Methylprednisolone for multiple sclerosis
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What is methylprednisolone used for?
Methylprednisolone is a man-made molecule that mimics cortisol, a naturally occurring glucocorticoid hormone with powerful immunosuppressive and anti-inflammatory properties.
Because of its ability to dampen inflammatory responses, methylprednisolone is often used in the treatment of multiple sclerosis (MS) and other immune system disorders.
It is commonly used to manage acute relapses — times when new symptoms appear or existing ones suddenly worsen — in people with MS. It does not slow the overall progression of the disease, but helps to reduce inflammation and speed recovery from relapses.
Methylprednisolone is approved for MS use under the brand names Medrol and Solu-Medrol. Generic versions of this medicine also are available.
Therapy Snapshot
| Brand Name: | Medrol, Solu-Medrol |
| Chemical Name: | Methylprednisolone |
| Usage: | Relapse management therapy for acute MS exacerbations |
| Administration: | Oral and injectable formulations |
How does methylprednisolone work for MS?
MS relapses are driven by new inflammatory activity of certain immune cells, which cause new lesions (regions of damage) or increase the volume of existing lesions in the brain and spinal cord.
Like other corticosteroids, methylprednisolone works mainly by dampening the inflammatory activity of immune cells, decreasing their numbers and the pro-inflammatory signaling molecules they produce.
The medication also reduces the permeability of blood vessels, including the capillaries that form the blood-brain barrier — a highly selective and protective membrane that prevents certain substances and immune cells from entering the brain and spinal cord. This results in fewer inflammatory cells being able to reach and cause damage to these organs.
Methylprednisolone’s mechanism of action is virtually identical to the corticosteroid prednisone. But due to chemical differences, methylprednisolone is generally more potent, so a lower dose is needed to achieve the same effect. Specifically, a 4 mg dose of methylprednisolone is equivalent to a 5 mg dose of prednisone.
Who with MS can take methylprednisolone?
Methylprednisolone is used to control symptoms during acute MS relapses, but the exact regimen — the dose and duration — usually is adapted to a person’s individual needs. Some patients may experience a gradual improvement in symptoms after a relapse and may forgo corticosteroid treatment, avoiding potential side effects.
While the overall safety and efficacy of methylprednisolone are similar in children and adults, the medication can interfere with normal growth in young people. Thus, the growth and development of children on prolonged therapy should be carefully monitored.
Some methylprednisolone formulations that are given via injection — such as Solu-Medrol — contain benzyl alcohol as a preservative. This has been associated with serious adverse events and death, especially in infants.
There are limited data on patients ages 65 and older to determine if they respond differently to corticosteroids. Some studies have not shown any overall differences in safety and efficacy, but methylprednisolone nonetheless should be used with caution in this population.
Research has shown a greater incidence of other medical conditions, called comorbidities, and increased use of additional medications at more advanced ages.
Who should not take methylprednisolone?
Methylprednisolone should not be used by anyone with a known allergy to the medication or any of the components in its formulation. It also is not recommended for patients with an active fungal infection.
Formulations of methylprednisolone administered via injection may include components produced from cow’s milk and should not be given to anyone with a known allergy to dairy products. These formulations also are preserved with benzyl alcohol and, for this reason, should not be given to premature infants.
How is methylprednisolone administered in MS?
Several formulations of methylprednisolone are available: the medication may be taken orally, or given via injection into the bloodstream (intravenous injection) or into the muscle (intramuscular injection).
A number of different protocols may be used to manage relapses in MS, but treatment generally involves a few days of high doses of corticosteroids, such as methylprednisolone, that are given intravenously.
After the initial high-dose treatment, patients then receive gradually lower doses of oral methylprednisolone or other oral corticosteroids for the next several days or weeks. This “tapering off” is recommended because suddenly stopping corticosteroids can cause withdrawal symptoms such as anxiety, sweating, nausea, and insomnia.
According to the label for Solu-Medrol, a daily dosage of 160 mg of methylprednisolone for one week, followed by 64 mg every other day for one month, has been shown to be effective for controlling relapses in MS.
However, dosing may require some fine-tuning in each patient and, during individual relapses, to identify a dose that is high enough to ease MS symptoms, but as low as possible to prevent the potential side effects of corticosteroids.
| Administration | Oral and injectable formulations |
| Dosage | 160 mg for one week, then 64 mg |
| Timing | Daily for initial high dose; every other day for one month for lower dose |
Common side effects of methylprednisolone
The most common side effects of methylprednisolone include:
- swelling and fluid retention
- alterations in glucose tolerance (how the body processes sugar)
- increased blood pressure
- changes in mood and behavior
- increased appetite and weight gain
- neurological issues such as headache or dizziness
- menstrual irregularities
- abdominal pain and bloating
- muscle weakness and pain
Blood pressure and fluid retention
Corticosteroids can cause the body to retain water and salt, while increasing the excretion of calcium and potassium. They also can increase blood pressure. Blood pressure and salt levels should be monitored during treatment.
