Which is better: Medrol or Metipred?

Comparison of the effectiveness of Medrol and Metipred

The effectiveness of Medrol is quite similar to Metipred - this means that the ability of the drug substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Medrol is more pronounced, then using Metipred even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of therapeutic action - is approximately the same for Medrol and Metipred. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

Metypred

— Since complications of methylprednisolone therapy depend on the dose and duration of treatment, in each specific case, based on an analysis of the “benefit/risk” ratio, a decision is made on the need for GCS therapy, and the duration of treatment and frequency of administration are determined.

· The minimum effective dose of the drug should be used to ensure a sufficient therapeutic effect; if necessary, the dose should be reduced gradually.

— During GCS therapy, the development of various mental disorders is possible: from euphoria, insomnia, mood instability, personality changes and severe depression to acute psychotic manifestations. In addition, existing emotional instability or a tendency to psychotic reactions may increase.

- Potentially severe mental disorders may occur with the use of methylprednisolone. Symptoms usually appear within a few days to weeks after starting therapy. Most reactions disappear either after reducing the dose or after discontinuation of the drug. Despite this, specific treatment may be required. Psychiatric disturbances have been reported in association with discontinuation of methylprednisolone therapy; the frequency of these effects is not known.

— Patients and/or their relatives should be warned that if changes occur in the patient’s psychological status (especially with the development of depression and suicidal attempts), it is necessary to seek medical help. Patients or their relatives should also be warned about the possibility of developing mental disorders during or immediately after reducing the dose of the drug or completely stopping it.

- For patients who may be exposed to stress during GCS therapy, an increase in the dose of the drug is indicated before, during and after a stressful situation.

— Although controlled clinical studies have shown that methylprednisolone is effective in accelerating the recovery process during exacerbation of multiple sclerosis, it has not been established that methylprednisolone affects the outcome and pathogenesis of this disease. Studies have also shown that sufficiently high doses of methylprednisolone must be administered to achieve a significant effect.

— There are reports of the development of epidural lipomatosis in patients receiving methylprednisolone. Usually with long-term therapy at high doses.

- In patients receiving immunosuppressive doses of methylprednisolone, live or live attenuated vaccines are contraindicated, but killed or inactivated vaccines can be given, although the response to such vaccines may be reduced. Patients receiving treatment with methylprednisolone in doses that do not have an immunosuppressive effect may be immunized according to appropriate indications.

— During GCS therapy, some infections may occur in an erased form, in addition, new infections may develop. When using methylprednisolone, it is possible to reduce resistance to infections, and also reduce the body's ability to localize the infectious process. The development of infections caused by various pathogenic organisms, such as viruses, bacteria, fungi, protozoa or helminths, which are localized in various systems of the human body, may be associated with the use of methylprednisolone, both as monotherapy and in combination with other immunosuppressants affecting cellular immunity, humoral immunity or neutrophil function. These infections can be mild, but in some cases they can be severe and even fatal. Moreover, the higher doses of methylprednisolone are used, the higher the likelihood of developing infectious complications.

- The use of methylprednisolone in active tuberculosis should be limited to cases of fulminant disseminated tuberculosis, when GCS are used to treat the disease in combination with appropriate anti-tuberculosis chemotherapy. If the drug is prescribed to patients with latent tuberculosis or positive tuberculin tests, then treatment should be carried out under strict medical supervision, since activation of the process is possible. During long-term treatment with methylprednisolone, such patients should receive appropriate prophylactic treatment.

· The drug should be used with caution in case of eye damage caused by the herpes simplex virus, due to possible perforation of the cornea.

- GCS, including methylprednisolone, can lead to an increase in blood glucose concentrations, worsen the course of existing diabetes mellitus and, with long-term therapy, can lead to a predisposition to diabetes mellitus.

- Long-term use of methylprednisolone can lead to the occurrence of posterior subcapsular cataracts, glaucoma with possible damage to the optic nerve and provoke the addition of a secondary ocular fungal or viral infection.

· Methylprednisolone therapy can lead to the development of central serous chorioretinopathy, which in turn can lead to retinal detachment.

— Children receiving long-term therapy with methylprednisolone are at increased risk of developing intracranial hypertension.

- The use of high doses of methylprednisolone can lead to the development of pancreatitis in children.

- Allergic reactions (for example, angioedema) may develop. When using methylprednisolone, precautions should be taken, especially in patients with a history of allergic reactions to drugs.

