[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/) › Methylprednisolone

[Pharmacology](https://durgical.com/en/pharmacology/) · [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

# Methylprednisolone

An intermediate-acting corticosteroid given by mouth or as high-dose IV «pulses» for severe flares such as multiple sclerosis relapses.

Updated 2026-11-01

- Class: [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)
- Receptor: Glucocorticoid receptor (GR), a nuclear receptor
- ATC code: H02AB04
- WHO Model List of Essential Medicines

◎**Glucocorticoid receptor (GR), a nuclear receptor**Methylprednisolone

ⓘ The figure shows cortisol (hydrocortisone) in the ligand-binding pocket of the human glucocorticoid receptor; methylprednisolone binds the same pocket.

**Target in 3D:** Glucocorticoid receptor (GR), a nuclear receptor. PDB structure 4P6X (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4P6X) · Drag to rotate · pinch to zoom

## Mechanism of action

Methylprednisolone is a methylated prednisolone that binds the glucocorticoid receptor. The complex enters the nucleus, switches on anti-inflammatory genes and represses NF-κB and AP-1. At very high IV doses it rapidly suppresses inflammation and immune activity, which is why it is used in pulses for severe autoimmune flares.

- Methylprednisolone binds the glucocorticoid receptor
- The drug-receptor complex moves into the nucleus
- It switches on anti-inflammatory genes and represses NF-κB and AP-1
- Fewer cytokines, prostaglandins and immune cells reach the tissue

## Pharmacokinetics

**Absorption**
Oral tablets; the sodium succinate salt is given IV or IM; the acetate is a depot suspension

**Metabolism**
In the liver, partly by CYP3A4

**Half-life**
Intermediate-acting glucocorticoid

## Indications

- Acute exacerbations of multiple sclerosis (IV pulses) [Multiple sclerosis →](https://durgical.com/en/conditions/multiple-sclerosis/)
- Severe lupus and other systemic autoimmune flares [Systemic lupus erythematosus →](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- Severe asthma [Asthma →](https://durgical.com/en/conditions/asthma/)
- Giant cell arteritis and other vasculitides [Giant cell arteritis →](https://durgical.com/en/conditions/giant-cell-arteritis/)
- Acute transplant rejection, with other immunosuppressants

## Adverse effects

### Common

- Hyperglycaemia, sometimes marked after pulses
- Insomnia, agitation and mood changes
- Fluid retention and higher blood pressure

### Serious (rare, important)

- Infections, which the drug can also mask
- Adrenal suppression: adrenal insufficiency if stopped abruptly after prolonged use
- Osteoporosis and fractures with long use
- Peptic ulcer and gastrointestinal bleeding, especially with NSAIDs
- Posterior subcapsular cataract and glaucoma
- Psychiatric reactions (euphoria, depression, psychosis)
- Arrhythmias or cardiac arrest after rapid IV injection of large doses
- Toxic hepatitis after repeated high-dose IV pulses

## Contraindications

- Systemic fungal infections
- Hypersensitivity to the product
- Live or live attenuated vaccines during immunosuppressive doses
- Intrathecal use

## Key interactions

**CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, barbiturates)**
Faster clearance and a weaker corticosteroid effect

**Strong CYP3A4 inhibitors (ketoconazole)**
Higher corticosteroid levels and more side effects

**Aspirin and other NSAIDs**
Higher risk of gastrointestinal ulcer and bleeding

**Potassium-depleting drugs (loop or thiazide diuretics, amphotericin B)**
Hypokalaemia; with digoxin, more risk of arrhythmia

**Ciclosporin**
Mutual inhibition of metabolism; seizures have been reported

## What is monitored

- Blood glucose
- Blood pressure and weight
- Potassium
- Signs of infection
- Eye pressure and bone density with long use
- Heart rhythm during high-dose IV infusion

## Administration and safety

- High IV doses are infused slowly over the time the protocol sets, never as a rapid push
- Sodium succinate (IV/IM) and acetate (depot suspension, not IV) are different products
- Formulations with benzyl alcohol are not used in neonates
- Epidural injection of corticosteroids has caused serious neurological events

## Nursing care

- During pulses, check blood pressure, heart rate and glucose
- Watch for infection: fever and other signs may be blunted
- Watch mood and sleep; report agitation, depression or confusion
- Teach that a long course is not stopped suddenly; it is tapered under medical supervision
- Check the product label to confirm the salt and route before giving it

## Pregnancy and breastfeeding

Used in pregnancy when the benefit justifies it; newborns of mothers on substantial doses are watched for adrenal insufficiency.

## Memory aid

METHYLpred = the «pulse» steroid: big IV doses, given slowly, for MS relapses and severe lupus.

## Test yourself

Think of the answer, then tap the question to see it.

## Why must high-dose IV methylprednisolone be infused slowly?

Rapid injection of large doses has been linked to arrhythmias, circulatory collapse and cardiac arrest.

## What do IV methylprednisolone pulses do in a multiple sclerosis relapse?

They suppress the inflammation of the relapse quickly, which speeds recovery from that episode.

## Which methylprednisolone salt is never given IV?

The acetate, a depot suspension for IM or intra-articular use. The sodium succinate is the IV form.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/methylprednisolone/)

## Related drugs

- [Prednisolone](https://durgical.com/en/pharmacology/prednisolone/)
- [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/)
- [Hydrocortisone](https://durgical.com/en/pharmacology/hydrocortisone/)

## Related conditions

- [Multiple sclerosis](https://durgical.com/en/conditions/multiple-sclerosis/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Asthma](https://durgical.com/en/conditions/asthma/)
- [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/)

[← Back to the class: Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Methylprednisolone: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682795.html) (MedlinePlus (U.S. National Library of Medicine), 2017); [DailyMed - METHYLPREDNISOLONE SODIUM SUCCINATE injection, powder, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=060bcf13-ce9e-488c-ad43-9d66abb23b18) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=H02AB04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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