Meprelon

Leaflet attached to the packaging: information for the user

Meprelon, 4 mg, tablets

Methylprednisolone

Please read this leaflet carefully before taking the medicine, as it contains important information for the patient.

• Please keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, please consult your doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same as yours.
• If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is Meprelon and what is it used for
• 2. Important information before taking Meprelon
• 3. How to take Meprelon
• 4. Possible side effects
• 5. How to store Meprelon
• 6. Contents of the packaging and other information

1. What is Meprelon and what is it used for

The active substance of Meprelon is a glucocorticosteroid (adrenal cortex hormone) that affects metabolism (i.e., metabolism), water and electrolyte balance, and tissue function. Meprelon is used in diseases that require the administration of glucocorticosteroids. Depending on the symptoms and severity, these include inflammatory and systemic rheumatic diseases, autoimmune diseases, allergic conditions, anaphylactic shock, severe asthma, transplant rejection.

• Rheumatic diseases: progressive rheumatoid arthritis in severe, progressive form, e.g., with rapid joint destruction, and extra-articular forms.
• Juvenile rheumatoid arthritis with severe course, involving internal organs (Still's syndrome) or involving the eyes, when local treatment is ineffective (uveitis and adjacent structures).

Respiratory tract diseases:

• Bronchial asthma (concomitant administration of bronchodilators is recommended).
• Exacerbation of chronic obstructive pulmonary disease (recommended treatment period: up to 10 days).
• Specific lung diseases, such as acute alveolitis, pulmonary fibrosis; maintenance treatment of chronic sarcoidosis in stage II and III (with shortness of breath, cough, and deterioration of lung function parameters).
• Severe forms of hay fever and allergic rhinitis after failure of treatment with a glucocorticosteroid nasal spray.

Skin diseases:
Diseases of the skin and mucous membranes that cannot be sufficiently treated with topical corticosteroids due to their severity and/or size or involvement of internal organs. These include:

• Allergic reactions and reactions similar to allergies, allergic reactions associated with infections, e.g., urticaria, anaphylactoid reactions.
• Severe skin reactions, sometimes causing skin destruction, drug rash, erythema multiforme, toxic epidermal necrolysis (Lyell's syndrome), generalized acute pustular psoriasis, nodular erythema, severe febrile neutrophilic dermatosis (Sweet's syndrome), allergic contact dermatitis.
• Immune system diseases (autoimmune diseases), e.g., dermatomyositis, discoid and subacute lupus erythematosus.

Blood diseases:

• Autoimmune blood diseases: anemia due to red blood cell destruction (acquired [autoimmune] hemolytic anemia).

Gastrointestinal tract diseases:

• Ulcerative colitis.
• Crohn's disease.

Replacement therapy:
Reduced or absent adrenal cortex function (adrenal insufficiency of any cause, e.g., Addison's disease, adrenogenital syndrome, postoperative adrenal removal, pituitary insufficiency) after completion of growth (hydrocortisone and cortisone are the drugs of choice).

2. Important information before taking Meprelon

When not to take Meprelon

• If the patient is allergic to methylprednisolone or any of the other ingredients of this medicine (listed in section 6).
• If the patient has systemic fungal infections. Except for allergic reactions, there are no contraindications to short-term use of Meprelon in life-threatening conditions or replacement therapy.

Warnings and precautions

Before starting to take Meprelon, the patient should discuss it with their doctor or pharmacist,

• if the patient has hyperthyroidism. If it is necessary to use Meprelon in doses higher than substitution (doses used to supplement the lack of corticosteroids produced by the human body), Meprelon should only be used when the doctor considers it necessary. In some cases, specific drugs may need to be used at the same time to counteract the disease-causing factors. This applies to the following cases:
• acute viral infections (chickenpox, shingles, herpes virus infections, herpes simplex keratitis);
• acute and chronic bacterial infections;
• fungal infections with internal organ involvement;
• certain parasitic diseases (strongyloidiasis, worm infestations);
• lymph node disease after tuberculosis vaccination (in case of tuberculosis in the medical history, the medicine can only be used with anti-tuberculosis drugs);
• hepatitis (chronic active hepatitis with a positive HBsAg test result);
• poliomyelitis;
• about 8 weeks before and up to 2 weeks after vaccinations with live vaccines.