- Medium and large doses of hydrocortisone or cortisone may cause increased blood pressure, sodium and water retention, and increased potassium excretion. These effects are less likely to occur with the use of synthetic corticosteroids (including methylprednisolone), except when used in high doses. It is necessary to limit the consumption of table salt with food and prescribe potassium supplements. All corticosteroids increase calcium excretion.

— Systemic corticosteroids, including methylprednisolone, are not indicated and should not be used for the treatment of traumatic brain injury. An increase in mortality was found at 2 weeks or 6 months after head injury in patients treated with methylprednisolone sodium succinate. There was no direct association with the administration of methylprednisolone sodium succinate.

— Osteoporosis is a common and, at the same time, rarely diagnosed adverse reaction that develops with long-term use of high doses of methylprednisolone.

- Children receiving the drug for a long time daily, several times a day, may experience growth retardation, so this dosage regimen should be used only for absolute indications. The use of alternating therapy usually avoids or minimizes this adverse reaction. When methylprednisolone is used in children, patients should be closely monitored for normal growth and development.

— Manifestations of secondary adrenal insufficiency that develop during GCS therapy can be minimized by gradually reducing the dose. This type of relative deficiency may persist for several months after the end of treatment, so methylprednisolone should be reintroduced during this period in any stressful situations.

Since the secretion of mineralocorticosteroids may be impaired, electrolytes and/or mineralocorticosteroids should be administered simultaneously.

— There is a more pronounced effect of methylprednisolone in patients with hypothyroidism and cirrhosis of the liver.

— Patients receiving drugs that suppress the immune system are more susceptible to infections than healthy people. For example, chickenpox and measles may be more severe and even fatal in unimmunized children or in adults receiving methylprednisolone.

— There is no consensus on the likelihood of developing peptic ulcers during methylprednisolone therapy. Methylprednisolone therapy may mask the symptoms of a peptic ulcer, which may result in perforation or bleeding without significant pain. GCS therapy may mask symptoms of peritonitis, as well as other signs and symptoms associated with gastrointestinal dysfunction, such as perforation, obstruction and pancreatitis. When used simultaneously with NSAIDs, the risk of gastrointestinal ulcers increases.

- The use of methylprednisolone in high doses can lead to the development of acute pancreatitis.

— There are reports of the development of reversible liver damage, which is relieved by discontinuation of therapy. In this regard, appropriate monitoring should be carried out.

- Undesirable reactions of methylprednisolone from the cardiovascular system, such as dyslipidemia, increased blood pressure, can provoke new reactions in predisposed patients in the case of high doses of methylprednisolone and long-term treatment. In this regard, methylprednisolone should be used with caution in patients predisposed to cardiovascular diseases and special attention should be paid to additional monitoring of the state of the cardiovascular system.

- Cases of thrombosis, including venous thromboembolism, have been reported with the use of GCS. Therefore, GCS should be used with caution in patients with current thromboembolic complications or who are predisposed to developing these complications.

- Methylprednisolone should be prescribed with caution for ulcerative colitis, if there is a threat of perforation of the walls of the gastrointestinal tract, the development of an abscess or other purulent infection, as well as for diverticulitis, in the presence of fresh intestinal anastomoses, with active or latent peptic ulcers, renal failure, arterial hypertension, osteoporosis, myasthenia gravis.

— Cases (including fatalities) of the development of crises have been reported in patients suffering from pheochromocytoma receiving systemic therapy with corticosteroids, including methylprednisolone. In patients with suspected or confirmed pheochromocytoma. Methylprednisolone should only be used after a careful benefit/risk assessment.”

— There have been cases of the development of Kaposi's sarcoma in patients receiving GCS therapy (after discontinuation of GCS, clinical remission may occur).

— The effectiveness of methylprednisolone in septic shock is questionable. The results of a systematic review of the use of the drug in short courses at high doses do not support its use in this regimen. However, it is assumed that the use of methylprednisolone in long courses (5-11 days) in low doses may reduce mortality.

- When using methylprednisolone in therapeutic doses for a long period, suppression of the hypothalamic-pituitary-adrenal system (secondary adrenal insufficiency) may develop. The degree and duration of adrenal insufficiency is individual for each patient and depends on the dose, frequency of use, time of administration and duration of therapy. The severity of this adverse reaction can be reduced by using the drug every other day or by gradually reducing the dose (see section “Dosage and Administration”).

- In addition, the development of acute adrenal insufficiency, leading to death, is possible with abrupt withdrawal of methylprednisolone.

- Caution must be exercised in patients with systemic scleroderma due to the fact that an increased incidence of acute scleroderma nephropathy has been observed when taking GCS, including methylprednisolone.

