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Day 1: 8 mg PO before breakfast, 4 mg after lunch and after dinner, and 8 mg at bedtime Day 2: 4 mg PO before breakfast, after lunch, and after dinner and 8 mg at bedtime Day 3: 4 mg PO before breakfast, after lunch, after dinner, and at bedtime Day 4: 4 mg PO before breakfast, after lunch, and at bedtime Day 5: 4 mg PO before breakfast and at bedtime Day 6: 4 mg PO before breakfast May be tapered over 12 days (to decrease chance of dermatitis flareup) Methylprednisolone: Usual dosing range, 2-60 mg/day PO divided q6-24hr Methylprednisolone acetate: Usual dosing range, 10-80 mg IM every 1-2 weeks; as temporary substitute for PO, given in daily IM dose equal to daily PO dose; for prolonged effect, given in weekly IM dose equal to 7 times daily PO dose; unlike methylprednisolone sodium succinate, may not be given IV Methylprednisolone sodium succinate: Usual dosing range, 10-250 mg IM/IV up to q4hr PRN Acne Adrenal suppression Amenorrhea Delayed wound healing Delirium Diabetes mellitus Edema Emotional instability Erythema Fluid retention GI perforation Glucose intolerance Growth suppression (children) Hallucinations Headache Hepatomegaly Hepatitis Hypokalemic alkalosis Increased transaminases Insomnia Leukocytosis Menstrual irregularity Myopathy Neuritis Osteoporosis Peptic ulcer Perianal pruritus Pituitary adrenal axis suppression Protein catabolism Pseudotumor cerebri (on withdrawal) Psychosis Sodium and water retention Seizure Tachycardia Ulcerative esophagitis Urticaria Vasculitis Verto Weht gain Untreated serious infections Documented hypersensitivity Intrathecal administration Systemic fungal infection (except intra-articular injection in localized joint conditions) IM route is contraindicated in idiopathic thrombocytopenic purpura Premature infants (formulations containing benzyl alcohol only) Traumatic brain injury (hh doses) Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, history of seizure disorders, multiple sclerosis, thromboembolic disorders, myocardial infarction Long-term treatment: Risk of osteoporosis, myopathy, delayed wound healing Minimal mineralocorticoid activity Use in septic shock or sepsis syndrome not proven effective and may increase mortality in some patients including patients with elevated serum creatinine and patients who develop secondary infections Clearance of corticosteroids may increase in hyperthyroid patients and decrease in hypothyroid ones; dose adjustments may be necessary Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored) Some suggestion (not fully substantiated) of slhtly increased cleft palate risk if corticosteroids are used in pregnancy May cause hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, or hyperglycemia Prolonged corticosteroid use may result in elevated IOP, glaucoma, or cataracts ed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease) Injection may result in dermal and/or subdermal changes forming depressions in the skin at injection site; to minimize incidence of dermal and subdermal atrophy, care must be exercised not to exceed recommended doses in injections; avoid injection into deltoid muscle due to hh incidence of subcutaneous atrophy Increased dosage of rapidly acting corticosteroids indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation Not for use in the treatment of traumatic brain injury Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium; dietary salt restriction and potassium supplementation may be necessary; all corticosteroids increase calcium excretion Drug induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage; relative insufficiency may persist for months after discontinuation of therapy; therefore, in situation of stress occurring during that period, hormone therapy should be reinstituted Rarely, hh doses of cycliy pulsed intravenous methylprednisolone (usually for the treatment of exacerbations of multiple sclerosis at doses of 1 g/day) can induce a toxic form of acute hepatitis; discontinue therapy if it occurs; since recurrence has occurred after re-challenge, avoid use in patients with a history of toxic hepatitis caused by methylprednisolone With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases; corticosteroids may also mask some sns of current infection; corticosteroids may exacerbate systemic fungal infections and should not be used in presence of such infections unless needed to control drug reactions; latent amebiasis or active amebiasis should be ruled out before initiating corticosteroid therapy patients who have spent time in tropics or patients with unexplained diarrhea Lowest possible dose should be used to control condition under treatment; when reduction in dosage possible, reduction should be gradual Risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used Kaposi’s sarcoma reported in patients receiving corticosteroid therapy, most often for chronic conditions; discontinuation of therapy may result in clinical improvement Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not affect the ultimate outcome or natural history of the disease Psychic derangements may appear when corticosteroids used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations; also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids Potent glucocorticoid with minimal to no mineralocorticoid activity Modulates carbohydrate, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis Controls or prevents inflammation by controlling rate of protein synthesis, suppressing mration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level Solution: D5/0.5 NS, D5/NS, D5W, LR, NS Additive: Coramphenicol sodium succinate, cimetidine, clindamycin, dopamine, granisetron, heparin, norepinephrine, penicillin G potassium, ranitidine, theophylline, verapamil Syringe: Diatrizoate meglumine, diatrizoate meglumin/diatrizoate sodium, granisetron, iohexol, iopamidol, iothalamate meglumine, ioxalate meglumine/ioxalate sodium, metoclopramide Y-site (partial list): Acyclovir, amifostine, amiodarone, cisplatin, dopamine, enalaprilat, famotidine, heparin, inamrinone, linezolid, meperidine, metronidazole, midazolam, morphine, sodium bicarbonate Additive: Aminophylline(? ), glycopyrrolate, metaraminol, nafcillin, penicillin G sodium Syringe: Doxapram Y-site: Allopurinol, amsacrine, ciprofloxacin, cisatracurium(? ), etoposide phosphate, fenoldopam, filgrastim, gemcitabine, heparin/hydrocortisone(? ), propofol, sargramostim, vinorelbine, vitamins B and C(? 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