Depo-Medrol – composition, action, indications, dosage. When should I use Depo-Medrol?

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Depo-Medrol is a drug dedicated to people suffering from rheumatoid diseases, as well as those struggling with degenerative arthritis or tendonitis. Its action is also used in medicine in the treatment of skin diseases that are resistant to other pharmaceuticals.

Depo-Medrol – what is this drug?

The active substance in Depo-Medrol, methylprednisolone acetate, belongs to the group of glucocorticosteroids intended for internal use, and lidocaine hydrochloride is a strong local anesthetic.

Depo-Medrol should only be used for symptomatic treatment. The drug is administered intramuscularly, periarticular or intraarticularly. Depo-Medrol is indicated for short-term administration as an adjunct therapy during an acute episode or exacerbation in the following conditions:

1. synovitis in the course of osteoarthritis,
2. rheumatoid arthritis,
3. post-traumatic osteoarthritis,
4. acute and subacute bursitis,
5. epicondylitis,
6. acute nonspecific tenosynovitis,
7. acute gouty arthritis.

Depo-Medrol can also be used to treat cystic tumors, inflammation of the tendons or inflammation of the tendons (ganglions).

See: Arthritis – causes, symptoms, treatment

Depo-Medrol – composition and mechanism of action

Each vial of Depo-Medrol contains 40 mg of methylprednisolone acetate (Methylprednisoloni acetas) and 10 mg of lidocaine hydrochloride (Lidocaini hydrochloridum). The excipient with known effect is 8,7 mg of benzyl alcohol in each 1 ml, corresponding to 8,7 mg / ml.

Depo-Medrol with lidocaine belongs to the group of hormonal drugs for internal use – corticosteroids for internal use. Methylprednisolone acetate with lidocaine is a sterile aqueous suspension of the synthetic glucocorticoid-methylprednisolone acetate and the local anesthetic lidocaine hydrochloride.

Methylprednisolone acetate is a potent and sustained anti-inflammatory glucocorticosteroid. It inhibits local inflammation caused by mechanical, chemical or immunological factors. Lidocaine is a powerful amide-type local anesthetic.

See: Rosehip – a natural remedy for joint pain and degeneration

Depo-Medrol – dosage

Always take Depo-Medrol exactly as prescribed by your doctor. Check with your doctor or pharmacist if you are not sure.

Your doctor will decide on the appropriate dose, method and place of administration of Depo-Medrol with lidocaine. Treatment with Depo-Medrol with lidocaine does not eliminate the need for other medications.

Below are detailed instructions on how to dose Depo-Medrol.

1. Rheumatoid arthritis and osteoarthritis

The size of the intra-articular dose depends on the size of the joint and the severity of the condition to be treated in the individual patient. The usual recommended doses may be from 4 mg to 80 mg. For chronic conditions, injections may be repeated at intervals of one to five or more weeks depending on the degree of symptom reduction obtained with the first injection.

1. Bursitis

The doctor will adjust the dose of the drug administered to the joint bursa, depending on the severity of the disease and the patient’s response to treatment.

1. Other states: ganglion, tendinitis, epicondylitis

Your doctor will adjust the dose according to the severity of the condition being treated and your response to treatment. The usual recommended doses may be from 4 mg to 30 mg. A second injection may be necessary to treat relapsed or chronic conditions. In many cases, a single injection of the drug significantly reduces the size of an articular cyst and may even cause it to disappear.

Depo-Medrol – when should you not use the drug?

In the Depo-Medrol package leaflet there are strictly defined situations in which you should not use Depo-Medrol.

The use of Depo-Medrol is contraindicated:

1. in people who are hypersensitive to methylprednisolone or to any of the excipients of the drug,
2. in people hypersensitive to lidocaine or other local anesthetics of the amide type,
3. in people with systemic fungal infections,
4. in intrathecal (intrathecal) administration,
5. in intravenous administration,
6. in epidural administration,
7. in administration to the nose and eyeball, as well as to other places (skin covering the skull, oropharyngeal cavity, wedge-palatal ganglion),
8. in premature babies and newborns.

Depo-Medrol is not recommended for pregnant and breastfeeding women.

