. The process of metabolism in the liver is mainly through the CYP3A4 enzyme (see the list of drug interactions due to metabolism through CYP3A4 intermediaries in the interaction section with other drugs and other forms of interactions).

Like many types of substrates of CYP3A4, methylprednisolon may be a substrate for p-glycoprotein, box shaped protein attached to ATP (ABC), affecting the distribution in tissue and interacting with other drugs.

Elimination

Methylprednisolon's average semi -discharged lifetime is about 1.8 - 5.2 hours. Overall elimination speed is about 5 - 6ml/min/kg.

No dose adjustment in people with renal failure. Hemorrhaging for methylprednisolon can be separated.

Precautions when using

The effect of inhibiting immunity/increasing sensitivity to bacterial diseases

corticosteroids may increase infection sensitivity, cover some bacterial signs, and new infections may occur when using corticosteroids. This may reduce resistance and lose their localities of infection when using corticosteroids.

Pathogenic microorganisms include viral, bacteria, fungi, single or helminths in any position of the body, which may be related to the use of separate corticosteroids or in combination with other immunosuppressants that have an impact on cell immune, immune immune or neutral leukemia. These infections may be mild, but can also be serious, sometimes fatal. When increased the dose of corticosteroids, the rate of complications due to infections increases.

Patients are taking the immune system inhibitors more susceptible to infections than others. For example, in children or adults without immunity using corticosteroids when suffering from chickenpox and measles may be worse and even death.

can use dead vaccines or vaccines for patients who are taking corticosteroids with immunosuppressive doses; However, response to these vaccines can decrease. Immune methods may be used for patients who are taking corticosteroid immunosuppressants.

It is necessary to limit the use of corticosteroids in active tuberculosis, in cases of scattered or violent tuberculosis, in which corticosteroids are used to manage the disease, combined with appropriate tuberculosis anti -tuberculosis regime. When corticosteroid is indicated in potential tuberculosis patients or reacting with tuberculin, it is necessary to observe very closely because the disease may recur. If used for prolonged corticosteroids, these patients need to prevent antiviral drugs.

There have been reports on Sarcom Kaposi in patients with corticosteroid therapy. When stopping corticosteroids, it may be clinically relieved.

The role of corticosteroids in infections is unclear, initial studies show that both beneficial effects as well as adverse effects. Recently, the supplementation of corticosteroids has been thought to be beneficial for patients to be identified as bacterial shock and adrenal disabilities.

However, the regular use of corticosteroids in infections is not recommended and a systematic assessment concluded that high -dose corticosteroids in a short time did not work. However, through general analysis and evaluation, the use of low doses of corticosteroids for a longer period of time (5-11 days) can reduce death, especially in patients with bacterial shock, which must be used with vasoconstrictor drugs.

immune system

may occur allergic reactions (eg angiography).

Because some rare cases of skin allergies and anaphylaxis/anaphylactic reactions occur in patients treated with corticosteroid therapy, appropriate precautions should be taken before treatment, especially for patients with a history of allergies for any drug.

Endocrine

In patients who are in the period of corticosteroid treatment that is under abnormal pressure, need to be indicated to increase the dose of corticosteroids quickly before, during and after that pressure.

When using corticosteroids in the dose, pharmacological effects for a long time can lead to inhibition of hypothalamus axes - pituitary - adrenal gland (HPA) (secondary adrenal energy). The level and time of secondary adrenal insufficiency vary between patients and depends on the dose, frequency, use time and the time of treatment with glucocorticoid therapy. This effect can be minimized by using alternating treatment therapy. (See the dosage and usage - Interlacious treatment). In addition, adrenal disabilities also lead to death if stopped using glucocorticoids suddenly.

Secondary adrenal energy is because the drug can be minimized by gradually reducing the dose. This type of adrenal disability may survive months after stopping the drug; Therefore, in any stress occurs during this period, hormone therapy should be started again. Because mineral corticosteroid secretions may be reduced, indicated simultaneously with salt and/or a mineral corticosteroid.

Steroid "sudden stop syndrome" is not related to adrenal insufficiency may appear after stopping using glucocorticoid. This syndrome includes symptoms such as anorexia, nausea, vomiting, coma, headache, fever, joint pain, peeling, muscle pain, weight loss and/or hypotension. These effects are thought to be due to a sudden change in glucocorticoid levels than low corticosteroids. Because glucocorticoid can cause or worsen the Cushing syndrome, do not use glucocorticoids for patients with Cushing disease.

