Methylprednisolone side effects and how to avoid them

Common methylprednisolone side effects | Serious side effects | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Methylprednisolone is a common systemic corticosteroid used for a large number of medical conditions. For most, methylprednisolone is used for its anti-inflammatory and immune-suppressing properties. Methylprednisolone is usually taken as a tablet, but healthcare providers may use injections of Solu-Medrol (methylprednisolone sodium succinate) or Depo-Medrol (methylprednisolone acetate) instead.

Methylprednisolone belongs to a subclass of corticosteroids known as glucocorticoids. Glucocorticoids are synthetic versions of the naturally occurring steroid hormone in your body known as cortisol, and they affect nearly every system in the body. A wide range of side effects affecting all parts of the body is common. In addition, the drug may sometimes cause serious problems in people with certain pre-existing conditions or who are taking other types of drugs. 

RELATED: What is Methylprednisolone?

Common side effects of methylprednisolone

As with all corticosteroid medications, methylprednisolone results in several unwanted side effects. Lengthy treatment or high doses are more likely to produce these side effects. The most common are:

Skin problems

• Skin rash
• Hives
• Acne
• Facial redness
• Thinning skin
• Bruising easily
• Skin discoloration
• Skin spots
• Unwanted hair growth
• Excessive sweating
• Slow wound healing (when taken long-term)
• Injection site reactions (when administered as an injection)

Mental and mood changes

• Mood swings
• Anxiety
• Depression
• Euphoria
• Irritability

Nervous system problems

• Headache
• Dizziness and vertigo
• Insomnia

Digestive system problems

• Abdominal discomfort
• Appetite changes
• Nausea
• Vomiting
• Tarry stools

Fluid and electrolyte problems

• Fluid retention (edema)
• Sodium retention
• Potassium depletion
• High blood pressure

Endocrine (hormone) disorders

• Decreased glucose tolerance
• Weight gain
• Changes in menstrual periods
• Redistribution of body fat (called Cushingoid appearance: puffy face, obese torso, and buffalo hump)

Muscle problems

• Loss of muscle mass
• Muscle weakness

Serious side effects of methylprednisolone

Serious and possibly life-threatening side effects of methylprednisolone include:

Mental and mood changes

• Steroid psychosis

Nervous system problems

• Convulsions
• Elevated fluid pressure in the brain

Digestive system problems

• Stomach ulcers
• Perforation
• Swelling of the pancreas

Fluid and electrolyte problems

• Dangerously low potassium levels
• Congestive heart failure
• Hypertension
• Kidney failure (scleroderma renal crisis)

Endocrine (hormone) disorders

• • Adrenal insufficiency
  • Cushing syndrome
  • Diabetes
  • Growth suppression in children (when used long-term)

• Withdrawal symptoms 

Muscle and bone problems

• Muscle pain
• Tendon rupture
• Decreased calcium absorption (when used long-term)
• Bone tissue death (osteonecrosis)
• Osteoporosis (when used long-term)

Immune system problems

• Immune suppression
• Infection
• Kaposi’s sarcoma (a type of skin cancer)

Eye problems

• Protruding eyeballs
• Glaucoma (when used long-term) 
• Cataracts (when used long-term)

Severe allergic reactions

• Anaphylaxis (fast heartbeat, trouble breathing, wheezing, confusion, and shock)

Methylprednisolone sodium succinate is sometimes administered intravenously. Depending on the rate of administration, people can experience high blood pressure, changes in the heart’s rhythm, and even death as adverse effects of the IV.

How long do side effects last?

The most commonly experienced side effects of methylprednisolone fade away quickly after the last dose is given, particularly if the drug is taken in small amounts for only a few days. When the body’s natural concentration of corticosteroids returns to normal, edema, mood, blood pressure, electrolyte balance, and the digestive system also return to normal. Even extra weight rapidly falls away because the weight gain caused by a short course of corticosteroids is due to fluid retention. Severe allergic reactions and dangerously low potassium levels can be quickly reversed with treatment but will require immediate medical care.

Other side effects may take a few days or weeks to get better, such as acne, unwanted hair growth, or infections. Thin skin, fat redistribution, muscle loss, and weight gain due to a long course of methylprednisolone treatment may take several weeks to reverse. Intervention, such as diet and exercise, may be required. 

Adrenal insufficiency, if mild, can cause symptoms of withdrawal which typically take a few weeks to fade. For severe cases of adrenal insufficiency and Cushing’s syndrome, it may take months or over a year to return to normal.

Some of methylprednisolone’s most severe side effects such as osteoporosis or bone tissue death may persist for years. Others, such as diabetes or kidney failure may have lifelong consequences.

Methylprednisolone contraindications & warnings

Methylprednisolone has powerful physiological effects on nearly the entire body. Some people may not be suitable for this medicine.