See: Milking the umbilical cord helps premature babies

Depo-Medrol – precautions

Depo-Medrol contains benzyl alcohol. The benzyl alcohol content is 8,7 mg per ml vial. Benzyl alcohol may have a toxic effect on that tissue when injected into or near nervous tissue.

During treatment with Depo-Medrol, clinical monitoring is necessary and the treatment period should be as short as possible in people belonging to the following groups at increased risk:

1. people with diabetes: emergence of latent diabetes or an increase in the need for insulin or oral antidiabetic drugs,
2. people with hypertension: worsening of hypertension.

Metabolism and nutrition disorders

Corticosteroids, including methylprednisolone, may increase blood glucose levels, worsen pre-existing diabetes mellitus, and increase the risk of diabetes in people taking long-term corticosteroids.

Mental disorders

People with a history of mental illness: the use of glucocorticoids may worsen existing emotional instability or psychotic tendencies. Potentially serious psychiatric adverse reactions can occur with systemic steroid use. Symptoms usually appear within a few days or weeks of starting treatment.

Effects on the nervous system

Corticosteroids should be used with caution in people with seizure disorders. Corticosteroids should be used with caution in people with myasthenia gravis. Cases of epidural lipomatosis have been reported in people taking corticosteroids, usually with long-term use of high doses.

Effects on the stomach and intestines

Glucocorticoids should be used with caution in the treatment of inflammatory ulcerative colitis if there is a risk of perforation, or the development of an abscess or other form of purulent infection. Caution should also be exercised in the case of diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer disease, when steroids are used as basic or adjuvant therapy.

Other warnings:

1. People with ocular herpes or herpes zoster with symptoms affecting the eyeball: treatment with Depo-Medrol with lidocaine may lead to a risk of perforation of the cornea.
2. complications of glucocorticoid therapy depend on the dose level and the duration of treatment. The doctor will decide on the dosage and duration of treatment individually for each patient,
3. inform the doctor about all medications taken by the patient now or recently, including those over the counter,
4. some drugs can increase the effect of Depo-Medrol with lidocaine and your doctor may want to carefully monitor you if you are taking such drugs (including some HIV drugs: ritonavir, cobicistat),
5. due to the possibility of skin and subcutaneous tissue atrophy, the doctor will prescribe the appropriate dosage and injection method to reduce the occurrence of these complications,
6. Corticosteroids, including methylprednisolone, may increase blood glucose levels, aggravate pre-existing diabetes and predispose patients to diabetes on long-term use of corticosteroids.
7. Epidural lipomatosis has been reported in people using corticosteroids, usually with long-term use of high doses,
8. posterior subcapsular cataracts and nuclear cataracts (especially in children), exophthalmos or an increase in intraocular pressure may develop in long-term use of Depo-Medrol with lidocaine, and may be associated with the development of secondary eye infections caused by by fungi or viruses,
9. the use of Depo-Medrol with lidocaine is associated with the development of central serous chorioretinopathy, which may lead to retinal detachment,
10. if you experience blurred vision or other visual disturbances, contact your doctor,
11. in the case of high doses and long-term treatment with Depo-Medrol with lidocaine in patients with cardiovascular risk factors, the drug should be administered with caution and additional monitoring of the cardiovascular system, if necessary,
12. in people with congestive heart failure, Depo-Medrol with lidocaine should be administered with caution and only if absolutely necessary,
13. Osteoporosis can occur in people who take high doses of Depo-Medrol with lidocaine for a long time,
14. Depo-Medrol with lidocaine should be used with caution in people with renal insufficiency.

Also read: Can osteoporosis be avoided? Five steps to help you do this

Depo-Medrol – mental disorders

People with a history of mental illness: the use of glucocorticoids may worsen existing emotional instability or psychotic tendencies. Potentially serious psychiatric adverse reactions can occur with systemic steroid use.

Symptoms usually appear within a few days or weeks of starting treatment. Most reactions will improve with dose reduction or discontinuation of the drug, but appropriate treatment may be required. Psychotic disorders have been reported after discontinuation of corticosteroids, but the frequency of cases is unknown.