The effect of corticosteroids increases in thyroid disabilities.

Metabolism and nutrition

Corticosteroids including methylprednisolon may increase blood glucose, making diabetes worse and if used for corticosteroids for a long time can lead to diabetes.

Mental

Mental disorder may appear when using corticosteroids, from refreshment, insomnia, mood change, oscillation and severe depression to real mental manifestations. Unstable emotions or mental trends may also be more severe by corticosteroids.

The ability to experience unwanted mental effects that can occur when using steroids by systemic lines (see unwanted effects, mental disorders). Special symptoms appear for a few days or the first few weeks of treatment. Most of the reactions are lost when reducing the dose or stopping the drug, although it is necessary to have specific treatments.

Mental effects have been reported when stopping corticosteroids; Do not know the frequency. Patients/medical staff should be noted if the mental manifestations appear in patients, especially if they suspect depression or intent on suicide. The patient/medical staff should be warned that mental disorders may occur during treatment or immediately after reducing the dose or stopping steroids in systemic.

Nervous system

Be cautious when taking corticosteroids in patients with seizures.

Be cautious when taking corticosteroids in patients with severe muscle weakness (see more information about muscle disease in the item affecting skeletal muscle).

Although controlled clinical trials have shown that corticosteroids have a quick effect in the treatment of exacerbated multi -sclerosis, these tests show that corticosteroids do not affect the final result or natural development of the disease. Studies show that the relatively high corticosteroid dose is required to have a clear effect. (See the dosage and usage).

There have been reports on epidural fat accumulation in patients using corticosteroids, usually high doses for a long time.

Eyes

Be cautious when taking corticosteroids in patients with herpes simplex in the eye because it can cause corneal puncture.

Use of corticosteroids for a long time can cause cataracts under the following bags and cataracts in the center (especially in children), convex eyes, or intraocular pressure that can lead to glaucoma that can be destroyed with visual neurological nerves. In patients with glucocorticoids may increase fungal infections or secondary viruses in the eye. Corticosteroid therapy has been related to the central retinopathy, which can lead to retina.

heart

The adverse effects of glucocorticoids for the cardiovascular system, such as dyslipidemia and hypertension, can cause patients to be being treated and have cardiovascular risk factors to suffer more effects on the cardiovascular disease, if treated with high and prolonged doses. Therefore, it is necessary to use corticosteroids cautiously in these patients and pay attention to the implementation of risks and follow the heart for further monitoring if necessary. Low doses and Japanese ways can reduce complications in corticosteroid therapy.

In case of congestion heart failure, should be cautious when using systemic corticosteroids and only use only when special needed.

circuit

Be cautious when taking corticosteroids in high blood pressure patients.

digestive

There is no common concept that corticoteroids are responsible for gastrointestinal ulcers during treatment, however, using glucocorticoids can cover the symptoms of gastrointestinal ulcers, causing perforation or bleeding without obvious pain. Increased risk of developing gastrointestinal ulcers when used in combination with nonsteroidal anti -inflammatory drugs (NSAID).

Be cautious when using corticosteroids in non-specific colon ulcers if there is a threat of perforation, abscess or other pus infections; Inflammation of redundant bags, new small intestinal connectivity, or have a history of gastrointestinal ulcer.

honey

Corticosteroid high doses can cause acute pancreatitis.

skeletal muscle

There have been a report on acute muscle disease when using high doses of corticosteroids, which often occurs in patients with neurotrotomic disorders (for example, severe muscle weakness) or on patients who are taking cholinergic drugs such as neurotransmitter (e.g. pancuronium). This acute muscle disease spreads, may be related to eye muscles, respiratory muscles and can lead to paralysis. The increase in creatinine kinase may occur. In order to have clinical or recovery progress, it is necessary to stop the drug within a few weeks to a few years.

Osteoporosis is a common harmful effect, but it is less noticeable when using high and prolonged doses of glucocorticoids.

Kidney and urinary tract

Be cautious when using corticosteroids in patients with renal failure.

Studies

Trauma, poisoning and surgical complications

Do not use high doses of corticosteroids by systemic lines to treat brain injury wounds.

Other warnings

Due to complications when treating with glucocorticoid depends on the dose and duration of treatment, the decision on treatment must be based on the consideration between the risk/benefit with each specific case and the duration of treatment must also be considered or used daily or using distance.

