Indications:
Helps reduce airway swelling associated with bronchospasm:
- Wheezing refractory to inhaled bronchodilators
- Status asthmaticus
- Severe anaphylaxis, in conjunction with epinephrine and diphenhydramine
Contraindications: Known hypersensitivity to the product and its constituents
Precautions:
- Methylprednisolone is an adjunct to, not a substitute for, bronchodilator therapy in acute asthma exacerbation.
- Safety in pregnancy is unclear – administer to gravid females, nursing mothers, and women of childbearing potential only when the anticipated benefits outweigh the known risks.
Side Effects:
- May produce hypertension
- Rare instances of:
- Anaphylactic reactions
- Exacerbation of congestive heart failure
- Seizure
- Most side effects are related to dosages higher than typically used in EMS
Adult Dose:
Standing order, if available:
- Severe allergic reaction (anaphylaxis):
- 60 – 125 mg IV/IO, if there are no contraindications
- Refractory bronchospasm and status asthmaticus:
- 60 – 125 mg IV/IO, if there are no contraindications
Pediatric Dose:
Standing order, if available, and there are no contraindications:
- Severe allergic reaction (anaphylaxis), OR refractory bronchospasm or status asthmaticus** – 125 mg reconstituted in 2 mL and diluted with 8 mL Normal Saline to a final volume of 10 mL (12.5 mg/mL). Administer IVP/IO:
- Age under 1 yr**: 12.5 mg (1 mL)
- Age 1 to 3 yr**: 25 mg (2 mL)
- Age 3 to 5 yr: 37.5 mg (3 mL)
- Age 5 to 9 yr: 50 mg (4 mL)
- Age 9 to 13 yr: 62.5 mg (5 mL)
- **Do not administer for respiratory distress to children less than 2 years of age, unless the child has a history of asthma.
- Consult BioTel for dosing confirmation if IM administration is required because of lack of vascular access:
- Reconstitute in 2 mL vial, as supplied (125 mg/2mL), but do NOT dilute
- Dose: 2 mg/kg (0.032 mL/kg) IM
Route:
IV and IO (all indications)
IM (refractory bronchospasm/status asthmaticus only – not for anaphylaxis)
Drug Action: Potent anti-inflammatory steroid
Class: Synthetic Glucocorticoid
Onset: 60 – 120 minutes; clinical response in 4 – 6 hours
Duration: 12 – 36 hours