Solu-Medrol Drug Interactions





Zuellig Pharma
Full Prescribing Info
Drug Interactions
Methylprednisolone is a cytochrome P-450 enzyme (CYP) substrate and is mainly metabolized by the CYP3A4 enzyme. CYP3A4 is the dominant enzyme of the most abundant CYP subfamily in the liver of adult humans. It catalyzes 6β-hydroxylation of steroids, the essential phase I metabolic step for both endogenous and synthetic corticosteroids. Many other compounds are also substrates of CYP3A4, some of which (as well as other drugs) have been shown to alter glucocorticoid metabolism by induction (upregulation) or inhibition of the CYP3A4 enzyme.
CYP3A4 Inhibitors: Drugs that inhibit CYP3A4 activity generally decreased hepatic clearance and increased plasma concentration of CYP3A4 substrate medications eg, methylprednisolone. In the presence of a CYP3A4 inhibitor, the dose of methylprednisolone may need to be titrated to avoid steroid toxicity.
CYP3A4 Inducers: Drugs that induce CYP3A4 activity generally increase hepatic clearance, resulting in decreased plasma concentration of medications that are substrates for CYP3A4. Co-administration may require an increase in methylprednisolone dosage to achieve the desired result.
CYP3A4 Substrates: In the presence of another CYP3A4 substrate, the hepatic clearance of methylprednisolone may be affected, with corresponding dosage adjustments required. It is possible that adverse events associated with the use of either drug alone may be more likely to occur with co-administration.
Non-CYP3A4-Mediated Effects: Other interactions and effects that occur with methylprednisolone (see Table 3).
Table 3 provides a list and descriptions of the most common and/or clinically important drug interactions or effects with methylprednisolone.

Click on icon to see table/diagram/image

Incompatibilities: To avoid compatibility and stability problems, it is recommended that methylprednisolone sodium succinate be administered separately from other compounds that are administered via the IV route of administration. Drugs that are physically incompatible in solution with methylprednisolone sodium succinate include but are not limited to: Allopurinol sodium, doxapram hydrochloride, tigecycline, diltiazem hydrochloride, calcium gluconate, vecuronium bromide, rocuronium bromide, cisatracurium besylate, glycopyrrolate, propofol.
The IV compatibility and stability of methylprednisolone sodium succinate solutions and with other drugs in IV admixtures is dependent on admixture pH, concentration, time, temperature and the ability of methylprednisolone to solubilize itself. Thus, to avoid compatibility and stability problems, whenever possible it is recommended that methylprednisolone sodium succinate be administered separately from other drugs and as either IV push, through an IV medication chamber, or as an IV "piggy-back" solution.
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