Should take the lowest dose of corticosteroids to control the treatment situation, and when the dose can be reduced, it should be gradually reduced.

Aspirin and nonsteroidal anti -inflammatory drugs should be used cautiously when combined with corticosteroids.

Chrome -preferred cell tumor can be reported after using corticosteroids by systemic lines. Corticosteroids should only be used for suspected patients or have been determined to have chromium cell tumors after evaluating the appropriate risk/benefit.

Use for children

Should carefully monitor the development and growth of children when using prolonged corticosteroid therapy.

Children may grow slowly when using glucocorticoid daily for a long time. The use of this therapy with a small dosage should be limited, only for the most urgent indication. This side effect can be avoided or minimized when using glucocorticoid therapy. (See the dosage and usage - Interlacious treatment).

Babies and children are treated with long -term corticosteroids, especially at risk of increased intracranial pressure.

Corticosteroid high doses can lead to pancreatitis in children.

The ability to drive and operate machinery

The effect of corticosteroids on the ability to drive and operate machines has not been systematically assessed. Unwanted effects, such as dizziness, dizziness, visual disorders and fatigue can occur after corticosteroid treatment. If affected, patients should not drive or operate machinery.

Pregnancy and lactation

reproductive ability

There is no evidence that corticosteroids have the effect of reducing fertility (see section of clinical safety data).

Pregnancy

Some animal studies have shown that corticosteroids for mothers in high doses can cause teratogenic. However, it seems that corticosteroids do not cause birth defects when used for pregnant women.

Despite such results on animals, it seems that it is less likely to harm the fetus when taking the drug during pregnancy. There are no adequate studies on humans with corticosteroids. Because there is no sufficient evidence of safety for pregnant women, only this medication is used for pregnant women when they are really necessary. Some corticosteroids easily pass the placenta. A rescue study showed that there was an increase in the proportion of underweight babies in mothers using corticosteroids.

Infants from the mother who used corticosteroids in significant doses during pregnancy should be carefully monitored and evaluated about the signs of adrenal insufficiency, although rare cases of adrenal insufficiency in infants are exposed to corticosteroids right from the uterus.

It is unknown the effect of corticosteroids on the process of giving up and giving birth. The cataract has been observed in infants from mothers treated for prolonged corticosteroids during pregnancy.

Breastfeeding period

corticosteroids are excreted through breast milk. The distribution of corticosteroids into breast milk can inhibit growth and hinder the production of endogenous glucocorticoids in breastfeeding children. Because there is no adequate research on the effects of glucocorticoids on fertility, only medication for women who are breastfeeding if they see the benefits of the mother than the risk of their children.

Drug interaction

methylprednisolon is the substrate of the cytochrom P450 enzyme (CYP) and is mainly metabolized by CYP3A4 enzyme. CYP3A4 is the main enzyme of most of the CYP stools in the liver in adults. It catalyzes the process of 6β - hydroxylation steroid, phase I is essential in metabolic steps for both endogenous and synthetic corticosteroids. There are also many other substances that are also the substrate of CYP3A4, some of these (as well as other drugs) that change the metabolism of glucocorticoid by causing induction (increased air conditioning) or inhibiting CYP3A4 enzyme.

CYP3A4 inhibitors: CYP3A4 activated inhibitors generally reduce the clearance of the liver and increase the concentration of the drugs that are the substrate of CYP3A4 such as methylprednisolon in plasma. If there are CYP3A4 inhibitors, methlyprednisolon should be standard to avoid steroid poisoning.

CYP3A induction substances: CYP3A4 induction drugs generally increase the clearance of the liver, leading to a reduction in the concentration of the medications that are the substrate of CYP3A4. Methylprednisolon may be increased when used with these drugs to achieve the desired treatment results.

substances that are substrate of CYP3A4: If there are substances that are substrate of CYP3A4, the liver clearance process of methylprednisolon may be affected, so the corresponding adjustment of the dose of methylprednisolin. It is possible that the reactions are harmful when used each of one of the two drugs that will occur more easily when used simultaneously.

Medications without intermediaries CYP 3A4: Interactions and other influences occur with methylprednisolon presented in Table 1.

Table 1 includes common or important drug interactions with methylprednisolon.

Table 1: Important interactions/effects of drugs or active ingredients with methylprednisolon.