What is it used for?

Medrone tablets can be used to treat a wide variety of diseases and conditions that require either reduction of inflammation or suppression of the immune system. These include those listed below.

• Severe allergic reactions, eg severe allergic rhinitis, drug allergies, serum sickness, contact dermatitis.
• Asthma.
• Inflammatory bowel disease such as Crohn's disease and ulcerative colitis.
• Rheumatoid arthritis.
• Juvenile chronic arthritis.
• A form of arthritis affecting the joints of the spine (ankylosing spondylitis).
• Inflammatory muscle disorders, eg polymyositis, polymyalgia rheumatica.
• Inflammatory condition of the blood vessels that supply the area around the temples (temporal arteries), called giant cell arteritis.
• Inflammatory disease called systemic lupus erythematosus, which can affect many organs throughout the body and is caused by the immune system attacking connective tissue in the body.
• Rheumatic fever with severe inflammation in the heart (carditis).
• Inflammatory skin disorders, including pemphigus vulgaris, exfoliative dermatitis.
• Inflammatory eye disorders, eg uveitis, optic neuritis.
• Sarcoidosis.
• Inflammation of the lungs caused by inhaling stomach acid (gastric aspiration).
• Severe or widespread tuberculosis (in combination with anti-tuberculosis medicines).
• Idiopathic thrombocytopenia purpura.
• Anaemia caused by the immune system attacking red blood cells (autoimmune haemolytic anaemia).
• Acute and lymphatic leukaemia.
• Cancer of the lymph nodes (lymphoma).
• Helping to prevent the immune system attacking a transplanted organ, eg heart, liver, kidney etc.

Medrone tablets are also licensed to treat the hormone disorders listed below.

• Inadequate production of natural steroid hormones by the adrenal glands (adrenal insufficiency).
• Returning hormone levels to normal in a disorder of the adrenal glands called congenital adrenal hyperplasia.

How does it work?

• Medrone tablets contain the active ingredient methylprednisolone, which is a type of medicine known as a corticosteroid. Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions in the body, including control of inflammatory responses. Corticosteroid medicines are man-made derivatives of the natural hormones. They are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.
• Methylprednisolone is a synthetic steroid that has an anti-inflammatory effect. It is used to decrease inflammation in various different diseases and conditions.
• Methylprednisolone decreases inflammation by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states characterised by excessive inflammation. These include severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis.
• Methylprednisolone also decreases the numbers of white blood cells circulating in the blood. This, along with the decrease in inflammatory chemicals, can prevent the rejection of organ transplants, as it prevents the body from attacking foreign tissue. It is useful for the treatment of certain types of leukaemia, where there is an abnormally large production of certain white blood cells, and for treating certain diseases that are caused by the immune system attacking tissues in the body (autoimmune diseases).
• Corticosteroids have many important functions on every organ system. If the body's natural level of steroid hormones is too low because the adrenal glands are not producing enough hormones, this must be treated with replacement therapy to allow the body to function normally. Methylprednisolone can also be used for this purpose.

Warning!