Meprelon can only be used in the following diseases if the doctor considers it necessary and the disease is treated according to the applicable rules:

• peptic ulcer disease;
• hypertension that is difficult to control;
• severe diabetes;
• osteoporosis;
• mental illnesses (also in the medical history);
• increased intraocular pressure (glaucoma with closed or open angle);
• corneal damage or ulcers.

Due to the risk of intestinal perforation and peritonitis, Meprelon should only be used with absolute indications and under proper control in the following diseases:

• severe ulcerative colitis (ulcerative colitis) with a risk of perforation, with abscesses or purulent inflammation;
• diverticulitis of the intestine;
• after certain intestinal surgeries (intestinal anastomoses) immediately after surgery.

In patients taking high doses of glucocorticosteroids, symptoms of peritonitis after intestinal perforation may be masked. The use of Meprelon may cause gas accumulation in the intestinal wall, called intestinal pneumatosis cystoides (see section 4 "Possible side effects"). Intestinal pneumatosis cystoides can range from a mild condition that does not require treatment to more severe conditions that may require immediate treatment. If symptoms such as nausea, vomiting, and abdominal pain occur, which persist or worsen, the patient should contact their doctor immediately. The doctor will decide on the need for further diagnosis and treatment. During treatment of a certain type of muscle paralysis (myasthenia), there may be an initial worsening of symptoms. Therefore, Meprelon should be administered initially in a hospital. Especially in the case of severe facial and throat disorders with breathing difficulties, Meprelon should be introduced gradually. Meprelon may mask infection symptoms, making it difficult to diagnose an existing or emerging infection. Long-term use of even small doses of methylprednisolone increases the risk of infection with microorganisms that usually rarely cause infections. In principle, it is possible to vaccinate with vaccines containing killed microorganisms. However, it should be remembered that when taking higher doses of Meprelon, the effectiveness of the vaccination may be reduced. In patients with diabetes, metabolism (metabolism) should be regularly monitored. It is necessary to consider possible increased demand for anti-diabetic drugs (insulin, oral drugs, etc.). Especially during long-term treatment with relatively high doses of Meprelon, attention should be paid to adequate potassium intake (e.g., vegetables, bananas) and sodium restriction. The doctor should monitor potassium levels in the blood. In cases of severe hypertension or severe heart failure, the doctor should carefully monitor the patient, as there is a risk of deterioration. Before starting to take Meprelon, the patient should discuss it with their doctor if: The patient has scleroderma (an autoimmune disorder also known as systemic sclerosis), as doses of at least 12 mg per day may increase the risk of a serious complication called scleroderma renal crisis. The symptoms of scleroderma renal crisis include increased blood pressure and decreased urine production. The attending physician may recommend regular blood pressure and urine output checks. The patient should inform their doctor if they experience symptoms of tumor lysis syndrome, such as muscle cramps, muscle weakness, confusion, vision loss or disturbances, shortness of breath, seizures, irregular heartbeat, or kidney failure (decreased urine output or darker urine color), as well as in the case of hematological malignancies (see section 4 "Possible side effects"). After administration of Meprelon, cases of pheochromocytoma crisis (increased blood pressure, headache, excessive sweating, palpitations, pallor) have been reported, which can be life-threatening. Treatment of patients with suspected or diagnosed pheochromocytoma should only be started after careful assessment of the benefit-risk ratio. If the patient experiences blurred vision or other vision disturbances, they should contact their doctor. During long-term administration of Meprelon, regular medical check-ups (including ophthalmological check-ups) are necessary. In cases where the body is under special stress, e.g., diseases with fever, injuries, or surgeries, the patient should consult their attending physician or inform the emergency doctor about the treatment. Sometimes, a temporary increase in the daily dose of Meprelon may be necessary. Depending on the duration of treatment and dose, there may be a negative impact on calcium metabolism. Therefore, osteoporosis prevention is recommended. This applies especially to people with existing risk factors, such as family history, advanced age, inadequate protein and calcium intake, smoking, excessive alcohol consumption, postmenopausal period, or lack of physical activity. Prevention involves adequate calcium and vitamin D intake and physical activity. In the case of existing osteoporosis, additional consideration should be given to the use of drugs. After completion or possible discontinuation of long-term use of Meprelon, the following risks should be remembered: worsening or recurrence of the underlying disease, acute adrenal insufficiency (especially in stressful situations, e.g., during infection, after injuries, with increased stress), "steroid withdrawal syndrome" (see section 4 "Possible side effects"). In patients treated with Meprelon, viral diseases may have a particularly severe course, especially in children with impaired immunity and individuals who have not previously had measles or chickenpox. In the event of contact with people suffering from measles or chickenpox during treatment with Meprelon, the patient should immediately consult a doctor, who may take preventive measures if necessary. In cases of uncontrolled hypothyroidism or liver cirrhosis, relatively small doses may be sufficient, or the dose may need to be reduced, which should be determined by the doctor. The patient should immediately consult their doctor if they experience weakness or muscle pain, cramps, and stiffness during methylprednisolone treatment. These may be symptoms of a condition called thyrotoxic periodic paralysis, which can occur in patients with hyperthyroidism treated with methylprednisolone. Additional treatment may be necessary to alleviate this condition.

