Methylprednisolone is administered orally. The initial adult dosage may range from 2-60 mg daily, depending on the disease being treated, and is usually administered in 4 divided doses. Some clinicians state that children may be given a dosage of 0.117-1.66 mg/kg daily or 3.3-50 mg/m daily, administered in 3 or 4 divided doses.
For certain allergic conditions (e.g., contact dermatitis including poison ivy), methylprednisolone may be administered for short-term use (e.g., 6 days) using 4-mg tablets; the recommended initial dosage is 24 mg (6 tablets) for the first day, which is then tapered by 4 mg daily until 21 tablets have been administered. On the first day, 8 mg (2 tablets) is administered twice daily (before breakfast and at bedtime) and 4 mg (1 tablet) is administered twice daily (after lunch and dinner). On the second day, 4 mg (1 tablet) is administered 3 times daily (before breakfast, after lunch, and after dinner) and 8 mg (2 tablets) is administered at bedtime. On the third day, 4 mg (1 tablet) is administered 4 times daily (before breakfast, after lunch, after dinner, and at bedtime). On the fourth day, 4 mg (1 tablet) is administered 3 times daily (before breakfast, after lunch, and at bedtime). On the fifth day, 4 mg (1 tablet) is administered twice daily (before breakfast and at bedtime). On the sixth day, 4 mg (1 tablet) is administered before breakfast. Some clinicians state that tapering the dosage of the drug over a longer period (e.g., 12 days instead of 6 days) may be associated with a lower incidence of flare-up of the dermatitis than that associated with 6-day therapy.
To gain prompt control of asthma in infants and children 4 years of age or younger with very poorly controlled, moderate-to-severe asthma (i.e., more than 3 exacerbations per year requiring oral corticosteroids) and in children 5-11 years of age with asthma of comparable control and severity (i.e., at least 2 exacerbations per year requiring oral corticosteroids), methylprednisolone 1-2 mg/kg daily (maximum 60 mg daily) may be added to existing asthma therapy. In adults and adolescents with very poorly controlled, moderate-to-severe asthma (i.e., at least 2 exacerbations per year requiring oral corticosteroids), methylprednisolone 40-60 mg daily as a single dose or in 2 divided doses may be added to low-to-high maintenance dosages of the inhaled corticosteroid and a long-acting inhaled β2-agonist bronchodilator. A short course (usually 3-10 days) of oral corticosteroid therapy should be continued until the patient achieves a peak expiratory flow (PEF) of 80% of his or her personal best and until symptoms resolve. However, a longer duration of treatment may be needed in some patients. There is no evidence that tapering the dosage after improvement will prevent a relapse.
Methylprednisolone 7.5-60 mg daily in the morning or every other day is suggested in adults and adolescents with severe asthma who are inadequately controlled with a high-dose inhaled corticosteroid, intermittent oral corticosteroid therapy, and a long-acting inhaled β2-agonist bronchodilator, based on consensus and clinical experience. A short course (2 weeks) of oral corticosteroids may be considered to confirm clinical response prior to implementing long-term therapy with these agents. Once long-term oral corticosteroid therapy is initiated, the lowest possible effective dosage (i.e., alternate-day or once-daily administration) should be used and the patient should be monitored carefully for adverse effects. Once asthma is well controlled, repeated attempts should be made to reduce the oral corticosteroid dosage.
For emergency department treatment of moderate-to-severe acute asthma exacerbations not controlled with an inhaled β2-adrenergic agonist in children 11 years of age or younger, methylprednisolone 1-2 mg/kg daily in 2 divided doses (maximum 60 mg daily) can be added. For treatment of such exacerbations in adults and adolescents, methylprednisolone 40-80 mg daily as a single dose or in 2 divided doses can be added to an inhaled β2-adrenergic agonist. Treatment should be continued until the patient achieves a PEF of 70% of predicted or personal best. For additional information on the stepped-care approach to drug therapy in asthma, .