Pharmacy/Weening of solu medrol from IVP to oral
My father has been on solu medrol 40 mg IVP every 8 hours for 5 days. How should he be weened from it? His last dose IVP was at 2 PM today.
He starts on a medrol pack 4 mg. tomorrow AM. I'm concerned about adrenal insufficiency.
Hi there, Sue.
I am assuming that your father has been an inpatient in a hospital while he was receiving the Solu Medrol, and then discharged on oral methylprednisolone (Medrol dosepak). At the very least, however, he should have been under the care of a physician whilst receiving treatment. I would be very concerned if a physician prescribed methylprednisolone without any directions...other than to self-wean. Weaning from steroids can get complicated and it is the responsibility of the physician to make these directions clear. Did the physician give your father a prescription to be dispensed by a pharmacist? Did the pharmacist question the physician about lack of directions? If not, this would also be poor care on the pharmacist's part, whose responsibility it is to ensure that the patient is thoroughly counseled about their medications and how they should be taken.
It is inappropriate for me to offer substitute directions for steroid dosing. This really (and legally) should come from the prescriber. Oftentimes, drugs will have safe, standard doses for administration, but dosing for steroids can vary substantially from patient to patient. I could make a recommendation based on dosing equivalencies and from professional experience having worked in a hospital, but, without a clear understanding of your father's condition, past history and medications, this may be unwise. In addition, as a pharmacist, I would ordinarily consult with the physician him/herself to discuss the most appropriate dose.
Are you able to get in touch with your father's prescriber? There are many schools of thought regarding weaning. Many physicians believe that adrenal insufficiency is not a concern unless patients have been on steroids for longer than 10 days. Others consider weaning essential despite duration of treatment particularly for older patients and for those with a complicated past medical history. Our preferred IV steroid in Australia is dexamethasone, while our oral steroid of choice is prednisolone. I worked out dose equivalencies with methylprednisolone. Your father's dose of methylpred 40mg IV every 8 hrs, is roughly the equivalent of what I commonly see patients being treated with in hospital for pneumonia and other inflammatory conditions. In other words, it's a typical IV dose to treat acute cases of inflammation. A five day duration is also typical. Most patients, but not all, would be weaned down to oral prednisolne 20mg (equiv. to methylpred 16mg, which could be taken as one dose or as 8mg twice a day). The process of weaning after that varies, but I often see a reduction by 5mg every 2-5days (or 4mg every 2-5 days in the case of methylprednisolone). But again, I must stress that the above information is merely a reflection of what I commonly see in hospital, and it is NOT meant as a substitute for your doctor's advice). As a pharmacist, I am not legally able to prescribe or dictate how steroids should be used.
Sue, I apologize for not being able to give you a definitive response to your question. I hope my information helps, however. It is important to liaise with your father's physician for accurate directions.
I wish you all the best. Feel free to shoot me a follow-up question should you have any further questions.