Children

Meprelon can only be used in children with absolute indications, due to the risk of growth retardation. The child's growth should be regularly monitored. After systemic treatment with glucocorticosteroids in premature infants, a specific heart muscle disease (hypertrophic cardiomyopathy) has been observed. Therefore, in infants treated systemically with glucocorticosteroids, heart function should be monitored.

Elderly

In elderly patients, caution should be exercised due to the increased risk of side effects, such as diabetes, osteoporosis, and hypertension.

Effect of the medicine when used inappropriately as a doping agent

Taking Meprelon may result in positive test results for doping substances. Additionally, using Meprelon as a doping agent can pose health risks.

Meprelon and other medicines

The patient should tell their doctor about all medicines they are currently taking or have recently taken, including those available without a prescription. Medicines that affect the action of Meprelon

Medicines that may enhance the effect of Meprelon

• Certain medicines may enhance the effect of Meprelon, and the doctor may want to closely monitor the patient's condition when taking such medicines (including certain HIV medicines: ritonavir, cobicistat).
• Medicines that slow down the metabolism of corticosteroids in the liver, such as certain antifungal medicines (containing ketoconazole, itraconazole), may enhance the effect of Meprelon.
• Certain female sex hormones, e.g., oral contraceptives: the effect of Meprelon may be increased.

Medicines that may weaken the effect of Meprelon

• Medicines that accelerate its metabolism in the liver (barbiturates, phenytoin, primidone, carbamazepine - antiepileptic drugs, rifampicin - anti-tuberculosis drug): the effect of Meprelon may be reduced.
• Medicines containing ephedrine, used to reduce swelling of mucous membranes, may accelerate the metabolism of glucocorticosteroids, which may reduce their effectiveness.

Other potential interactions

• Medicines used to treat heart diseases (e.g., diltiazem - a calcium channel blocker) may slow down the metabolism of methylprednisolone. Therefore, during the initial treatment period, it should be carried out under medical supervision. It may be necessary to adjust the dose of methylprednisolone.
• Medicines used to reduce excessive stomach acid production (antacids): in patients with chronic liver disease, it may be necessary to increase the dose of Meprelon.

Effect of Meprelon on the action of other medicines

Enhancement of action

• Medicines used to treat heart failure (cardiac glycosides): due to the potential induction of potassium deficiency by Meprelon, their action may be increased.
• Diuretics and laxatives: their action is enhanced in the form of increased potassium excretion.
• Certain muscle relaxants (non-depolarizing muscle relaxants): muscle relaxation may last longer.