- Since methylprednisolone may enhance the clinical manifestations of Cushing's syndrome, the use of methylprednisolone should be avoided in patients with Cushing's disease.

— Acute myopathy most often develops with the use of high doses of methylprednisolone in patients with impaired neuromuscular transmission (for example, with myasthenia gravis), or in patients simultaneously receiving n-anticholinergics, such as peripheral muscle relaxants (for example, pancuronium bromide). This acute myopathy is generalized and can affect the muscles of the eyes and respiratory system, leading to the development of tetraparesis.

Possible increase in creatine kinase activity. However, improvement or recovery after discontinuation of methylprednisolone may occur only after many weeks or even several years.

- Withdrawal syndrome, apparently not related to adrenal insufficiency, can also occur due to abrupt withdrawal of methylprednisolone.

This syndrome includes symptoms such as anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, skin peeling, myalgia, weight loss and/or decreased blood pressure. It is assumed that these symptoms occur due to sharp fluctuations in the concentration of methylprednisolone in the blood plasma, and not due to a decrease in the concentration of methylprednisolone in the blood plasma.

— The carcinogenic and mutagenic effects of the drug, as well as its adverse effects on reproductive functions, have not been established.

Comparison of the safety of Medrol and Metipred

The safety of a drug includes many factors.

At the same time, with Medrol it is quite similar to Metipred. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing metabolism in Medrol, as well as in Metipred, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Medrol does not have any risks when used, just like Metipred.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Medrol and Metipred.

Metypred 4 mg No. 30 tablet.

