Parenteral Manual

MethylPREDNISolone sodium succinate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Glucocorticoid, anti-inflammatory
Original Date: 
August 2005
Revised Date: 
December 2019
  • When anti-inflammatory, immunosuppressive or antileukemic effects are desired
Reconstitution and Stability: 
125 mg 2 mL 62.5 mg/mL
500 mg 4 mL 125 mg/mL
  • Reconstituted vials stable 48 hours at room temperature
  • Store at room temperature, protect from light
  • Concentrations of > 0.25 mg/mL are stable for 48 hours at room temperature
  • Act-O-Vial (self -contained powder for injection plus diluent) may be reconstituted by pressing into the center of the stopper to force diluent into the powder compartment.  Following gentle agitation, solution may be withdrawn via syringe through a needle inserted into the center of the stopper. 
    - Reconstitution of Acto-O-Vial 125 mg yields a final concentration of 62.5 mg/mL.  Discard any remaining contents of single-dose vial
  • Solutions Compatible: D5W, 0.9% NaCl, D5NS, ringer's lactate
  • Additives/Above Cassette Compatible: metoclopramide
  • Y-site Compatible: amiodarone, morphine, KCl (up to 40 mmol/L), TPN (amino acids/dextrose)

Incompatible: ciprofloxacin, glycopyrrolate, ondansetron, penicillin, propofol


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct

YES: ( < 1.8 mg/kg or <125 mg/dose ONLY)
DO NOT administer high doses IV direct

Usual dilution: 10 mg/mL
Infusion time: 3-15 minutes

IV Intermittent Infusion

Usual dilution: 2.5 mg/mL or 10 mg/mL

Doses greater than 250 mg; add dose to 100 mL minibag of D5W
Infusion time:
    - less than or equal to 1.8 mg/kg or less than or equal to 125 mg/dose: 3 - 15 minutes

    - greater than or equal to 2 mg/kg or 250 mg/dose: 15 - 30 minutes

    - greater than or equal to 10 mg/kg or 500 mg/dose:  1 hour

IV Continuous Infusion YES

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


- Status Asthmaticus: 

  • Load: 1-2 mg/kg/dose IV.  Maximum 125 mg
  • Maintenance: 0.5 -  1 mg/kg/dose (maximum 125 mg) IV Q 6 hours

- Anti-inflammatory/Immunosuppressive:   0.5-1.7 mg/kg/day IV/IM ÷ Q 6-12 hours

- Pulse Therapy:  10-30 mg/kg/dose IV once daily over 60 minutes x 3 days
                                 Maximum 1000 mg                              

  • May be given for various conditions (e.g. polyarticular and systemic juvenile arthritis, SLE, severe glomerular nephritis and dermatomyositis)

- ITP:  30 mg/kg/dose IV daily x 3 days

-Acute respiratory distress syndrome

  • Day 1 - loading dose 1 mg/kg x 1
  • Day 1 to 14 - infusion 1 mg/kg/day
  • Day 15 to 21 - infusion 0.5 mg/kg/day
  • Day 22 to 25 - infusion 0.25 mg/kg/day
  • Day 25 to 28 - infusion 0.125 mg/kg/day


  • if the patient is extubated between days 1 to 14, the patient will be advanced to day 15 and follow the schedule.

  • If the patient can tolerate enteral feeds, the infusion will change to equivalent dosing of Prednisone and follow the tapering schedule.

  • FYI, the conversion for methylprednisolone :prednisone is 4:5.


- Asthma:   60-250 mg/dose IV Q6H

- Anti-inflammatory/Immunosuppressant:  40-250 mg/dose IV Q 4-6 hours

- High-dose therapy:  30 mg/kg IV; repeat Q 4-6 hours PRN for 48-72 hours

- Lupus nephritis:  1000 mg (1 g) /day  IV for 3 days


Potential hazards of parenteral administration: 
  • Cardiovascular collapse, hypotension, cardiac arrythmia and sudden death have occurred with rapid IV injections of doses greater than 500 mg and over <20 minutes
  • Anaphylaxis and hypersensitivity reactions (rare)
  • Hypertension, edema
  • Glucose intolerance, hypokalemia, alkalosis
  • Psychosis     
  • Nausea, vomiting, peptic ulcers
  • HPA suppression, cushing's syndrome, growth suppression with higher doses


  • Monitor blood pressure, serum glucose and electrolytes
  • For pulse therapy - suggested monitoring - vital signs every 15 minutes during infusion and 60 minutes post infustion if BP stable.  Call MD if systolic BP increases by 15mm Hg over baseline or diastolic BP increases by 10mm Hg over baseline or if HR increases by 15 beats/minute over baseline
  • Administer with caution in patients with diabetes, osteoporosis, chronic psychoses, active tuberculosis, hypothyroidism, cirrhosis, hypertension, CHF, ulcerative colitis, peptic ulcer disease, thromboembolic disorders
  • 4 mg methylprednisolone = 20 mg hydrocortisone for antiinflammatory action
  • Sodium content of 1 g methylprednisolone sodium succinate injection = 2.01 mmoL  Na
  • Decreased effectiveness of concomitant vaccines, interacts with skin tests
  • Drug interactions with phenytoin, rifampin, salicylates, cyclosporine, tacrolimus
    - Phenytoin and rifampin may increase clearance of methylprednisolone
    - Methylprednisolone may increase cyclosporine and tacrolimus serum concentrations

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