Weakening of action

• Antidiabetic medicines (oral, insulin): their action may be weakened, leading to increased blood sugar levels.
• Medicines that inhibit blood clotting (oral anticoagulants, coumarin derivatives): their blood clotting-inhibiting action may be weakened.
• Medicines used to treat parasitic infections (praziquantel): the action of this medicine may be reduced.
• Growth hormones (somatotropin): their action is weakened, especially when Meprelon is used in higher doses.
• Protirelin (pituitary hormone): the increase in thyroid-stimulating hormone (TSH) levels is weakened.

Other potential interactions

• Anti-inflammatory and anti-rheumatic medicines (salicylates, indomethacin, and other non-steroidal anti-inflammatory drugs): the risk of stomach or intestinal ulcers or bleeding may increase.
• Certain ophthalmic medicines (atropine) and medicines with similar action (other anticholinergic medicines): intraocular pressure may increase further.
• Medicines used to treat malaria or rheumatic diseases (chloroquine, hydroxychloroquine, mefloquine): there is an increased risk of muscle diseases or heart muscle diseases.
• Cyclosporin (an immunosuppressive medicine): the level of cyclosporin in the blood increases, which may increase the risk of seizures.
• Certain medicines used to treat hypertension (angiotensin-converting enzyme inhibitors): there is an increased risk of blood disorders.

Effect on test results: the skin reaction in allergy tests may be reduced.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before taking this medicine. Animal studies have shown that Meprelon has a fertility-impairing effect. Until appropriate studies are conducted on the effect of Meprelon on human reproductive processes, this medicine should not be given to pregnant women unless a thorough assessment of the benefit-risk ratio for the mother and fetus has been made. Some corticosteroids easily cross the placental barrier. In one retrospective study, an increased incidence of low birth weight in newborns born to mothers taking corticosteroids was found. In humans, the risk of low birth weight is dose-dependent. This risk can be reduced by administering smaller doses of corticosteroids. If there is a need to discontinue long-term use of Meprelon during pregnancy, it should be done gradually. In some situations (e.g., in replacement therapy for adrenal insufficiency), it may be necessary to continue treatment or even increase the dose. Children born to mothers who took Meprelon during pregnancy should be closely monitored and examined for adrenal insufficiency. The effect of Meprelon on the course of labor is not known. In infants born to mothers treated with Meprelon for a long time during pregnancy, cataract development has been observed. Meprelon passes into breast milk. This medicine can be used by breastfeeding women only after a thorough assessment of the benefit-risk ratio for the mother and infant.

Driving and using machines

Due to the occurrence of certain side effects, such as impaired vision (due to cataracts or increased intraocular pressure), dizziness, or headaches, there may be a deterioration in the ability to concentrate and react. It is possible that the patient may not be able to react quickly enough to sudden and unexpected events. This may be associated with a risk, for example, when driving a vehicle or operating machinery. The patient may unnecessarily expose themselves and others to risk. It should be noted that alcohol can increase this risk. The medicine contains less than 1 mmol (23 mg) of sodium per tablet, which means that the medicine is considered "sodium-free".

3. How to take Meprelon

This medicine should always be taken according to the doctor's instructions. In case of doubts, the patient should consult their doctor or pharmacist. The doctor will determine the dose of the medicine individually for each patient, depending on the type of disease and the patient's individual reaction. The patient should follow the instructions, as otherwise, the effect of Meprelon will not be correct. In case of doubts, the patient should contact their doctor or pharmacist again. Generally, relatively high initial doses are used (from 4 mg to 48 mg). These must be clearly higher in acute, severe forms of diseases than in chronic diseases. Depending on the course of the disease, the dose can be reduced to a possible minimum maintenance dose (usually from 4 to 12 mg of methylprednisolone per day). Especially in the treatment of chronic diseases, long-term treatment with small maintenance doses is often necessary. Method of administration The medicine is taken orally. Usually, the tablets (the entire daily dose) are taken before or after breakfast (from 6:00 to 8:00), without chewing, with a sufficient amount of liquid, e.g., with one glass of water. If the clinical condition allows, the doctor may recommend taking the medicine every other day.