Behavioral and mood disturbances
Methylprednisolone can cause mood and behavioral changes, such as:
- euphoria
- trouble sleeping
- mood swings
- depression
- changes in personality
- psychosis
These emotional issues also may worsen due to corticosteroid therapies.
Hormonal changes
Corticosteroids like methylprednisolone mimic the activity of a naturally occurring hormone called cortisol, and may increase the risk of hormone-related problems that should be monitored. These may include the following:
- Cushing’s syndrome, which occurs due to excessive cortisol levels in the body, high blood sugar.
- hypothalamic-pituitary-adrenal (HPA) axis suppression. In HPA, the body makes too little cortisol because it senses high levels of this hormone in circulation.
Infections and cancer
Because methylprednisolone works to reduce the activity of the immune system, it can increase the risk of infections and worsen pre-existing ones. It also can mask symptoms of an infection, because some obvious signs of infection (e.g., fever) are caused by the immune system’s response and not by the infectious agent.
Special caution is advised in patients who have never had chicken pox (varicella) or measles, as these viral infections may have serious consequences for patients on corticosteroids.
Patients on corticosteroids also should be monitored for a type of cancer called Kaposi’s sarcoma, associated with the gastrointestinal tract. In some cases, discontinuing the therapy may be sufficient for the immune system to clear out this cancer.
Vaccination
Because methylprednisolone reduces immune activity, it may compromise a person’s ability to respond to vaccinations and mount effective immune responses once exposed to the threat. Vaccines containing live or attenuated (weakened) viruses are not recommended for patients receiving immunosuppressive doses of methylprednisolone; killed or inactivated vaccines can be administered.
Eye problems
Prolonged use of methylprednisolone can increase the risk of eye infections and other eye problems like cataracts and glaucoma. Patients with herpes simplex, a type of eye infection, should use the medication with caution, as it may cause a tear in the cornea, the transparent layer at the front of the eye.
Heart and gastrointestinal perforations
Methylprednisolone also may increase the risk of gastrointestinal perforation — a tear in the digestive tract — in people with certain gastrointestinal conditions, though signs of such perforation may be minimal or absent.
In patients who recently experienced a heart attack, the use of corticosteroids may increase the risk of rupture in the heart’s chambers. These patients should use methylprednisolone with extreme caution.
Decreased bone density and slowed growth
By lowering calcium levels in the body, corticosteroids like methylprednisolone can decrease bone formation and lead to osteoporosis — a condition in which bones are more fragile and break easily. The medications also can interfere with bone growth in children and adolescents, who should be monitored closely during treatment for alterations in growth and development.
Skin changes
Injectable formulations of methylprednisolone may cause skin changes at the injection site, usually in the form of depressions. Patients should not exceed the recommended doses of methylprednisolone to avoid potential skin problems.
Use in pregnancy and breastfeeding
Methylprednisolone has not been well-studied during pregnancy in humans, but research in animals suggests that it may cause toxicity to the developing fetus. A decision on whether or not to use this medicine during pregnancy should be made by carefully weighing the potential benefits and risks. Patients should discuss this treatment with their physicians and care team.
Close monitoring is recommended for children exposed to methylprednisolone during pregnancy.
According to methylprednisolone’s label, the medication can pass into breast milk and cause unwanted side effects in nursing babies, including hormonal problems and slowed growth. Patients who are nursing should discuss with their healthcare team whether to breastfeed or take methylprednisolone.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
FAQs about methylprednisolone in MS
Methylprednisolone is a corticosteroid that is used to manage acute relapses in people with multiple sclerosis (MS), which are periods when symptoms suddenly worsen or new symptoms appear. It works by reducing inflammation, which can ease symptoms and accelerate the recovery from MS relapses, though it does not affect overall disease progression.
Methylprednisolone may cause harm to a developing fetus and should only be used during pregnancy if its potential benefits outweigh the risks. Patients and their healthcare providers should discuss these decisions in detail based on their unique situation.
There is no known direct interaction between alcohol and methylprednisolone. However, methylprednisolone can make the stomach and intestines more susceptible to the irritating effects of alcohol, which increases the risk of ulcers. Patients should ask their healthcare team whether it’s safe to drink alcohol while on methylprednisolone.
For people experiencing a multiple sclerosis (MS) relapse, treatment with methylprednisolone can lead to benefits within a few days, with more substantial progress often seen in the following weeks. Still, the timeline for seeing improvements can vary significantly from person to person.
Increased appetite and weight gain are common side effects of corticosteroids, and thinning scalp hair is also indicated on methylprednisolone’s label as a possible side effect. Patients should talk with their healthcare provider if they experience any unanticipated side effects while on the medication.
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