Patients and / or caregivers should be encouraged to contact their physician if the patient experiences psychotic symptoms, especially when depressed mood or suicidal ideation is suspected.

Patients and / or caregivers should be informed of the possibility of psychiatric disorders occurring during or immediately after the reduction / discontinuation of systemic corticosteroids.

The editorial board recommends: This type of depression has some unusual symptoms. What is Sisi Syndrome?

Depo-Medrol – endocrine disorders

If severe stress occurs in individuals undergoing treatment with corticosteroids, it is advisable to increase the dosage of rapid-acting corticosteroids before, during and after the stressful situation. Long-term administration of therapeutic doses of corticosteroids may lead to suppression of the hypothalamic-pituitary-adrenal (PPN) axis (secondary adrenal insufficiency).

The degree and duration of induced adrenal insufficiency varies from person to person and depends on the dose, frequency of dosing, timing of administration, and duration of glucocorticoid treatment. A steroid “withdrawal syndrome” apparently unrelated to adrenal insufficiency may also occur following abrupt discontinuation of glucocorticoid treatment.

This syndrome includes symptoms such as anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, peeling skin, muscle pain, weight loss and / or hypotension. These effects are believed to be due to the sudden change in glucocorticoid levels rather than to low corticosteroids.

Since glucocorticoids may induce or worsen Cushing’s syndrome, their use in patients with Cushing’s disease should be avoided. Corticosteroids are potent in people with hypothyroidism.

Also read: Diet for patients with hypothyroidism

Depo-Medrol – interactions with other drugs

Tell your doctor about all the medications you are taking or have recently taken, and about any medications you plan to take. The drug Depo-Medrol with lidocaine may influence the action of other drugs, and other drugs may affect the action of Depo-Medrol with lidocaine.

Dose adjustment of Depo-Medrol with lidocaine may be possible when used concomitantly with the following drugs:

1. antibacterial drugs: isoniazid,
2. anti-tuberculosis antibiotic: rifampicin,
3. anticoagulants (by mouth). Concomitant use with Depo-Medrol with lidocaine may reduce or increase the effect of anticoagulants. Blood coagulation indicators should be monitored to ensure adequate anticoagulant activity.
4. anticonvulsants: carbamazepine, phenobarbital, phenytoin,
5. anticholinergic drugs: neuromuscular blocking agents. Acute myopathy has been reported with the concomitant use of high doses of Depo-Medrol with lidocaine and anticholinergics, e.g. neuromuscular blocking agents.
6. muscle relaxants, e.g. pancuronium, vencuronium; Depo-Medrol with lidocaine may partially inhibit the neuromuscular blockade caused by muscle relaxants,
7. anticholinesterases: Depo-Medrol with lidocaine may reduce the effect of anticholinesterases in people with myasthenia gravis.
8. Antidiabetic drugs: in people with diabetes, the dose of antidiabetic drugs may need to be adjusted, as Depo-Medrol with lidocaine may increase blood glucose levels.
9. antiemetic drugs: aprepitant, fosaprepitant,
10. antifungal drugs: itraconazole, ketoconazole,
11. antiviral drugs,
12. inhibitory proteazy HIV: indynawir i rytonawir − inhibitor aromatazy: aminoglutetymid,
13. calcium channel antagonist: diltiazem,
14. oral contraceptives: ethinylestradiol / norethindrone,
15. grapefruit juice,
16. immunosuppressants: cyclosporine. When cyclosporin and Depo-Medrol are used concomitantly with lidocaine, there is mutual inhibition of metabolism, which may increase the plasma concentration of one or both drugs. Therefore, there is a possibility that the risk of side effects from either of the medicaments may be increased upon co-administration. Convulsions have been reported with concomitant use,
17. immunosuppressants: cyclophosphamide, tacrolimus,
18. macrolide antibacterial drugs: clarithromycin, erythromycin, troleandomycin,
19. Non-steroidal anti-inflammatory drugs (NSAIDs): high doses of aspirin (acetylsalicylic acid). Concomitant use of anti-inflammatory drugs with Depo-Medrol with lidocaine may increase the incidence of gastrointestinal bleeding and ulceration. Caution should be exercised when aspirin is used in combination with Depo-Medrol with lidocaine,
20. drugs that lower potassium levels. When Depo-Medrol is used concomitantly with lidocaine with drugs that lower potassium levels (e.g. diuretics), patients should be monitored for the development of hypokalaemia (a condition where blood potassium levels are below the laboratory limit values). The risk of hypokalaemia increases when Depo-Medrol is used concomitantly with lidocaine with amphotericin B, xanthenes or beta2 agonists.