Instructions for medical use of the drug METIPRED Trade name Metipred International nonproprietary name Methylprednisolone Dosage form Tablets, 4 mg and 16 mg Composition One tablet contains the active substance - methylprednisolone 4 mg or 16 mg, excipients: lactose monohydrate, corn starch, gelatin, magnesium stearate , talc Description Tablets are round in shape, with a flat surface, with beveled edges, white or almost white, scored on one side, with a diameter of 6.9 to 7.3 mm (for a dosage of 4 mg). Tablets are round in shape, with a flat surface, with beveled edges, white or almost white, with a score on one side, with “ORN” and “346” engraved on both sides of the score, with a diameter of 8.9 to 9.3 mm (for a dosage of 16 mg). Pharmacotherapeutic group Hormonal drugs for systemic use (excluding sex hormones). Corticosteroids for systemic use. Glucocorticosteroids. Methylprednisolone. ATC code H02AB04 Pharmacological properties Pharmacokinetics The bioavailability of methylprednisolone when taken orally is usually more than 80%, but may be lower when large doses are prescribed. Peak serum concentrations occur within 1–2 hours, with an average half-life of 2–3 hours. The association of methylprednisolone with plasma proteins is 77%, the association with transcortin is insignificant. Volume of distribution – 1–1.5 l/kg. Methylprednisolone is metabolized to inactive metabolites. The specific CYP enzymes responsible for its conversion are not known. The average clearance is 6.5 ml/kg/min. The duration of the anti-inflammatory effect is 18–36 hours. About 5% of the drug is excreted from the body in the urine. Pharmacodynamics The effect of Metipred, like other glucocorticoids, is realized through interaction with steroid receptors in the cytoplasm. The steroid receptor complex is transported into the cell nucleus, binds to DNA and changes gene transcription for most proteins. Glucocorticoids inhibit the synthesis of numerous proteins, various enzymes that cause joint destruction (in rheumatoid arthritis), as well as cytokines that play an important role in immune and inflammatory reactions. They induce the synthesis of lipocortin, a key protein in the neuroendocrine interaction of glucocorticoids, which leads to a decrease in the inflammatory and immune response. Glucocorticoids, including Metypred, suppress or prevent the development of tissue responses to many thermal, mechanical, chemical, infectious and immunological agents. Thus, glucocorticoids act symptomatically, reducing the manifestations of the disease without affecting the cause. The anti-inflammatory effect of the drug is at least 5 times greater than the effectiveness of hydrocortisone. The endocrine effects of Metipred include suppression of ACTH secretion, inhibition of endogenous cortisol production, and with long-term use causes partial atrophy of the adrenal cortex. It affects the metabolism of calcium, vitamin D, carbohydrate, protein and lipid metabolism, therefore, with long-term use, an increase in blood glucose, a decrease in bone density, the phenomenon of muscle atrophy and dyslipidemia may be observed. The drug also helps to increase blood pressure and modulate behavior and mood. Metipred has virtually no mineralocorticoid activity. Indications for use - rheumatoid arthritis, including juvenile rheumatoid arthritis, ankylosing spondylitis - systemic lupus erythematosus, rheumatic disease, including acute rheumatoid carditis, systemic dermatomyositis (polymyositis), periarteritis nodosa - pemphigus - severe, disabling allergic conditions for which it is ineffective conventional therapy: bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, seasonal or persistent allergic rhinitis, hypersensitivity reaction to drugs - iritis, iridocyclitis, posterior uveitis and retrobulbar neuritis - ulcerative colitis, Crohn's disease - pulmonary sarcoidosis, aspiration pneumonitis - acquired (autoimmune) hemolytic anemia, idiopathic thrombocytopenic purpura - leukemia (acute and lymphatic), lymphosarcoma, lymphoma, malignant myeloma - to suppress transplant rejection Method of administration and dosage The initial dose depends on the disease and its severity. The oral starting dose for adults is usually 8 to 96 mg per day. The dose should be reduced when a positive clinical response is achieved. The oral maintenance dose should be minimal; for adults, usually 4–12 mg per day once in the morning. Lower doses are recommended for children. For long-term treatment, taking the drug in the morning once every other day may be adequate. 4 mg methylprednisolone is equivalent to 5 mg prednisolone, 4 mg triamcinolone and 0.75 mg dexamethasone. Indications for use Recommended initial daily dose Rheumatoid arthritis: - severe 12-16 mg - moderate 8-12 mg - moderate - children 4-8 mg 4-8 mg Systemic dermatomyositis 48 mg Systemic lupus erythematosus 20-100 mg Rheumatic attack 48 mg until normalization of ESR for 1 week Allergic diseases 12-40 mg Bronchial asthma Up to 64 mg at a time or up to 100 mg every other day Ophthalmological diseases 12-40 mg Hematological diseases, incl. leukemia 16-100 mg Malignant lymphoma 16-100 mg Ulcerative colitis 16-60 mg Crohn's disease up to 48 mg during exacerbation Organ transplantation up to 3.6 mg/kg/day Pulmonary sarcoidosis 32-48 mg every other day Polymyalgia 64 mg Pemphigus 80-360 mg Children: for adrenal insufficiency, orally 0.14 mg/kg or 4 mg/m2 per day in 3 divided doses, for other indications - orally 0.417–1.67 mg/kg or 12.5–50 mg/m2 in three divided doses Side effects The development of severe adverse reactions depends on the dose and duration of treatment. Adverse reactions usually develop with long-term treatment with the drug; over a short period, the risk of their occurrence is unlikely. - development and exacerbation of bacterial, viral and fungal infections, relapse of tuberculosis, immunosuppression - increase in the total number of leukocytes with a decrease in the number of eosinophils, monocytes and lymphocytes, thrombocytosis - hypercoagulation, thrombosis - inhibition of the hypothalamic-pituitary-adrenal system, growth retardation, delayed sexual development in children, menstrual irregularities, disturbances in the production of sex hormones (amenorrhea), Cushing's syndrome, hirsutism, - increased appetite, weight