• Medrone tablets should be taken in the morning to mimic the natural production of corticosteroids by the body. They should be taken after food to minimise irritation to the stomach.
• You must not stop taking this medicine suddenly if you have been taking more than 6mg daily for more than three weeks. This is because long-term use of corticosteroids can suppress the natural production of corticosteroids by the adrenal glands, which means that the body becomes temporarily reliant on the medicine. When it is time to stop treatment the dose should be tapered down gradually, to allow the adrenal glands to start producing adequate amounts of natural steroids again. Follow the instructions given by your doctor or pharmacist. Your doctor may also want you to stop treatment gradually if you have been taking high doses (more than 32mg methylprednisolone daily) even if only for three weeks or less; if you have been treated with corticosteroid tablets or injections in the last year; if you had problems with your adrenal glands before treatment was started; or if you have been repeatedly taking doses in the evening.
• You will be given a steroid card with this medicine that you should carry with you at all times. Show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist, anaesthetist). The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as a reminder that your medicine should not be stopped suddenly, and to provide information of your treatment to other people treating you. This is important because the effects that corticosteroids have on the body may affect other medical treatment you may be given. If you have an accident the card contains information that could save your life. You should also show your steroid card to anyone who treats you for three months after you stop treatment with steroids.
• During times of physical stress, for example illnesses, trauma or surgery, your adrenal glands would normally produce more steroid hormones to cope. However, during long-term treatment with this medicine the action of your adrenal glands will be suppressed, so this increase in hormones won't happen naturally. As a result your steroid dose will normally need to be increased temporarily during these kind of events. Discuss this with your doctor.
• Corticosteroids decrease the body's natural immune and inflammatory responses. They may increase your susceptibility to infections and can also mask the symptoms of infections, making you think they are less serious than they are. For this reason, it is important to consult your doctor if you get any signs of infection during treatment.
• If you have never had chickenpox you could be at risk of severe chickenpox while having treatment with this medicine and should avoid close personal contact with people who have chickenpox or shingles (herpes zoster). You should also avoid contact with people who have measles. If you are exposed to people with these diseases either during treatment, or in the three months after stopping treatment, you should consult your doctor urgently, as you will need an injection of immunoglobulin to help you stop getting the diseases. This is very important as these diseases can be life-threatening in people treated with long-term corticosteroids.
• Corticosteroid treatment, especially with high doses, can alter mood and behaviour early in treatment. People may experience confusion, irritability, nightmares, difficulty sleeping, mood changes and depression, and suffer from delusions and suicidal thoughts. In a few cases these effects have also occured when corticosteroid treatment is being withdrawn. For this reason, it is important to let your doctor know if you notice any change in your mood or behaviour during treatment or when stopping treatment, particularly if you begin to feel depressed, or have any disturbing thoughts or feelings. Most of these problems go away if the dose is lowered or the medicine is stopped. However if problems do happen they might need treatment.
• Children and adolescents having long-term treatment with this medicine should have their growth regularly monitored.

Use with caution in

• Children and adolescents.
• Elderly people.
• Decreased kidney function.
• Liver failure.
• Liver cirrhosis.
• Peptic ulcer.
• Inflammation of the bowel and back passage (ulcerative colitis).
• Painful inflammation of small sacs or pouches in the wall of the gut (diverticulitis).
• People who have recently had a surgical procedure called intestinal anastomosis, which involves the joining together of ends of the intestine after a section has been removed.
• People with a tendency to suffer from inflammation of veins associated with blood clot formation (thrombophlebitis).
• Heart failure.
• People who have recently had a heart attack.
• High blood pressure (hypertension).
• Diabetes, or a family history of diabetes.
• Underactive thyroid gland (hypothyroidism).
• Epilepsy.
• Glaucoma, or a family history of glaucoma.
• Current severe psychiatric illness, or a personal or family history of psychiatric illness, including depression, manic depression or schizophrenia.
• History of psychiatric illness caused by the use of a corticosteroid.
• Osteoporosis.
• Women who have passed the menopause.
• Abnormal muscle weakness (myasthenia gravis).
• People who have previously experienced muscle disorders (myopathy) caused by steroids.
• People with a history of tuberculosis (TB).
• People with abscesses or other pus-producing infections.
• Herpes simplex virus infection of the eye.
• People with a low level of potassium in their blood (hypokalaemia).

Not to be used in

• People with widespread infection, unless this is being treated with specific anti-infectives.
• Corticosteroids should not be used for the management of head injury or stroke because they are unlikely to be of benefit and may even be harmful.
• This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the developing baby. When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of slowed growth in the developing baby. They may also cause the baby to make less of its own steroid hormones after birth, though this usually resolves on its own and rarely causes any problems. Seek further medical advice from your doctor.
• If you think you could have fallen pregnant while you are taking this medicine you should consult your doctor for advice. It is important that you do not suddenly stop taking the medicine unless your doctor tells you to - see the warnings above.
• This medicine passes into breast milk. It should be used with caution in mothers who are breastfeeding and only if the benefits to the mother outweigh any risks to the nursing infant. Doses of up to 40mg methylprednisolone daily taken by the mother are unlikely to significantly affect the baby, but if the mother is taking higher doses for long periods of time, the medicine could cause the baby's adrenal glands to make less of their own steroid hormones. Seek medical advice from your doctor.