Abuse and dependence

Methylprednisolone is not considered an addictive drug nor is it commonly abused. However, this medicine does cause physical dependence and withdrawal because of its effects on the body’s endocrine system. Methylprednisolone may inadvertently decrease your body’s natural cortisol production, which is important for your everyday life. This dependence is managed by gradually weaning patients off the drug with steadily decreasing doses so that your body gradually begins to maintain its own cortisol levels again.

Overdose

Methylprednisolone is usually taken in doses ranging from 5 to 60 mg, but much higher doses may be used. Very large doses of methylprednisolone are not toxic, but will significantly raise the risk and severity of side effects. If too much methylprednisolone is taken, call a poison helpline for medical advice. Emergency medical help may be needed.

Contraindications

Methylprednisolone can be so hazardous in people with certain medical conditions that the drug is never used. Called “contraindications,” conditions that completely rule out methylprednisolone are:

• Hypersensitivity to methylprednisolone or other corticosteroids
• Systemic fungal infection
• Cerebral malaria

Methylprednisolone sodium succinate, an alternative form of methylprednisolone administered as an intramuscular or intravenous injection, is also contraindicated in:

• Premature infants
• People with hypersensitivity to milk proteins

Methylprednisolone acetate and methylprednisolone sodium succinate injections are never injected into the spinal cord (epidural injection) because of potentially serious side effects. They also cannot be injected into the muscles in anyone with idiopathic thrombocytopenic purpura. 

Only methylprednisolone sodium succinate may be given intravenously. Never give formulations of methylprednisolone acetate intravenously. All forms of methylprednisolone are never to be given intrathecally, and epidural administration carries many risks you should cover with your provider before providing consent.

Restrictions

Other medical conditions may require caution, monitoring, or even treatment modifications to avoid problems. 

• Immune suppression: Methylprednisolone weakens the immune system, making people more vulnerable to infections. Close attention to signs of infection is required when giving methylprednisolone to people who are immune-suppressed, have active infections, have a latent or active tuberculosis infection, or who have been exposed to measles or chickenpox. 
• Herpes zoster infection of the eye: People with a herpetic eye infection are at risk of eye perforation when taking methylprednisolone.
• Gastrointestinal problems: Ulcers and sores are also more likely in people at risk for gastrointestinal perforation. This includes people with peptic ulcer disease (PUD), ulcerative colitis, diverticulitis, or any recent intestinal surgery in which one part of the intestine was connected to another part. 
• Thyroid problems: An underactive thyroid increases the risks of methylprednisolone side effects.
• Mental illness: Corticosteroid treatment can worsen existing emotional problems or psychotic tendencies.
• Seizure disorder: Seizures, a possible side effect of methylprednisolone, are more likely in people with a history of seizures.
• Diabetes: Methylprednisolone increases the body’s production of sugar, raising blood sugar and making glucose levels harder to control with medications. Dose adjustments of oral medications or insulins may need to occur.
• Hypertension: Methylprednisolone increases blood pressure, so blood pressure medications may need to be changed or the doses increased.
• Cirrhosis: Methylprednisolone can injure the liver, worsening any existing liver disease.
• Myasthenia gravis: Although methylprednisolone is often used to treat myasthenia gravis, it is used with great caution for other medical conditions in people with myasthenia gravis. 
• Systemic sclerosis: People with systemic sclerosis are at an increased risk of scleroderma renal crisis when taking methylprednisolone.
• Osteoporosis: Long-term use of methylprednisolone can cause significant bone loss, so people with or at risk for osteoporosis will require monitoring while taking this drug.
• Heart disease: Because methylprednisolone causes fluid retention and electrolyte imbalances, anyone with congestive heart failure or who has recently experienced a heart attack will need to be monitored when taking methylprednisolone.
• Blood clotting disorders: Methylprednisolone can increase the coagulability of blood causing blood clots in the vascular system and thromboembolism. It should be used with extreme caution in patients with pre-existing coagulation disorders.
• Other medical conditions that will require extra care and monitoring include:
  • Kidney problems
  • Adrenal gland tumor
  • Swelling of the optic nerve

Pregnancy and nursing

Taking methylprednisolone during pregnancy is a discussion pregnant women must have with their healthcare provider. Methylprednisolone crosses the placenta and may cause problems for the fetus, including low birth rate, premature birth, and adrenal suppression. Because of possible problems, healthcare providers use methylprednisolone very carefully in pregnant women in their first trimester.

Nursing women also need to talk about the possible risks of methylprednisolone treatment when breastfeeding. Methylprednisolone is present in breast milk and could affect a baby’s hormones or stunt the infant’s growth. 

Children

Methylprednisolone is FDA approved for use in children as young as newborns. Even so, methylprednisolone can suppress the growth of a child, so long-term treatment will require monitoring.

Methylprednisolone interactions

As with all corticosteroids, methylprednisolone can cause problems when combined with certain types of drugs.

• Live vaccines: Methylprednisolone suppresses the immune system, so no one taking methylprednisolone can receive a live vaccine. 
• Immune–suppressants: Drugs that suppress the immune system will worsen methylprednisolone’s effects on the immune system. The combination can leave patients dangerously vulnerable to infections and cancer. Drugs like cyclosporine can worsen methylprednisolone side effects.
• NSAIDs: Both methylprednisolone and nonsteroidal anti-inflammatory drugs (NSAIDs) can damage the stomach, esophagus, and intestines. Combining these medications raises the risk of side effects such as ulcers and perforation.
• Loop and thiazide diuretics: The combination increases the risk of potassium depletion, a significant side effect of methylprednisolone. Potassium levels will need to be checked regularly when these drugs are combined with methylprednisolone.
• Estrogens: Estrogens used for hormone replacement can increase the incidence and severity of methylprednisolone side effects. 
• Migraine medications: Both migraine medications and methylprednisolone significantly raise blood pressure. Other drugs that significantly increase blood pressure include stimulants and epinephrine. 
• Quinolone antibiotics: Tendon rupture is a risk when methylprednisolone is combined with quinolone antibiotics (such as ciprofloxacin). 
• Androgens: Testosterone can increase the incidence and severity of fluid retention when combined with methylprednisolone.
• Antipsychotics: Drugs that treat psychosis and related conditions may change the heart’s rhythm. Methylprednisolone alters the body’s electrolyte balance and worsens these heart problems. 
• Diabetes drugs: Methylprednisolone raises the body’s production of glucose so it may impair the ability of diabetes drugs to keep blood sugar under control.
• Blood pressure drugs: Methylprednisolone raises blood pressure, reducing the ability of blood pressure drugs to control high blood pressure.
• Mifepristone: Mifepristone is a potentially hazardous drug used only under a restricted pharmacy program. Because of the risk of adrenal insufficiency, it is never given with corticosteroids such as methylprednisolone. 
• Desmopressin nasal spray: Desmopressin nasal spray is never combined with any steroid medication due to the risk of severe sodium loss.

How to avoid methylprednisolone side effects

Unfortunately, methylprednisolone causes side effects in many people. Because methylprednisolone affects so many aspects of the body, there are several different ways to manage these effects. Here are the top 10:

1. Tell the doctor about all medical conditions and medications

Any healthcare provider prescribing or administering methylprednisolone must know about all existing medical conditions and medications being taken. Pre-existing medical conditions or drug interactions can cause unwanted or even serious side effects.

2. Tell all other healthcare providers about methylprednisolone

When taking methylprednisolone, tell all other medical professionals about this drug. The best advice is to carry a card or wear a medical alert tag that can notify healthcare professionals about any corticosteroids being taken.

3. Take methylprednisolone as directed

Always take this medicine as directed. The usual dose is 5–60 mg per day, but the dose will be determined by your healthcare professional and may be adjusted.

4. Take methylprednisolone as scheduled

Always follow the dosing schedule assigned by the prescriber. To prevent hormone disruption, most doctors will instruct patients to take methylprednisolone early in the morning. If scheduled doses are being regularly missed, ask a pharmacist for useful tools that can serve as reminders.

5. Take prednisolone with food

It’s okay to take methylprednisolone tablets with food or milk. It’s also a good way to avoid stomach upset and other digestive system problems.

6. Avoid NSAIDs and alcohol

Speaking of gastrointestinal problems, the risk of heartburn, stomach acid problems, stomach ulcers, and even perforation goes up when methylprednisolone is taken with nonsteroidal anti-inflammatory drugs (NSAIDs). If pain or fever is a problem, use different over-the-counter pain relievers like acetaminophen.

7. Be extra careful about catching infections

Methylprednisolone weakens the body’s ability to fight off infections. While taking this drug, try to avoid people with infections. Regular hand washing and showering are also in order. If you notice any signs of an infection, talk to a healthcare provider immediately and before the infection gets too serious.

8. Eat a healthy diet

It’s not amusing to see one’s weight go up while taking methylprednisolone. Most of the weight gain is due to sodium retention, so switch to a low-sodium diet while taking this drug. Methylprednisolone also increases the body’s weight by ramping up the body’s production of glucose, so it’s also a good idea to go on a healthy, lean protein diet. To avoid potassium depletion, make sure to eat plenty of potassium-rich foods.

9. Take calcium and vitamin D supplements

Another good diet idea is to take calcium and vitamin D supplements to prevent bone loss while on methylprednisolone. Some healthcare providers may prescribe calcium supplements to people who already have osteoporosis. 

10. Do not stop taking methylprednisolone

The side effects of methylprednisolone can be unpleasant, but steroid withdrawal might be worse. Like all glucocorticoids, methylprednisolone can cause withdrawal when stopped all of a sudden. Get professional medical advice before stopping this medicine. You will be put on a gradually decreasing dose to minimize withdrawal symptoms.