gain, decreased tolerance to carbohydrates, increased need for insulin and oral hypoglycemic drugs, hyperlipidemia, negative nitrogen balance, hypocalcemia, hypokalemia , hypokalemic alkalosis, sodium and fluid retention in the body - headache, dizziness, irritability, anxiety, labile mood, insomnia, euphoria, depression, suicidal tendencies, mania, hallucinations, mental dependence, psychosis, exacerbation of schizophrenia, dementia, seizures, cognitive dysfunction (including amnesia and confusion), increased intracranial pressure - increased intraocular pressure, glaucoma, papilledema, cataracts, thinning of the cornea and sclera, viral and fungal infectious exacerbations of the eyes, exophthalmos - myocardial infarction, arterial hypo- or hypertension, bradycardia, ventricular arrhythmia, asystole (as a result of rapid administration of the drug), atherosclerosis, thrombosis, vasculitis, heart failure - allergic reactions, which include anaphylactic shock with a fatal outcome, changes in reactions to skin tests - nausea, vomiting, unpleasant taste in the mouth, flatulence , esophagitis, esophageal ulcer, esophageal candidiasis, gastric and duodenal ulcer with perforation and bleeding, pancreatitis, gallbladder perforation, local ileitis, ulcerative colitis - increased activity of ALT, AST and alkaline phosphatase - slower regeneration, skin atrophy, petechiae, hematomas, striae, telangiectasia, acne, ecchymosis, purpura, hyper- or hypopigmentation, post-steroid panniculitis, which is characterized by the appearance of erythematosis, hot subcutaneous thickenings within 2 weeks after discontinuation of the drug - Kaposi's sarcoma - osteoporosis, fractures of the spine and long bones, aseptic osteonecrosis, myopathy , muscle weakness, muscle atrophy, tendon rupture - increased risk of uroliths, leukocyturia, erythrocyturia, without existing kidney damage, nocturia - malaise, persistent hiccups when using the drug in high doses - adrenal insufficiency, which can lead to deaths in stressful situations , such as surgery, injury or infection, if the dose of Metipred is not increased, withdrawal syndrome is possible if the drug is abruptly discontinued. The severity of symptoms depends on the degree of adrenal atrophy: dizziness, headache, anorexia, nausea, abdominal pain, weakness, mood changes, lethargy, fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itching of the skin, weight loss. In more severe cases - severe mental disorders and increased intracranial pressure, steroid pseudorheumatism in patients with rheumatism, death. Contraindications - hypersensitivity to the components of the drug - tuberculosis, other acute and chronic bacterial or viral infections (without proper chemotherapeutic protection) - systemic fungal infections Drug interactions Anticoagulants: when used together with glucocorticoids, an increase or decrease in the effect of anticoagulants may be observed. Parenteral administration of Metipred strictly potentiates the thrombolytic effect of vitamin K antagonists (fluindione, acenocoumarol). Salicylates and other non-steroidal anti-inflammatory drugs: Concomitant use of salicylates, indomethacin and other non-steroidal anti-inflammatory drugs may increase the likelihood of ulceration of the gastric mucosa. Metypred can help reduce the level of salicylates in the blood serum, increasing their renal clearance. Caution is necessary when reducing the dose of Metypred during long-term simultaneous use. Hypoglycemic drugs: Metypred may partially suppress the hypoglycemic effect of oral antidiabetic agents and insulin. Inducers of microsomal liver enzymes: for example, barbiturates, phenytoin, primidone, carbamazepine and rifampicin increase the systemic clearance of methylprednisolone, thereby reducing the effects of methylprednisolone by almost 2 times. CYP3A4 inhibitors: for example, erythromycin, clarithromycin, ketoconazole, diltiazem, aprepitant, itraconazole and troleandomycin increase the elimination and plasma levels of methylprednisolone, which may lead to increased therapeutic and side effects of Metypred. Estrogens: may enhance the effects of Metypred by slowing its metabolism. It is not recommended to adjust Metypred doses in women taking oral contraceptives, which may contribute not only to an increase in the half-life, but also to the development of atypical immunosuppressive effects of Metypred. Fluoroquinolones: Concomitant use may cause tendon damage. Amphotericin, diuretics and mild laxatives: Metypred may increase potassium excretion from the body in patients receiving these drugs concomitantly. Immunosuppressants: Metypred has additive immunosuppressive effects, which may increase the therapeutic effects or the risk of various adverse reactions when taken together with other immunosuppressants. Only some of these effects can be explained by pharmacokinetic interactions. Glucocorticoids, including Metypred, improve the antiemetic effectiveness of other antiemetic drugs used in parallel during therapy with anticancer drugs that cause vomiting. Glucocorticoids, including Metipred, can increase the concentration of tacrolimus in plasma when used together; when corticosteroids are withdrawn, the concentration of tacrolimus in plasma increases. Immunization: the drug may reduce the immunizing effectiveness of vaccines and increase the risk of neurological complications. The use of therapeutic (immunosuppressive) doses of glucocorticoids in combination with live viral vaccines may increase the risk of developing viral diseases. Anticholinesterase agents: In patients with myasthenia gravis, the use of the drug and anticholinesterase agents may cause muscle weakness. Others: Two serious cases of acute myopathy have been reported in elderly patients receiving doxacarium chloride and high-dose methylprednisolone. With long-term therapy, glucocorticoids can reduce the effect of somatotropin. Cases of acute myopathy have been described with the use of corticosteroids in patients who are simultaneously receiving treatment with neuromuscular transmission blockers (for example, pancuronium). Cases of seizures have been reported with the simultaneous use of Metipred and cyclosporine. Since the simultaneous administration of these drugs causes mutual inhibition of metabolism, it is likely that seizures and other