Label warnings

• Follow the printed instructions you have been given with this medication.
• Take this medication with or after food.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

• Raised blood sugar level.
• Increased appetite and weight gain.
• Increased susceptibility to infections and increased severity of infections (see warnings above).
• Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis).
• Ulceration or thrush infection in the throat.
• Muscle weakness or wasting.
• Thinning of the bones (osteoporosis) and increased risk of breaking a bone.
• Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism).
• Psychiatric reactions, such as mood changes (including irritability, depression and suicidal thoughts), psychotic reactions (including mania, delusions and hallucinations), anxiety, confusion, memory loss, sleep disturbances (see warning above).
• Cushing's syndrome, characterised by a moon-shaped face.
• Menstrual disturbances.
• Sodium and water retention.
• Increase in blood pressure (hypertension).
• Decrease in the level of potassium in the blood.
• Decrease in the production of natural steroids by the adrenal glands (adrenal suppression - see warning above).
• Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts.
• Slowed growth in children and adolescents.
• Hiccups.
• Blood clots in the blood vessels (thromboembolism).

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Methylprednisolone can cause fluid and salt retention and so may oppose the effects of the following medicines:

• antihypertensive medicines used to treat high blood pressure
• diuretics, eg furosemide.

There may be an increased chance of the level of potassium in the blood falling too low (hypokalaemia) if methylprednisolone is used in combination with any of the following medicines, which can also lower the amount of potassium in the blood:

• acetazolamide
• amphotericin
• beta agonists, eg salbutamol, salmeterol, terbutaline
• carbenoxolone
• potassium-losing diuretics, eg furosemide, bendroflumethiazide
• theophylline.

Methylprednisolone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets.

Methylprednisolone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. People taking anticoagulant medicines in combination with methylprednisolone should have their blood clotting time (INR) regularly monitored, particularly after starting or stopping treatment with methylprednisolone and after any dose changes.

If methylprednisolone is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, there may be an increased risk of side effects on the gut, such as stomach ulceration and bleeding.

Methylprednisolone may decrease the blood levels of salicylates such as aspirin. When methylprednisolone is stopped, this may result in excessive levels of the salicylate, unless the dose is readjusted.

The following medicines may increase the removal of methylprednisolone from the body, thus reducing its effects. You may need a larger dose of methylprednisolone if you are also taking any of these medicines:

• barbituates, eg amobarbital, phenobarbital
• carbamazepine
• phenytoin
• primidone
• rifabutin
• rifampicin.

The effect of corticosteroids may be reduced in the three to four days following use of mifepristone.

The following medicines may reduce the removal of methylprednisolone from the body and so may increase its effects or side effects:

• aprepitant
• ciclosporin (methylprednisolone may also increase the blood level and risk of side effects of ciclosporin)
• diltiazem
• itraconazole
• ketoconazole
• macrolide-type antibiotics, eg clarithromycin, erythromycin
• protease inhibitors, eg ritonavir.

Methylprednisolone may decrease the body's immune response. This means that vaccines may be less effective if given during treatment, because the body does not produce sufficient antibodies. Live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral polio, oral typhoid and yellow fever. These should not be given to people whose immune system is underactive due to treatment with this medicine.

References:

http://www.netdoctor.co.uk/medicines/a7072/medrone-tablets-methylprednisolone/

http://www.medicines.ie/medicine/7004/SPC/Depo-Medrone+40+mg+ml+1ml+vial/#MACHINEOPS

https://www.medicines.org.uk/emc/medicine/1536

https://www.drugs.com/uk/medrone-4-mg-tablets-leaflet.html

https://patient.info/medicine/methylprednisolone-tablets-medrone