See: Aspirin and NSAIDs fight cancer

Depo-Medrol – side effects

The following side effects have been reported with the use of Depo-Medrol with lidocaine, the following contraindicated routes of administration: intrathecal or epidural: arachnoiditis, gastrointestinal or bladder dysfunction, headache, meningitis, transverse paresis (paralysis ), seizures, sensory disturbance.

Possible side effects following administration of Depo-Medrol with lidocaine include:

1. opportunistic infections, peritonitis,
2. leukocytosis (increased number of white blood cells in the blood),
3. drug hypersensitivity, anaphylactic reaction, anaphylactoid reaction,
4. development of Cushing’s syndrome (a group of clinical symptoms that is a consequence of an excess of glucocorticoid hormones in the body),
5. hypopituitarism, steroid withdrawal syndrome,
6. metabolic acidosis, sodium retention (accumulation of sodium in the body), fluid retention, hypokalaemic alkalosis (alkalosis with low blood potassium levels), dyslipidaemia (abnormal fasting serum levels of one or more lipoprotein fractions or their composition), impaired glucose tolerance, increased need for insulin (or oral antidiabetic drugs in people with diabetes), lipomatosis (excessive accumulation of fat), increase in appetite (which may lead to weight gain),
7. affective disorders (including depressed mood, euphoric mood, affective emotional lability, drug addiction, suicidal thoughts), psychotic disorders (including mania, delusions, hallucinations and schizophrenia), mental disorders, personality changes, confusional state, restlessness, mood swings, dysfunctional behavior, insomnia, irritability, nervousness,
8. epidural lipomatosis, increased intracranial pressure (with papilloedema [benign intracranial hypertension]), loss of consciousness, seizures, amnesia, cognitive impairment, tremor, somnolence, hypoesthesia, dizziness, headache,
9. chorioretinopathy, cataracts, glaucoma, exophthalmia, double vision, visual disturbances.

See: The worst cases of amnesia. “It’s just like being dead”

Depo-Medrol – overdose

Long-term use of Depo-Medrol in frequently repeated doses (once a day or several times a week) may cause Cushing’s syndrome and other reactions associated with chronic use of steroid therapy. Acute toxicity and / or death have been rarely reported following overdose with corticosteroids. In the event of overdose, there is no specific antidote and treatment is supportive and symptomatic. Methylprednisolone is dialysable.

Lidocaine overdose may manifest as transient CNS excitation with the following early symptoms: yawning, restlessness, dizziness, nausea, vomiting, arthralgia, ataxia, hearing and vision disturbances. In case of moderate poisoning, muscle twitching and convulsions may occur. Subsequently, unconsciousness, respiratory depression and coma may occur.

In very severe poisonings, due to a decrease in myocardial contractility and delayed impulse conduction, arterial hypotension and cardiovascular collapse may occur, followed by complete atrioventricular block and cardiac arrest; treatment should be symptomatic. In the event of seizures, diazepam should be given. Patients with respiratory depression should be ventilated.

Hypotension can be treated with fluids and dopamine. For asystole, adrenaline should be administered and, if necessary, a pacemaker introduced.

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Depo Medrol — scene

The price of Depo-Medrol varies across the country and ranges from PLN 7,39 to PLN 14,77 for one vial, containing 40 mg / ml. In patients with a problem with the adrenal gland, this dose is sufficient for two weeks. One injection is then given. In patients with rheumatoid arthritis or tendonitis, the dose may range from 40 to 120 mg / ml once, similar to those in people with dermatological problems. Usually treatment takes about four weeks and the drug is given once a week.