Solu-medrol

Leaflet accompanying the packaging: information for the user

SOLU-MEDROL, 40 mg, powder and solvent for solution for injection

SOLU-MEDROL, 125 mg, powder and solvent for solution for injection

SOLU-MEDROL, 500 mg, powder and solvent for solution for injection

SOLU-MEDROL, 1000 mg, powder and solvent for solution for injection

Methylprednisolone

Read the leaflet carefully before using the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult a 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 you experience any side effects, including those not listed in this leaflet, you should tell your doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What is SOLU-MEDROL and what is it used for
• 2. Important information before using SOLU-MEDROL
• 3. How to use SOLU-MEDROL
• 4. Possible side effects
• 5. How to store SOLU-MEDROL
• 6. Contents of the packaging and other information

1. What is SOLU-MEDROL and what is it used for

The active substance of SOLU-MEDROL, methylprednisolone, belongs to a group of medicines called corticosteroids. Corticosteroids penetrate cell membranes and bind to specific receptors located in the cytoplasm. These complexes then enter the cell nucleus, stimulating further synthesis of various enzymes that are probably responsible for the numerous actions of corticosteroids observed after systemic use. In addition to their significant effect on inflammatory and immune processes, corticosteroids also affect carbohydrate, protein, and fat metabolism. They also act on the cardiovascular system, skeletal muscles, and the central nervous system.

SOLU-MEDROL is used as symptomatic treatment, except in cases of endocrine disorders, when it is used as substitution therapy, in the following diseases:

Endocrine disorders

• primary or secondary adrenal cortex insufficiency (in certain circumstances, in combination with mineralocorticosteroids)
• acute adrenal cortex insufficiency (mineralocorticosteroids may need to be administered in combination)
• treatment of shock caused by adrenal cortex insufficiency, or shock that does not respond to conventional treatment, in cases where adrenal cortex insufficiency is confirmed or suspected (in cases where mineralocorticosteroids are contraindicated)
• before surgical procedures and in cases of severe illness or injury, in patients diagnosed with adrenal cortex insufficiency or decreased adrenal hormone levels
• congenital adrenal hyperplasia
• non-suppurative thyroiditis
• hypercalcemia in cancer

Rheumatic diseases

Supportive treatment for short-term use during episodes of exacerbation or worsening of the condition in:

post-traumatic osteoarthritis

synovial inflammation in osteoarthritis

rheumatoid arthritis, including juvenile rheumatoid arthritis

acute and subacute bursitis

epicondylitis

acute non-specific tenosynovitis

acute gouty arthritis

psoriatic arthritis

ankylosing spondylitis

Systemic connective tissue diseases

During exacerbation or as maintenance treatment in:

systemic lupus erythematosus (and kidney inflammation in lupus)

acute rheumatic myocarditis

systemic polymyositis and dermatomyositis

giant cell arteritis

Goodpasture's syndrome

Dermatological diseases

pemphigus

severe form of erythema multiforme (Stevens-Johnson syndrome)

exfoliative dermatitis

severe form of psoriasis

bullous pemphigoid

severe form of seborrheic dermatitis

mycosis fungoides

Allergic diseases

Treatment of severe allergic diseases, when other treatment methods are ineffective:

bronchial asthma

contact dermatitis (contact eczema)

atopic dermatitis

chickenpox

drug hypersensitivity reaction

transfusion-related urticaria

acute non-inflammatory laryngeal edema (epinephrine is the first-line treatment)

Ophthalmic diseases

Severe, acute, and chronic allergic and inflammatory processes affecting the eye and its appendages, such as:

herpes zoster ophthalmicus

uveitis, iritis, and iridocyclitis

chorioretinitis

diffuse choroiditis and chorioretinitis

optic neuritis

sympathetic ophthalmia

anterior segment inflammation

allergic conjunctivitis

allergic marginal corneal ulcers

keratitis

Gastrointestinal diseases

As systemic treatment during exacerbation of:

ulcerative colitis

Crohn's disease

Respiratory diseases

Symptomatic sarcoidosis

Berylliosis

Fulminant or disseminated pulmonary tuberculosis, in combination with appropriate antitubercular chemotherapy

Loeffler's syndrome not responding to other treatments

Aspiration pneumonia

Moderate or severe pneumonia caused by Pneumocystis jiroveci in patients with AIDS (as adjunctive treatment, when administered within the first 72 hours of initial treatment targeting Pneumocystis)

Hematological diseases

Acquired (autoimmune) hemolytic anemia

Idiopathic thrombocytopenic purpura in adults (only intravenous administration; intramuscular administration is contraindicated)

Secondary thrombocytopenia in adults

Erythroblastopenia in the bone marrow

Congenital hypoplastic anemia

Oncological diseases

Palliative treatment:

leukemia and lymphoma in adults

acute leukemia in children

improving the quality of life of patients with advanced cancer

Edema

To induce diuresis or remission of proteinuria in nephrotic syndrome, without azotemia

Nervous system

Cerebral edema associated with the presence of a tumor - primary or metastatic - and (or) related to surgical treatment or radiotherapy

Exacerbation in multiple sclerosis

Acute spinal cord injuries. Treatment should be started within 8 hours of injury.

Other indications

Tuberculous meningitis with subarachnoid block or risk of subarachnoid block, in combination with appropriate antitubercular therapy

Trichinosis with involvement of the nervous system or heart muscle

Organ transplantation

Prevention of nausea and vomiting associated with cancer chemotherapy

2. Important information before using SOLU-MEDROL

When not to use SOLU-MEDROL

• for intrathecal administration
• for epidural administration
• in premature infants and newborns

Administration of live or live attenuated vaccines is contraindicated during treatment with SOLU-MEDROL, at doses that cause immunosuppressive effects.

Warnings and precautions

In patients with the following diseases, treatment with SOLU-MEDROL should be as short as possible and they require special medical care during treatment with SOLU-MEDROL.

Before starting to take this medicine, you should discuss it with your doctor or pharmacist if you have any of the following conditions:

Infectious diseases, such as tuberculosis and certain viral diseases (herpes and zoster with eye symptoms).

The use of SOLU-MEDROL in active tuberculosis should be limited to cases of fulminant or disseminated pulmonary tuberculosis, in which SOLU-MEDROL is used in combination with antitubercular chemotherapy. During long-term treatment with SOLU-MEDROL, in patients with latent tuberculosis or a positive tuberculin test, careful observation is necessary, as the disease may recur.

In patients with ocular herpes simplex infection, who are treated with SOLU-MEDROL, there is a risk of corneal perforation.

Diabetes

Treatment with SOLU-MEDROL may cause symptoms of latent diabetes, increased insulin requirements, or increased blood glucose levels.

Hypertension

Treatment with SOLU-MEDROL may exacerbate hypertension.

Psychiatric disorderscurrently or in the past

SOLU-MEDROL may exacerbate existing emotional instability or psychotic tendencies. During treatment, psychiatric disorders may occur, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to severe psychotic disorders.

Severe stress

In patients exposed to severe stress, it may be necessary to increase the dose of rapidly acting corticosteroids before, during, and after the stress-causing situation.

Allergyto any medicines

If an allergic reaction occurred after taking any medicine, you should inform your doctor before starting treatment with SOLU-MEDROL.

Hypothyroidism

The effect of SOLU-MEDROL is stronger in patients with hypothyroidism.

Hyperthyroidism

Liver cirrhosis

The effect of SOLU-MEDROL is stronger in patients with liver cirrhosis.

Head injury

Nonspecific ulcerative colitis, in case of possible perforation, abscess, or other purulent infection

Diverticulitis

Recent intestinal anastomosis

Active or latent peptic ulcer

Kidney failure

Osteoporosis

Myasthenia gravis(acquired, chronic disease characterized by rapid fatigue and weakness of skeletal muscles).

If the patient experiences blurred vision or other vision disturbances, they should contact their doctor.

Immunosuppressive effect, increased susceptibility to infections

SOLU-MEDROL may increase the susceptibility to infections and may mask some symptoms of infection. During its use, new infections may develop. During treatment with SOLU-MEDROL, there may be decreased immunity and inability to limit the development of infection. The risk of infections with pathogens such as viruses, bacteria, fungi, protozoa, or parasites increases with increasing dose.

Patients using SOLU-MEDROL are more susceptible to infections than healthy individuals, e.g., in children with immunodeficiency or in adults using SOLU-MEDROL, chickenpox and measles can have a more severe course or even be fatal.

During treatment with SOLU-MEDROL, at doses that cause immunosuppressive effects, it is contraindicated to administer certain vaccines. Inactivated vaccines may be administered, but the response to them may be limited or they may be ineffective. Patients receiving SOLU-MEDROL at doses that do not have an immunosuppressive effect may undergo all required vaccinations.

In patients treated with SOLU-MEDROL, Kaposi's sarcoma has been observed. Discontinuation of treatment may lead to remission of the disease.

Effect on the immune system

In patients, allergic reactions may occur. In patients taking SOLU-MEDROL, skin reactions and anaphylactic/pseudoanaphylactic reactions have occurred rarely.

Endocrine disorders

During long-term treatment with SOLU-MEDROL, adrenal insufficiency may occur, which may persist for several months after discontinuation of treatment.

The doctor may also decide to gradually reduce the dose of SOLU-MEDROL. You should inform your doctor about any stressful situations that occur during this period. The doctor will consider initiating hormone therapy.

Sudden discontinuation of SOLU-MEDROL may cause acute adrenal insufficiency, leading to death.

After sudden discontinuation of SOLU-MEDROL, a "steroid withdrawal syndrome" may also occur. This syndrome includes symptoms such as loss of appetite, nausea, vomiting, lethargy, headache, fever, joint pain, peeling, muscle pain, weight loss, and (or) hypotension.

SOLU-MEDROL may cause or exacerbate Cushing's syndrome, so patients with Cushing's disease should not use it.

In patients with hypothyroidism, the effect of SOLU-MEDROL is stronger.

You should immediately consult a doctor if, during treatment with methylprednisolone, weakness or muscle pain, cramps, and stiffness occur. These may be symptoms of a condition called thyrotoxic periodic paralysis, which may occur in patients with hyperthyroidism treated with methylprednisolone. Additional treatment may be necessary to alleviate this condition.

Psychiatric disorders

During treatment with SOLU-MEDROL and after its completion, psychiatric disorders may occur. They usually occur within a few days or weeks of starting treatment with SOLU-MEDROL. Most of them disappear after reducing the dose or discontinuing SOLU-MEDROL. Patients and their caregivers should consult a doctor if the patient develops psychological symptoms, especially if they suspect depressive mood or suicidal thoughts. Patients and their caregivers should pay special attention to psychiatric disorders that may occur during treatment, immediately after dose reduction, or after discontinuation of SOLU-MEDROL.

Effect on the nervous system

SOLU-MEDROL should be used with caution in patients with seizure disorders.

In patients using SOLU-MEDROL, usually with long-term use of high doses, cases of supratentorial tumors have been reported.

Effect on the eye

In patients using SOLU-MEDROL for a long time, posterior subcapsular cataract and nuclear cataract (especially in children) may develop, as well as exophthalmos or increased intraocular pressure, which can cause glaucoma with potential optic nerve damage.

Patients using SOLU-MEDROL may also be more likely to develop secondary fungal or viral eye infections.

As a result of systemic and local use of the medicine, vision disturbances may occur. If they occur, the patient should contact a doctor to determine the possible causes, which may include cataract, glaucoma, or rare diseases such as central serous chorioretinopathy.

Central serous chorioretinopathy may lead to retinal detachment.

The use of SOLU-MEDROL is associated with the development of central serous chorioretinopathy, which may lead to retinal detachment.

Effect on the heart

With the use of high doses and long-term treatment with SOLU-MEDROL, in patients with cardiovascular risk factors, it should be administered with caution and with additional monitoring of the cardiovascular system if necessary. The frequency of complications associated with the use of SOLU-MEDROL can be reduced by using small doses and administering the medicine every other day.

After rapid intravenous administration of high doses of SOLU-MEDROL, cardiac arrhythmias and (or) cardiovascular collapse, and (or) cardiac arrest may occur.

In patients with congestive heart failure, SOLU-MEDROL should be administered with caution and only if necessary.

Effect on the vascular system

During treatment with SOLU-MEDROL, thrombosis, including venous thromboembolism, has been reported. Therefore, caution should be exercised in patients with thromboembolic disorders or those who may be prone to them.

Effect on the stomach and intestines

After administration of high doses of SOLU-MEDROL, acute pancreatitis may occur.

Treatment with SOLU-MEDROL may mask symptoms of peptic ulcers, so perforation or bleeding may occur without significant pain. Corticosteroid treatment may mask peritonitis or other symptoms related to gastrointestinal disorders, such as perforation, obstruction, or pancreatitis.

In combination with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the risk of developing peptic ulcer disease of the stomach and intestines increases.

Effect on the liver and bile ducts

Cyclic, pulse intravenous administration of methylprednisolone may cause drug-induced liver damage, such as acute hepatitis. Acute hepatitis may occur within a few weeks or longer. After discontinuation of treatment, this adverse event has been observed to resolve.

Effect on the musculoskeletal system

During treatment with high doses of SOLU-MEDROL, acute myopathy may occur, especially in patients with neuromuscular transmission disorders (e.g., myasthenia gravis) or in patients treated with anticholinergic drugs, including neuromuscular blockers (e.g., pancuronium). Myopathy may affect the eye muscles and respiratory muscles, leading to quadriparesis. Increased creatine kinase activity may occur. Improvement in clinical condition or complete recovery after discontinuation of SOLU-MEDROL may occur after several weeks or even years.

Effect on the kidneys and urinary tract

Caution should be exercised in patients with systemic sclerosis, as an increased frequency of scleroderma renal crisis has been observed with corticosteroids, including methylprednisolone.

SOLU-MEDROL should be used with caution in patients with renal failure.

Diagnostic tests

In patients using medium and high doses of SOLU-MEDROL, blood pressure, sodium and water retention, and potassium excretion may increase. Therefore, it may be necessary to restrict salt in the diet and supplement potassium. All corticosteroids, including SOLU-MEDROL, increase calcium excretion.

Injuries, poisonings, and post-procedure complications

SOLU-MEDROL should not be used to treat traumatic brain injury.

Other

Complications of corticosteroid therapy depend on the dose and duration of treatment. The doctor will decide on the dosage and duration of treatment individually for each patient.

Patients should be cautious when using aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) with SOLU-MEDROL.

After administration of SOLU-MEDROL, a breakthrough in the course of a pheochromocytoma has been reported, sometimes fatal. In patients suspected of or diagnosed with pheochromocytoma, the doctor will decide on the use of SOLU-MEDROL only after a thorough assessment of the benefit-to-risk ratio.

Tumor lysis syndrome may occur during corticosteroid treatment for cancer. You should inform your doctor if you have cancer and experience symptoms of tumor lysis syndrome, such as muscle cramps, weakness, confusion, irregular heartbeat, vision loss or disturbances, and shortness of breath.

Use in children

In children, long-term treatment with SOLU-MEDROL in divided daily doses may lead to growth retardation. The use of this treatment regimen should be limited to the most severe indications, and treatment with SOLU-MEDROL should be as short as possible. Patients should be under close medical supervision.

Infants and children taking SOLU-MEDROL for a long time are particularly at risk of increased intracranial pressure.

After administration of high doses of SOLU-MEDROL in children, pancreatitis may develop.

After administration of SOLU-MEDROL in premature infants, hypertrophic cardiomyopathy (thickening of the heart muscle) may develop.

Other warnings

You should tell your doctor about all medicines you are currently taking or have recently taken, including those available without a prescription.

Some medicines may enhance the effect of SOLU-MEDROL, and the doctor may want to monitor the patient's condition closely when taking such medicines (including some HIV medicines: ritonavir, cobicistat).

Corticosteroid therapy affects the results of many tests and biological parameters (e.g., skin tests, thyroid hormone level tests).

SOLU-MEDROL should not be administered by intramuscular injection into the deltoid muscle, due to the frequent occurrence of subcutaneous atrophy.

Use of SOLU-MEDROL in patients with liver function disorders

The effect of SOLU-MEDROL is particularly strong in patients with liver cirrhosis.

Caution should be exercised when using SOLU-MEDROL in patients with liver function disorders.

Use of SOLU-MEDROL in patients with hypothyroidism

The effect of SOLU-MEDROL is particularly strong in patients with hypothyroidism.

SOLU-MEDROL and other medicines

The patient should inform the doctor or pharmacist about all medicines they are currently taking or plan to take, as SOLU-MEDROL may affect the action of other medicines, and other medicines may affect the action of SOLU-MEDROL.

It may be necessary to adjust the dose of SOLU-MEDROL when used in combination with the following medicines:

antibacterial agents: isoniazid

antitubercular antibiotic: rifampicin

• anticoagulant medicines (oral). Concomitant use with SOLU-MEDROL may decrease or increase the effect of anticoagulant medicines. Blood coagulation tests should be monitored to ensure adequate anticoagulant effect. antiepileptic drugs: carbamazepine, phenobarbital, phenytoin anticholinergic drugs: neuromuscular blockers. During concomitant use of high doses of SOLU-MEDROL and anticholinergic drugs, e.g., neuromuscular blockers, cases of acute myopathy have been reported
• muscle relaxants, e.g., pancuronium, vecuronium: SOLU-MEDROL may partially inhibit neuromuscular blockade caused by muscle relaxants anticholinesterases: SOLU-MEDROL may reduce the effect of anticholinesterases in patients with myasthenia gravis

antidiabetic medicines: in diabetic patients, it may be necessary to adjust the dose of antidiabetic medicines, as SOLU-MEDROL may increase blood glucose levels

antiemetic medicines: aprepitant, fosaprepitant

antifungal medicines: itraconazole, ketoconazole

antiviral medicines - HIV protease inhibitors: indinavir and ritonavir

aromatase inhibitor: aminoglutethimide

calcium channel blocker: diltiazem

oral contraceptives: ethinyl estradiol/norethindrone

grapefruit juice

immunosuppressive medicines: cyclosporine. When cyclosporine and SOLU-MEDROL are used concomitantly, mutual inhibition of metabolism occurs, which may increase the concentration of one or both medicines in the blood. Therefore, there is a possibility that the risk of adverse reactions associated with the use of one of the medicines may increase during concomitant administration. Seizures have been reported during concomitant use

immunosuppressive medicines: cyclophosphamide, tacrolimus

macrolide antibacterial agents: clarithromycin, erythromycin, troleandomycin

• nonsteroidal anti-inflammatory drugs (NSAIDs): high doses of aspirin. Concomitant use of NSAIDs with SOLU-MEDROL may increase the frequency of bleeding and peptic ulcer disease. Caution should be exercised when using aspirin in combination with SOLU-MEDROL
• potassium-lowering medicines. During concomitant use of SOLU-MEDROL with potassium-lowering medicines (e.g., diuretics), patients should be monitored for the development of hypokalemia (a condition where the potassium ion concentration in the blood is below the laboratory norm). During concomitant use of SOLU-MEDROL with amphotericin B, xanthines, or beta2 agonists, the risk of hypokalemia increases

Pregnancy, breastfeeding, and fertility

Fertility

In animal studies, it has been shown that SOLU-MEDROL has a fertility-reducing effect.

Pregnancy

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, you should consult your doctor or pharmacist before using this medicine.

In some animal studies, it has been shown that corticosteroids administered to pregnant mothers in high doses may cause fetal developmental abnormalities. However, it does not appear that SOLU-MEDROL administered to pregnant women causes congenital abnormalities in the fetus. Until appropriate studies are conducted on the effect of SOLU-MEDROL on human reproductive processes, this medicine should not be administered to pregnant women unless a thorough assessment of the benefit-to-risk ratio for the mother and fetus is made.

SOLU-MEDROL crosses the placenta. In one retrospective study, an increased frequency of low birth weight in newborns born to mothers who took corticosteroids was found. In humans, the risk of low birth weight appears to be dose-dependent. This risk may be reduced by administering lower doses of corticosteroids.

Although adrenal insufficiency in newborns exposed to SOLU-MEDROL in utero(during fetal life) is rare, children born to mothers who took high doses of SOLU-MEDROL during pregnancy should be carefully monitored and evaluated for adrenal insufficiency.

The effect of SOLU-MEDROL on the course of labor is not known.

In newborns born to mothers treated with SOLU-MEDROL for a long time during pregnancy, cataract development has been observed.

SOLU-MEDROL 500 mg and 1000 mg, powder and solvent for solution for injection, contains benzyl alcohol (see section 2 "SOLU-MEDROL 500 mg and 1000 mg contains benzyl alcohol").

Breastfeeding

SOLU-MEDROL is excreted in human milk.

In breastfed children, SOLU-MEDROL, which has passed into the mother's milk, may inhibit growth and affect the production of endogenous corticosteroids. This medicine may be used by breastfeeding women only after a thorough assessment of the benefit-to-risk ratio for the mother and infant.

SOLU-MEDROL 500 mg and 1000 mg, powder and solvent for solution for injection, contains benzyl alcohol (see section 2 "SOLU-MEDROL 500 mg and 1000 mg contains benzyl alcohol").

Driving and using machines

The effect of SOLU-MEDROL on the ability to drive and use machines has not been studied.

Patients who experience dizziness, vision disturbances, and fatigue during treatment with SOLU-MEDROL should not drive vehicles or operate machines.

SOLU-MEDROL 500 mg and 1000 mg contains benzyl alcohol

SOLU-MEDROL, 500 mg and 1000 mg, powder and solvent for solution for injection, contains 9 mg of benzyl alcohol per 1 ml of solution, which corresponds to 9 mg/1 ml of benzyl alcohol. Benzyl alcohol may cause allergic reactions. Administration of benzyl alcohol to newborns and young children is associated with a risk of serious adverse reactions, including respiratory disorders. SOLU-MEDROL containing benzyl alcohol should not be used in newborns (up to 4 weeks of age) and should not be used in young children (under 3 years of age) for more than 1 week without a doctor's recommendation. You should consult a doctor or pharmacist if the patient has liver or kidney disease, or if the woman is pregnant or breastfeeding, as a large amount of benzyl alcohol may accumulate in the body and cause adverse reactions such as increased blood acidity (metabolic acidosis).

SOLU-MEDROL contains sodium

SOLU-MEDROL, 40 mg and 125 mg, powder and solvent for solution for injection, contains less than 1 mmol (23 mg) of sodium per vial, i.e., the medicine is considered "sodium-free".

SOLU-MEDROL, 500 mg, powder and solvent for solution for injection, contains 58.3 mg of sodium (the main component of table salt) per vial. This corresponds to 2.92% of the maximum recommended daily sodium intake in the diet for adults.

SOLU-MEDROL, 1000 mg, powder and solvent for solution for injection, contains 116.8 mg of sodium (the main component of table salt) per vial. This corresponds to 5.84% of the maximum recommended daily sodium intake in the diet for adults.

3. How to use SOLU-MEDROL

This medicine should be used as directed by your doctor, who will adjust the dose individually for each patient. If you have any doubts, you should consult a doctor.

During treatment with SOLU-MEDROL, as well as after discontinuation of long-term treatment, the patient should be under close medical supervision.

SOLU-MEDROL may be administered by intravenous or intramuscular injection, or by intravenous infusion. The dose may be reduced in infants and children, but it should be based on the patient's condition and response to treatment, rather than age or body weight (it should not be less than 0.5 mg/kg body weight/24 hours).

Dosing requirements are variable and should be individualized, depending on the disease being treated, its severity, and the patient's response to treatment throughout the treatment period. The decision based on the benefit-to-risk ratio in each individual case should be made on an ongoing basis.

It is recommended to use the smallest effective dose of corticosteroid that ensures control of the treated disease for the shortest possible time. The appropriate maintenance dose should be determined by gradually reducing the initial dose of the medicine in appropriate time intervals until the smallest dose that provides an adequate clinical response is achieved.

If treatment is to be discontinued after a long period of use, the medicine should be withdrawn gradually; treatment should not be stopped abruptly.

After the initial period of use in emergency situations, it is recommended to switch to treatment with a medicine with a prolonged duration of action or an oral medicine.

If the medicine is used as supportive treatment in life-threatening conditions, it should be administered intravenously in a dose of 30 mg/kg body weight over at least 30 minutes. The dose may be repeated every 4 to 6 hours for a period not exceeding 48 hours.

Administration of methylprednisolone in the form of intravenous pulses in a dose of 250 mg/day or higher for several days (usually ≤ 5 days) may be effective in the treatment of exacerbations of disease or conditions in which standard therapy does not provide the desired effects. These include rheumatic diseases, systemic lupus erythematosus, and edematous conditions such as nephrotic syndrome or lupus nephritis. In patients with multiple sclerosis, in whom standard therapy has proven ineffective (or in patients with exacerbations of the disease), 30-minute intravenous pulses in doses of 500 mg/day or 1000 mg/day should be administered for 3 or 5 days.

If the medicine is used as supportive treatment for other conditions, the initial intravenous dose will range from 10 to 500 mg, depending on the patient's clinical condition.

In the case of short-term treatment of severe, acute conditions, higher doses may be required. Initial doses not exceeding 250 mg should be administered intravenously over at least 5 minutes, while higher doses should be administered over at least 30 minutes.

Subsequent doses may be administered intravenously or intramuscularly at intervals dictated by the patient's response to treatment and clinical condition.

During prolonged therapy, routine laboratory tests, such as urinalysis, postprandial glucose level, blood pressure, body weight, and chest X-ray, should be performed regularly.

X-rays of the upper gastrointestinal tract are required in patients with a history of ulcers or significant dyspepsia.

If you feel that the effect of SOLU-MEDROL is too strong or too weak, you should consult a doctor.

Use of a higher than recommended dose of SOLU-MEDROL

In case of overdose, you should immediately consult a doctor or pharmacist. There are no clinical symptoms of acute SOLU-MEDROL overdose. Chronic overdose causes typical symptoms of Cushing's syndrome. Dialysis is an effective method of removing SOLU-MEDROL from the body.

Missed dose of SOLU-MEDROL

You should not take a double dose to make up for a missed dose.

Discontinuation of SOLU-MEDROL

If you have any further doubts about the use of this medicine, you should consult a doctor or pharmacist.

4. Possible side effects

Like all medicines, SOLU-MEDROL can cause side effects, although not everybody gets them.

The following side effects have been reported for the following routes of administration:

intrathecal/epidural: meningitis, gastrointestinal or urinary tract disorders, headache, meningitis, transverse myelitis, seizures, sensory disturbances.

If you experience any of the following symptoms, you should immediately inform your doctor or go to the nearest hospital:

5. How to store SOLU-MEDROL

SOLU-MEDROL, 40 mg, 125 mg, 500 mg, 1000 mg:
No special storage precautions for the medicinal product.
SOLU-MEDROL, 40 mg:
After reconstitution, the product should be stored at a temperature below 25°C and used immediately or stored at a temperature of 2°C - 8°C and used within 48 hours.
After reconstitution and further dilution with other infusion solutions, the product should be stored at a temperature of 20°C - 25°C and used within 3 hours or stored at a temperature of 2°C - 8°C and used within 24 hours.
SOLU-MEDROL, 125 mg, 500 mg, 1000 mg:
After reconstitution, the product should be stored at a temperature below 25°C and used within 12 hours or stored at a temperature of 2°C - 8°C and used within 48 hours.
After reconstitution and further dilution with other infusion solutions, the product should be stored at a temperature of 20°C - 25°C and used within 3 hours or stored at a temperature of 2°C - 8°C and used within 24 hours.
From a microbiological point of view, the solution should be used immediately, unless the product has been opened and diluted under controlled and validated aseptic conditions.
If the prepared solution is not used immediately, the user is responsible for the storage conditions and storage time.
More information on the storage of reconstituted and diluted solutions can be found in the section: "Information intended for healthcare professionals only".
The medicinal product should be stored out of the sight and reach of children.
Do not use this medicinal product after the expiry date stated on the carton after: (EXP). The expiry date refers to the last day of the month.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Package contents and other information

What SOLU-MEDROL contains

SOLU-MEDROL, 40 mg, powder and solvent for solution for injection

• The active substance is methylprednisolone in the form of sodium succinate.
• The other excipients are: sucrose, sodium dihydrogen phosphate monohydrate, disodium phosphate anhydrous (see section 2 "SOLU-MEDROL contains sodium"). Solvent: water for injections.

SOLU-MEDROL, 125 mg, powder and solvent for solution for injection

• The active substance is methylprednisolone in the form of sodium succinate.
• The other excipients are: sodium dihydrogen phosphate monohydrate, disodium phosphate anhydrous (see section 2 "SOLU-MEDROL contains sodium"). Solvent: water for injections.

SOLU-MEDROL, 500 mg, 1000 mg, powder and solvent for solution for injection

• The active substance is methylprednisolone in the form of sodium succinate.
• The other excipients are: sodium dihydrogen phosphate monohydrate, disodium phosphate anhydrous (see section 2 "SOLU-MEDROL contains sodium"). Solvent: benzyl alcohol (E1519) (see section 2 "SOLU-MEDROL 500 mg and 1000 mg contain benzyl alcohol"), water for injections.

What SOLU-MEDROL looks like and contents of the pack

SOLU-MEDROL is a white, compact powder and a clear, colorless solvent.

Packaging contents:

SOLU-MEDROL, 40 mg
A two-chamber vial made of colorless glass with powder and solvent of 1 ml in a cardboard box.
SOLU-MEDROL, 125 mg
A two-chamber vial made of colorless glass with powder and solvent of 2 ml in a cardboard box.
SOLU-MEDROL, 500 mg
A vial made of colorless glass with powder and a vial with solvent of 8 ml in a cardboard box.
SOLU-MEDROL, 1000 mg
A vial made of colorless glass with powder and a vial with solvent of 16 ml in a cardboard box.

Marketing authorization holder

Pfizer Europe MA EEIG
Boulevard de la Plaine 17
1050 Brussels
Belgium

Manufacturer

Pfizer Manufacturing Belgium NV
Rijksweg 12
2870 Puurs-Sint-Amands
Belgium
To obtain more detailed information, please contact the local representative of the marketing authorization holder:
Pfizer Polska Sp. z o.o.
tel. 22 335 61 00

Date of last revision of the leaflet:

---------------------------------------------------------------------------------------------------------------------------

Information intended for healthcare professionals only

Incompatibilities
It is recommended to administer methylprednisolone sodium succinate separately, without other intravenously administered compounds, to avoid problems with compatibility or stability. Medicines that are not compatible in terms of physical parameters in a solution with methylprednisolone sodium succinate include, but are not limited to: allopurinol sodium, doksapram hydrochloride, tigecycline, diltiazem hydrochloride, calcium gluconate, vecuronium bromide, rocuronium bromide, cisatracurium besylate, glycopyrrolate.
The compatibility and stability of intravenously administered methylprednisolone sodium succinate solution and in combination with other products depend on the pH of the solution, concentration, time, temperature, and degree of solubility of methylprednisolone in the given solution. Therefore, whenever possible, the methylprednisolone sodium succinate solution should be administered separately, as a bolus or intravenous infusion, or as a "piggy-back" infusion.
To administer SOLU-MEDROL as a bolus or intravenous infusion, or as a "piggy-back" infusion, prepare the solution according to the instructions.
PREPARATION OF THE SOLUTION
In aseptic conditions, add the solvent to the vial containing the sterile powder. Use only the specially designed solvent. Treatment can be started by administering the methylprednisolone sodium succinate solution intravenously over at least 5 minutes (doses up to 250 mg) or over at least 30 minutes (doses of 250 mg and above). Subsequent doses can be administered in a similar manner.
SOLU-MEDROL, 40 mg:
The reconstituted solution should be stored at a temperature of 2°C - 8°C and used within 48 hours. If stored at a temperature below 25°C, use immediately.
SOLU-MEDROL, 125 mg, 500 mg, 1000 mg:
The reconstituted solution should be stored at a temperature below 25°C and used within 12 hours or stored at a temperature of 2°C - 8°C and used within 48 hours.
If necessary, the reconstituted solution can be further diluted in solutions:

• 5% dextrose solution in water for injections
• physiological saline solution
• 5% dextrose solution in 0.45% NaCl solution
• 5% dextrose solution in 0.9% NaCl solution

SOLU-MEDROL, 40 mg:
The reconstituted and further diluted solution stored at a temperature of 2°C - 8°C is chemically and physically stable for 24 hours. If stored at a temperature of 20°C - 25°C, use within 3 hours.
SOLU-MEDROL, 125 mg, 500 mg, 1000 mg:
The reconstituted and further diluted solution stored at a temperature of 20°C - 25°C is chemically and physically stable for 3 hours or 24 hours when stored at a temperature of 2°C - 8°C.
From a microbiological point of view, the solution should be used immediately, unless the product has been opened and diluted under controlled and validated aseptic conditions.
If the prepared solution is not used immediately, the user is responsible for the storage conditions and storage time.
INSTRUCTIONS FOR PREPARING THE SOLUTION IN TWO-CHAMBER VIALS (SOLU-MEDROL, 40 mg and SOLU-MEDROL, 125 mg)

• 1. Press the plastic activator to transfer the solvent to the lower chamber.
• 2. Gently shake to obtain a solution.
• 3. Remove the plastic cap covering the center of the stopper.
• 4. Sterilize the top of the stopper with a suitable bactericidal agent.

Note: Steps 1 to 4 should be performed before withdrawing the medicinal product.

• 5. Insert the needle perpendicularly through the center of the stopperuntil the tip is visible.
• 6. Invert the vial and withdraw the required dose.

Medicines administered parenterally should be inspected visually for particulate matter and discoloration prior to administration, whenever the solution and container permit.