side effects are associated with the use of each of these drugs as monotherapy, and may occur more frequently when they are used together. Special instructions The use of the drug should be discontinued gradually. The drug should be used with caution and under medical supervision in patients with arterial hypertension, congestive heart failure, mental disorders, patients with diabetes mellitus (or a family history of diabetes), pancreatitis, diseases of the gastrointestinal tract (peptic ulcer, local ileitis, ulcerative colitis or others inflammatory diseases of the intestinal tract or diverticulitis with an increased risk of bleeding and perforation), patients with osteoporosis, myasthenia gravis, ocular herpes, hypothyroidism, a history of corticosteroid-induced myopathy, liver and kidney failure, cirrhosis, epilepsy, abscess or other pyogenic infections, glaucoma, patients with a tendency to thrombophlebitis. Caution must also be exercised when prescribing the drug to patients who have recently suffered a myocardial infarction. Glucocorticoids can make it difficult to diagnose complications of the gastrointestinal tract, as they cause a decrease in pain, as well as mask the latent period of hyperparathyroidism. Metypred can potentiate the ulcerogenic effect of salicylates and other non-steroidal anti-inflammatory drugs. Patients with bleeding disorders should be under medical supervision. When Metipred and anticoagulants are used together, the risk of gastric ulceration and bleeding increases. Glucocorticoids can also reduce the effect of anticoagulants. The anticoagulant dosage regimen must necessarily be accompanied by monitoring of prothrombin time, namely the international normalized index (INI). Metipred, like other glucocorticoids, can contribute to the exacerbation of infectious diseases. There is a risk of relapse of tuberculosis, complications of chickenpox and herpes zoster. Live vaccines should not be administered to patients taking high-dose systemic corticosteroids during the period of induction of immunosuppression. The therapeutic response to other types of vaccines may also be reduced. Use with caution for 8 weeks before and after vaccination, with lymphadenitis after BCG vaccination, with immunodeficiency conditions, including AIDS or HIV infection. During long-term therapy with Metipred, it is necessary to consider prescribing bisphosphonates to patients with osteoporosis or with risk factors for its development. Risk factors for osteoporosis include age over 65 years, history or family history of frequent fractures, early menopause (before 45 years), premenopausal amenorrhea, and low body weight. The risk of developing osteoporosis can be minimized by adjusting the dose of Metypred, reducing it to the lowest therapeutic level. Long-term use of glucocorticoids suppresses the pituitary-adrenal axis, leading to the development of a secondary insufficiency of the corticoadrenal response, which can lead to exacerbation of diseases and the development of complications in various conditions, such as acute injury, disease, or surgery. High doses of Metypred significantly reduce the risk of developing these complications. To minimize side effects, the full daily dose of Metypred should be taken in the morning in accordance with the circadian rhythm of endogenous cortisol production. Patients with hypothyroidism or severe liver disease should reduce the dose of Metipred. In elderly patients, the drug should be prescribed with caution due to the increased risk of side effects (peptic ulcers, osteoporosis and skin ulceration). With long-term use of glucocorticoids, therapy should be discontinued gradually over several weeks to avoid withdrawal syndrome and serious complications, including mortality. Long -term therapy should not stop suddenly and in case of pregnancy. The drug contains lactose monohydrate, which should be considered patients with lactose intolerance. Pregnancy and lactation period penetrates through the placenta and is released into milk during breastfeeding. During pregnancy, it is necessary to carefully weigh the benefits of therapy with the metrmist for the mother and the potential risk to the fetus. Long -term use during pregnancy is caused by a violation of the fetal growth. There is a danger of developing atrophy of the adrenal cortex in the fetus, which may require replacement therapy in a newborn. Glucocorticoids can also increase the risk of stillbirth. It is necessary to avoid breastfeeding with prolonged systemic therapy with a meta -chapter. The use of a dose in children and the duration of therapy in pediatrics determines the doctor individually, depending on the age and severity of the disease. With prolonged admission in children, growth and gender development is possible. Features of the effect of the drug on the management of vehicles and mechanisms taking into account the side effects of the drug (the risk of mood disorders, psyche, cramps, headache) when using the drug should refrain from driving vehicles or other potentially dangerous mechanisms. Overdose symptoms: the drug does not cause acute intoxication. In chronic intoxication, which is manifested by adrenal suppression, it is possible to increase the side effects of the drug. Treatment: it is necessary to gradually reduce the dose, it is recommended to laundry of the stomach and the use of activated coal, symptomatic treatment. There is no specific antidote. The production form and packaging of 30 tablets in a high -density (PEVP) polyethylene bottle with a screw from the PEVP, protected from random opening. 1 bottle along with instructions for medical use in the state and Russian languages is invested in a cardboard box. Storage conditions Store at temperatures between 15 °C and 25 °C. Keep out of the reach of children! The storage period of 5 years is not used after the expiration date of the vacation condition from pharmacies according to the recipe manufacturer Orion Corporation, Orionine 1, 02200 Espo, Finland, the owner of the registration certificate Orion Corporation, Orionine 1, 02200 ESO, Finland address of the organization that accepts claims from the Republic of Kazakhstan from the Republic of Kazakhstan Consumers on the quality of products (goods): Viva Pharm LLP st. 2nd Ostroumova, 33, Almaty, RK Tel., Fax; e-mail

Comparison of addiction between Medrol and Metipred

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values of such parameters as “syndrome o” in Metipred is less than the similar values in Medrol. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible.

Medrol®

— Since the complications of methylprednisolone therapy depend on the dose and duration of treatment, in each specific case, based on an analysis of the risk/benefit ratio, a decision is made on the need for such treatment, and the duration of treatment and frequency of administration are also determined.

- The minimum effective dose of the drug should be used to ensure a sufficient therapeutic effect; if necessary, the dose should be reduced gradually.

— During therapy with methylprednisolone, the development of various mental disorders is possible: from euphoria, insomnia, mood instability, personality changes and severe depression to acute psychotic manifestations. In addition, existing emotional instability or psychotic tendencies may be exacerbated.

— Potentially severe mental disorders may occur when using MEDROL®. Symptoms usually appear within a few days to weeks after starting therapy. Most reactions disappear either after reducing the dose or after discontinuation of the drug. Despite this, specific treatment may be required. Psychological effects have been reported in association with methylprednisolone discontinuation; the frequency of these effects is not known.

- For patients who may be exposed to stress during methylprednisolone therapy, an increase in the dose of the drug before, during and after a stressful situation is indicated.

Studies have also shown that sufficiently high doses of methylprednisolone must be administered to achieve a significant effect.

— There are reports of the development of epidural lipomatosis in patients receiving methylprednisolone. Usually with long-term therapy at high doses.

- In patients receiving immunosuppressive doses of methylprednisolone, live or live attenuated vaccines are contraindicated, but killed or inactivated vaccines can be administered, although the response to such vaccines may be reduced. Patients receiving treatment with methylprednisolone in doses that do not have an immunosuppressive effect may be immunized according to appropriate indications.

— During therapy with methylprednisolone, some infections may occur in an erased form, in addition, new infections may develop. When using methylprednisolone, it is possible to reduce resistance to infections, and also reduce the body's ability to localize the infectious process. The development of infections caused by various pathogenic organisms, such as viruses, bacteria, fungi, protozoa or helminths, which are localized in various systems of the human body, may be associated with the use of methylprednisolone, both as monotherapy and in combination with other immunosuppressants affecting cellular immunity, humoral immunity or neutrophil function. These infections can be mild, but in some cases they can be severe and even fatal. Moreover, the higher doses of methylprednisolone are used, the higher the likelihood of developing infectious complications.

— The use of MEDROL® in active tuberculosis should be limited to cases of fulminant and disseminated tuberculosis, when GCS are used to treat the disease in combination with appropriate anti-tuberculosis chemotherapy. If the drug is prescribed to patients with latent tuberculosis or with positive tuberculin tests, then treatment should be carried out under strict medical supervision, since reactivation of the process is possible. During long-term treatment with methylprednisolone, such patients should receive appropriate prophylactic treatment.

— The drug should be used with caution in case of eye damage caused by the herpes simplex virus, due to possible perforation of the cornea.

- Methylprednisolone therapy can lead to the development of central serous chorioretinopathy, which in turn can lead to retinal detachment.

— Children receiving long-term therapy with MEDROL® are at increased risk of developing intracranial hypertension.

- The use of high doses of methylprednisolone can lead to the development of pancreatitis in children.

- Allergic reactions (for example, angioedema) may develop. When using methylprednisolone, precautions should be taken, especially in patients with a history of allergic reactions to drugs.

— The drug contains lactose produced from cow's milk. Caution should be exercised in patients with known or suspected hypersensitivity to cow's milk or its components or other dairy products as they may contain trace amounts of dairy ingredients.

- Medium and large doses of hydrocortisone or cortisone may cause increased blood pressure, sodium and water retention, and increased potassium excretion. These effects are less likely when using synthetic corticosteroids (including methylprednisolone), except when they are used in high doses. It is necessary to limit the consumption of table salt with food and prescribe potassium supplements. All corticosteroids increase calcium excretion.

