Solumedrol side effects

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Solu-Medrol etc. (I.V. Methylprednisolone) remains the preferred treatment for many medical conditions including severe rheumatoid arthritis flares, flares of systemic lupus erythematosus, vasculitis, moderate to severe MS relapses.

The most typical regimen involves high-dose intravenous infusions (either in the hospital or as an outpatient) for 3 days, followed by oral prednisone given for about 12 days with tapering doses.

Corticosteroids are synthetic drugs that closely resemble cortisol, a hormone that is naturally produced by the adrenal glands. Corticosteroids work by decreasing immune system antibody production and lymphocyte activation.

Methylprednisolone is stronger than prednisone. Other corticosteroids include prednisolone (a derivative of prednisone that has been chemically changed for easy passage through the liver); hydrocortisone (weaker in strength than prednisone); and dexamethasone (which is extremely potent and is only used in unusual circumstances).

Although steroids can be remarkably fast-acting, life saving drugs, they often cause many unwanted side effects. Some of the more common side effects include acne, development of a round or

moon-shaped face, weight gain, high blood pressure, thinning of the bones (osteoporosis), increased risk of diabetes, and an increased risk of infection. In general, there is a close relationship between steroid side effects and the dose and duration of their use, and for this reason steroid dosage should always be kept at the lowest effective level. In addition, steroids should never be stopped suddenly as the adrenal glands will need time to regain their ability to manufacture natural cortisone.

J Endocrinol Invest. 2002 Feb;25(2):129-33.

Effects of high doses of corticosteroids on bone metabolism.

Ardissone P, Rota E, Durelli L, Limone P, Isaia GC.

Department of Internal Medicine, University of Turin, Italy.

The effects of a chronic treatment with corticosteroids on bone are well known, but few data are available regarding the acute effect of these drugs on bone turnover. This study was aimed at evaluating the effects of high doses of corticosteroids administered for a short period on bone metabolism. We assessed 23 subjects (15 women and 8 men) suffering from multiple sclerosis and treated with methylprednisolone (1 g i.v. for 10 days) followed by oral prednisone for 9 days; patients affected by diseases involving bone or treated during the previous 6 months with drugs influencing bone metabolism were excluded. We observed a significant decrease of ALP and bone glia protein (BGP), in these subjects, and a significant sudden increase of urinary calcium/creatinine and urinary cross-laps after 3 days of treatment. All of these parameters, except urinary calcium/creatinine, returned to basal levels after 30 days from the beginning of treatment (11 days after the interruption of corticosteroids administration). Serum phosphorus showed a significant decrease after 3 days of treatment, but returned to basal levels after 10 days. These data suggest that high doses of corticosteroids administered for a short period are able to induce an increase of bone resorption and a decrease of bone formation; moreover, bone turnover returns to basal levels when the treatment is stopped.

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