Corticosteroid

Methylprednisolone (Solu-Medrol)

Also called Solu-Medrol

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Indications

• Asthma and COPD exacerbations when oral prednisone cannot be taken
• Anaphylaxis and angioedema, as an adjunct to epinephrine (weak evidence)
• Early moderate to severe ARDS (off-label)
• Post-extubation stridor prevention after a failed cuff-leak test, at least 4 h before extubation (off-label)
• Pulse therapy (up to 1 g a day for 3–5 days) for multiple sclerosis relapse or lupus flares
• Transplant rejection, vasculitis and severe checkpoint-inhibitor toxicity (off-label)

Dosing

On the quick cards

• Systemic corticosteroids (-sone, -solone)NCLEX Drug Classes: Inflammation, autoimmune flares, adrenal replacement
• Corticosteroid equivalenceEquivalents and Conversions: Glucocorticoid doses with the same anti-inflammatory effect

Mechanism of action

Methylprednisolone binds the cytoplasmic glucocorticoid receptor, which moves to the nucleus and switches anti-inflammatory and metabolic genes on, or tethers NF-κB and AP-1 to switch cytokines, adhesion molecules, COX-2 and inducible NO synthase off; these genomic effects take hours. Receptors are nearly saturated above about 100 mg of prednisone-equivalent a day (80 mg of methylprednisolone), so the extra effect of pulse doses is credited to non-genomic actions: membrane-bound receptors, signaling proteins released from the receptor complex and direct membrane effects that damp immune cells within minutes.

Pharmacology

• Respiratory: reduces airway inflammation, edema and mucus and restores β2-receptor responsiveness; benefit takes hours, so give it early
• Immune: lymphocytes and eosinophils fall within hours; high doses suppress T-cell and antibody responses
• Renal: per mg it has 5 times the glucocorticoid and half the mineralocorticoid potency of hydrocortisone, so an equivalent dose (4 mg for 20 mg) carries a tenth of the salt retention
• Metabolic: hyperglycemia, often marked after pulses; protein catabolism

Pharmacokinetics

Chemistry

• 6α-methylprednisolone: the 1,2 double bond adds glucocorticoid potency and slows metabolism, and the 6α-methyl group lowers salt retention below prednisolone's
• A neutral, lipophilic steroid nearly insoluble in water; the IV form is the 21-sodium succinate ester, buffered to pH 7–8
• Solu-Medrol 40 mg (with cow's milk lactose) and 125 mg vials are preservative-free; some larger vials contain benzyl alcohol. Use within 48 h of mixing, 4 h once diluted (24 h refrigerated)
• Depo-Medrol (the acetate) is a depot suspension for IM or joint injection only, never IV

Adverse effects and cautions

In the one-pagers

• Diagnostic Tests and Procedure PrepContrast: metformin, allergy and kidneys: Allergy (ACR): a prior allergic-like reaction to the same class of contrast raises the risk about fivefold and is the strongest predictor. Other allergies and asthma raise it modestly and do not justify premedication or withholding contrast, and shellfish or povidone-iodine allergy is no more a risk than any other allergy. There is no cross-reactivity betw

Other corticosteroid drugs

• Hydrocortisone
• Dexamethasone

Sources

1. FDA label: Solu-Medrol (2025)
2. UK SmPC: Solu-Medrone (2026)
3. Buttgereit 2002 (non-genomic effects)
4. AANS/CNS spinal cord injury guideline (2013)

For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow the order, the label and your institution's protocols.