— Systemic corticosteroids, including the drug MEDROL®, are not indicated and should not be used for the treatment of traumatic brain injury. An increase in mortality was found at 2 weeks or 6 months after head injury in patients treated with methylprednisolone sodium succinate. There was no direct association with administration of methylprednisolone sodium succinate.

— Osteoporosis is a common and, at the same time, rarely diagnosed adverse reaction that develops with long-term use of high doses of methylprednisolone.

- Children receiving the drug for a long time daily, several times a day, may experience growth retardation, so this dosage regimen should be used only for absolute indications. The use of alternative therapy can usually avoid or minimize this adverse reaction. When using MEDROL® in children, patients should be carefully monitored for normal growth and development.

- Manifestations of secondary adrenal insufficiency that develop during methylprednisolone therapy can be minimized by gradually reducing the dose. This type of relative deficiency may persist for several months after the end of treatment, so methylprednisolone should be reintroduced during this period in any stressful situations. Since the secretion of mineralocorticosteroids may be impaired, electrolytes and/or mineralocorticosteroids should be administered simultaneously.

— There is a more pronounced effect of methylprednisolone in patients with hypothyroidism and cirrhosis of the liver.

- The use of methylprednisolone in high doses can lead to the development of acute pancreatitis.

— There are reports of the development of reversible liver damage, which is relieved by discontinuation of therapy. In this regard, appropriate monitoring should be carried out.

— Undesirable reactions of the drug MEDROL® from the cardiovascular system, such as dyslipidemia, increased blood pressure, can provoke new reactions in predisposed patients when using high doses of the drug MEDROL® and long-term treatment. In this regard, methylprednisolone should be taken with caution in patients predisposed to cardiovascular diseases and special attention should be paid to additional monitoring of the state of the cardiovascular system.

— There have been cases of the development of Kaposi's sarcoma in patients receiving methylprednisolone therapy (if they are discontinued, clinical remission may occur).

— The effectiveness of MEDROL® in septic shock is questionable. The results of a systematic review of the use of the drug in short courses at high doses do not support its use in this regimen. However, it is assumed that the use of MEDROL® in long courses (5-11 days) in low doses may reduce mortality.

— When using the drug MEDROL® in therapeutic doses for a long period, suppression of the hypothalamic-pituitary-adrenal system (secondary adrenocortical insufficiency) may develop. The degree and duration of adrenocortical insufficiency are individual for each patient and depend on the dose, frequency of use, time of administration and duration of therapy. The severity of this effect can be reduced by using the drug every other day or by gradually reducing the dose (see section “Method of administration and dosage”),

— In addition, the development of acute adrenal insufficiency, leading to death, is possible with abrupt discontinuation of the drug MEDROL®. Caution is warranted in patients with systemic scleroderma as an increased incidence of acute scleroderma nephropathy has been observed when taking corticosteroids, including methylprednisolone.

- Since methylprednisolone may enhance the clinical manifestations of Cushing's syndrome, the use of methylprednisolone should be avoided in patients with Cushing's disease.

— Acute myopathy most often develops with the use of high doses of methylprednisolone in patients with impaired neuromuscular transmission (for example, with myasthenia gravis), or in patients simultaneously receiving anticholinergic drugs, such as peripheral muscle relaxants (for example, pancuronium bromide). Such acute myopathy is generalized in nature, can affect the muscles of the eye and respiratory system, and lead to the development of tetraparesis. Creatine kinase levels may be elevated. However, improvement or recovery after discontinuation of methylprednisolone may occur only after many weeks or even several years.

- Withdrawal syndrome, apparently not related to adrenal insufficiency, can also occur due to abrupt discontinuation of the drug MEDROL®. This syndrome includes symptoms such as anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, skin peeling, myalgia, weight loss and/or decreased blood pressure. It is assumed that these effects occur due to sharp fluctuations in the concentration of methylprednisolone in the blood plasma, and not due to a decrease in the concentration of methylprednisolone in the blood plasma.

— The carcinogenic and mutagenic effects of the drug, as well as its adverse effects on reproductive functions, have not been established.

Comparison of side effects of Medrol and Metipred

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Medrol has almost the same level of adverse events as Metipred. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Medrol are similar to Metipred: how quickly the body recovers after taking it and whether it recovers at all.

Comparison of the ease of use of Medrol and Metipred

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Medrol is approximately the same as Metipred. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-04 13:47:23