• The patient should not take a double dose to make up for a missed dose.

Taking a higher dose of Meprelon than recommended

Usually, Meprelon is well-tolerated without complications even after short-term use in high doses. There is no need for special measures. If enhanced or atypical side effects are observed, the patient should consult their doctor.

Missing a dose of Meprelon

A missed dose can be taken during the day. The next day, the dose is taken as usual. If several doses are missed, the disease may worsen. In such a case, the patient should consult their doctor, who will check and possibly correct the treatment. The patient should not take a double dose to make up for a missed dose.

Stopping treatment with Meprelon

The patient should carefully follow the doctor's instructions. The patient should not stop taking Meprelon on their own. The doctor may instruct the patient to gradually reduce the dose of the medicine until it is completely discontinued. In the event of sudden discontinuation of Meprelon, the patient should remember the following types of risks (see also section 2 "Warnings and precautions"): "steroid withdrawal syndrome" (see section 4 "Possible side effects"), adrenal insufficiency (low cortisol levels), worsening or recurrence of the underlying disease. Especially long-term use of Meprelon may lead to inhibition of the body's own glucocorticosteroid production. Increased stress on the body could be life-threatening (adrenal crisis). If the patient feels that the effect of Meprelon is too strong or too weak, they should consult their doctor or pharmacist. If the patient has any further doubts about the use of this medicine, they should consult their doctor or pharmacist.

4. Possible side effects

Like all medicines, Meprelon can cause side effects, although not everybody gets them. Side effects have been listed without information on their frequency. Frequency cannot be determined based on available data. Replacement therapy: Low risk of side effects when following the recommended dosage. Treatment of certain diseases, when using higher doses than in replacement therapy: Depending on the duration of treatment and dose, the following side effects may occur:

Blood and lymphatic system disorders
Changes in blood morphology (increased white blood cell count, red blood cells, platelets, decreased granulocyte count).
Immune system disorders
Weakened immune system (e.g., increased risk of infections, appearance of infection symptoms in people who were previously asymptomatic, worsening of infection symptoms), allergic reactions.
Endocrine disorders
Pheochromocytoma crisis (increased blood pressure, headache, sweating, palpitations, pallor), development of Cushing's syndrome (typical symptoms are moon face, central obesity, and facial flushing), adrenal insufficiency or atrophy, growth retardation in children, hormonal disorders (amenorrhea, hirsutism, erectile dysfunction).
In the event of sudden discontinuation of Meprelon after long-term treatment, the following side effects may occur, although not everybody may experience them: fever, loss of appetite, nausea, weakness, anxiety, drowsiness, malaise, joint pain, skin peeling, hypotension, weight loss.
Metabolic and nutritional disorders
Reports of tumor lysis syndrome in patients with hematological malignancies. Tumor lysis syndrome can be diagnosed by the doctor based on changes in blood test results causing high levels of uric acid, potassium, or phosphates and decreased calcium levels. Symptoms include muscle cramps, muscle weakness, confusion, vision loss or disturbances, shortness of breath, seizures, irregular heartbeat, or kidney failure (decreased urine output or darker urine color). If such symptoms occur, the patient should immediately contact their doctor (see section 2 "Warnings and precautions"). Fat tissue accumulation in certain parts of the body (lipomatosis of the suprarenal glands, mediastinum, or retroperitoneum). Increased blood sugar levels, diabetes, increased lipid levels in the blood (cholesterol and triglycerides), tissue edema, potassium deficiency due to increased potassium excretion (attention to cardiac arrhythmias), increased protein breakdown.
Psychiatric disorders
Depression, irritability, personality changes, euphoria, mood swings, increased drive and appetite, psychoses, sleep disturbances.
Nervous system disorders
Increased intracranial pressure (especially in children), emergence of symptoms of previously undiagnosed epilepsy, and increased susceptibility to seizures in existing epilepsy, dizziness, headaches.
Eye disorders
Increased intraocular pressure (glaucoma), lens opacity (cataract), worsening of corneal ulcers, worsening of viral, bacterial, or fungal infections, blurred vision. Retinal and choroidal disorders.
Cardiac disorders
Worsening of pulmonary congestion in heart failure, certain heart muscle disorders in premature infants (see section 2 "Children").
Vascular disorders
Increased blood pressure, increased risk of atherosclerosis and thrombosis, increased blood coagulability, vasculitis (also as a withdrawal syndrome after long-term treatment).
Gastrointestinal disorders
Stomach or intestinal ulcers with a risk of perforation (e.g., peritonitis), gastrointestinal bleeding, pancreatitis, abdominal discomfort, gas accumulation in the intestinal wall (intestinal pneumatosis cystoides).
Hepatobiliary disorders
Increased liver enzyme activity.
Skin and subcutaneous tissue disorders
Stretch marks, skin thinning ("parchment-like" skin), dilation of skin blood vessels, tendency to bruising, petechiae or ecchymoses, hirsutism, acne, delayed wound healing, facial skin inflammation, especially around the mouth, nose, and eyes, skin pigmentation changes, hypersensitivity reactions, e.g., skin rash.
Musculoskeletal and connective tissue disorders
Muscle weakness and atrophy, in the case of myasthenia (muscle weakness), reversible increased muscle weakness, which can lead to myasthenic crisis, induction of acute myopathy (muscle disease) when using non-depolarizing muscle relaxants (see also section 2 "Meprelon and other medicines"), bone atrophy (osteoporosis) that occurs depending on the dose and may occur even with short-term use of the medicine, in severe cases leading to an increased risk of bone fractures, other forms of bone atrophy (aseptic bone necrosis, e.g., of the humeral or femoral head), tendon rupture.
Attention: After rapid dose reduction after long-term treatment, muscle and joint pain may occur.
In patients receiving corticosteroids, Kaposi's sarcoma has been observed.
Renal and urinary disorders
Scleroderma renal crisis in patients with scleroderma (an autoimmune disorder). The symptoms of scleroderma renal crisis include increased blood pressure and decreased urine production.
Investigations
Weight gain.

Special recommendations:

If any side effects occur, including those not listed in this leaflet, the patient should inform their doctor or pharmacist. The patient should not stop treatment on their own. In the event of gastrointestinal or joint pain, mental disorders, significant changes in blood sugar levels, or other disorders in diabetic patients, the patient should immediately contact their doctor.

Reporting side effects

If any side effects occur, including those not listed in this leaflet, the patient should tell their doctor or pharmacist. Side effects can be reported directly to the Department of Drug Safety of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, tel. +48 22 49 21 301, fax +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl. Side effects can also be reported to the marketing authorization holder. By reporting side effects, more information can be collected on the safety of the medicine.

5. How to store Meprelon

The medicine should be stored out of sight and reach of children. Store at a temperature below 30°C. Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the specified month. Medicines should not be disposed of via wastewater or household waste. The patient should ask their pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the packaging and other information

What Meprelon contains

• The active substance of Meprelon is methylprednisolone. One tablet contains 4 mg of methylprednisolone.
• The other ingredients of the medicine are mannitol, hydroxypropylcellulose, hypromellose (type 2910, 3 mPas), mannitol (spray-dried), microcrystalline cellulose, sodium croscarmellose, colloidal silicon dioxide, dibehenyl glycerol, magnesium stearate.

What Meprelon looks like and contents of the pack

Meprelon 4 mg is a white to off-white, round tablet with a cross-shaped score line and a ring-shaped imprint, with a diameter of approximately 9 mm. The medicine is available in packs of 20, 30, 50, and 100 tablets. Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

SUN-FARM Sp. z o.o., ul. Dolna 21, 05-092 Łomianki, tel. +48 22 350 66 69

Manufacturer

mibe GmbH Arzneimittel, Münchener Straße 15, 06796 Brehna, Germany

Date of last revision of the leaflet: