Corticosteroids Pregnancy: Use with caution — short courses for acute severe asthma safe in pregnancy (uncontrolled asthma poses greater risk); long-term high-dose associated with foetal growth restriction; consider adrenal function in neonate

Methylprednisolone (Respiratory)

Brand names: Solu-Medrone

Adult dose

Dose: 125 mg IV for acute severe asthma; 500 mg–1 g IV for ABPA exacerbation; 0.5–1 mg/kg/day oral for ILD

Route: IV or oral

Frequency: Once daily IV for acute use; once daily oral for chronic use

Max: 1 g IV per pulse

For acute severe asthma: 125 mg IV 6-hourly or hydrocortisone 100 mg 6-hourly equally effective. For ABPA: high-dose prednisolone 0.5 mg/kg/day often preferred oral. For ILD (NSIP/COP): 0.5–1 mg/kg/day oral prednisolone equivalent.

Paediatric dose

Dose: 1–2 mg/kg IV (max 125 mg) for acute severe asthma mg/kg

Route: IV

Frequency: 6-hourly or daily per indication

Max: 125 mg/dose

Seek specialist paediatric respiratory opinion; BTS/SIGN asthma guidance for dose selection in children

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution in severe hepatic impairment — methylprednisolone is metabolised hepatically; steroid effects may be prolonged

Paediatric weight-based calculator

Patient weight (kg)

Seek specialist paediatric respiratory opinion; BTS/SIGN asthma guidance for dose selection in children

Clinical pearls

Acute severe asthma: IV methylprednisolone 125 mg is equivalent to hydrocortisone 400 mg or oral prednisolone 50 mg — BTS/SIGN guidelines allow any of these; IV not significantly faster-acting than oral if patient can swallow; prednisolone 40–50 mg oral for 5 days standard discharge treatment
ABPA (Allergic Bronchopulmonary Aspergillosis): high-dose prednisolone 0.5 mg/kg/day (up to 40 mg) for 4–6 weeks then taper over 3 months; itraconazole used concurrently as steroid-sparing agent; monitor IgE levels and CXR to assess response
ILD (Interstitial Lung Disease): methylprednisolone IV pulse 500 mg daily for 3 days used for acute exacerbations of ILD or initial treatment of NSIP/COP; oral prednisolone 0.5–1 mg/kg/day for chronic UIP/NSIP/COP management
MHRA — EOSINOPHILIA: if eosinophilia present with respiratory disease (EGPA/ABPA), check for parasites before high-dose steroids — risk of Strongyloides hyperinfection syndrome (fatal)
Relative potency: methylprednisolone 4 mg = prednisolone 5 mg = hydrocortisone 20 mg = dexamethasone 0.75 mg; equivalence important for converting between agents
Adrenal suppression: courses above 3 weeks require tapering; patients on long-term steroids need sick day rules — double dose if febrile illness, carry steroid alert card

Contraindications

Systemic infections (without specific antimicrobial cover)
Live vaccines (during high-dose treatment)

Side effects

Hyperglycaemia (monitor blood glucose — particularly post-infusion 6–10 hours)
Hypertension
Psychiatric effects (psychosis, mania — dose-dependent)
Immunosuppression (increased infection risk)
Osteoporosis (long-term use)
Adrenal suppression (with prolonged courses)

Interactions

NSAIDs (additive GI mucosal damage — co-prescribe PPI)
Antifungals (CYP3A4 inhibition — increases methylprednisolone exposure)
Rifampicin (CYP3A4 induction — reduces steroid effect significantly)

Monitoring

Blood glucose (6–10 hours post-IV infusion — steroid hyperglycaemia peak)
Blood pressure
Peak flow and spirometry (acute asthma response)
FEV1 and TLCO (ILD treatment response)
IgE levels and CXR (ABPA monitoring)
Bone density (DEXA scan) and fracture risk (long-term use)

Reference: BNFc; BNF 90; BTS/SIGN Asthma Guidelines 2022; NICE NG80; ABPA ISHAM Guidelines 2013; BTS ILD Guidelines 2008. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways