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

You should carefully read the contents of the leaflet 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.
• In case of 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 the patient experiences any side effects, including those not listed in this leaflet, they should tell their 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 with diagnosed 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
synovitis in osteoarthritis
rheumatoid arthritis, including juvenile rheumatoid arthritis
acute and subacute bursitis
tenosynovitis
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 lupus nephritis)
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
urticaria
drug hypersensitivity reactions
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:
ophthalmic zoster
uveitis, iritis, and iridocyclitis
chorioretinitis
diffuse posterior uveitis and chorioretinitis
optic neuritis
sympathetic ophthalmia
inflammation in the anterior segment of the eye
allergic conjunctivitis
allergic marginal keratitis
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 pneumocystis pneumonia in patients with AIDS (as adjunctive treatment, when administered within the first 72 hours of initial treatment against 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

brain edema associated with the presence of a tumor - primary or metastatic and (or) related to surgical treatment, or radiation therapy
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

• if the patient is hypersensitive to methylprednisolone or any of the other ingredients of this medicine (listed in section 6)
• if the patient has systemic fungal infections
• 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, the patient should discuss it with their doctor or pharmacist if they 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 given SOLU-MEDROL, there is a risk of corneal perforation.
diabetes
Treatment with SOLU-MEDROL may cause symptoms of latent diabetes, increased insulin requirements, or oral hypoglycemic agents.
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 the patient has had an allergic reaction after taking any medicine, they should inform their 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
non-specific ulcerative colitis,in case of possible perforation, abscess, or other purulent infection
diverticulitis
recent intestinal anastomosis
active peptic ulcer
renal failure
osteoporosis
myasthenia gravis(acquired, chronic disease characterized by rapid fatigue and weakness of skeletal muscles).
If the patient experiences blurred vision or other visual disturbances, they should contact their doctor.
Immunosuppressive effect, increased susceptibility to infections
SOLU-MEDROL may increase 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, in doses that cause immunosuppressive effects, some vaccines are contraindicated. Inactivated vaccines may be administered, but the response to them may be limited or they may be ineffective. Patients receiving SOLU-MEDROL in doses that do not have immunosuppressive effects may be given 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 been reported 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. The patient should inform their 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 cortex 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.
The patient should immediately consult their doctor if they experience weakness or muscle pain, cramps, and stiffness during treatment with methylprednisolone. 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 discontinuation, 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 their 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 fattening have been reported.
Effect on the eyes
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. In patients using SOLU-MEDROL, secondary fungal or viral eye infections may also occur more frequently.
As a result of systemic and local use of the medicine, visual disturbances may occur. If they occur, the patient should consult their 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 occurrence of central serous chorioretinopathy, which may lead to retinal detachment.
Effect on the heart
In case of high-dose and long-term treatment with SOLU-MEDROL, patients with cardiovascular risk factors should be given the medicine with caution and their cardiovascular system should be monitored, 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) circulatory 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 using 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. Treatment with corticosteroids may mask peritonitis or other symptoms related to gastrointestinal disorders, such as perforation, obstruction, or pancreatitis.
In combination with the use of non-steroidal anti-inflammatory drugs (NSAIDs), the risk of developing peptic ulcer disease of the stomach and intestines increases.
Effect on the liver and bile ducts
Cyclical, pulsatile 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. Clinical improvement or complete recovery may occur after discontinuation of SOLU-MEDROL, 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 to 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 acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs) with SOLU-MEDROL.
After administration of SOLU-MEDROL, a crisis in 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 careful assessment of the benefit-risk ratio.
Tumor lysis syndrome may occur during corticosteroid treatment for cancer. The patient should inform their doctor if they have cancer and symptoms of tumor lysis syndrome, such as muscle cramps, weakness, confusion, irregular heartbeat, vision loss, or 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

The patient should tell their doctor or pharmacist about all medicines they are currently taking or have recently taken, including those available without a prescription.
Certain 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 certain HIV medicines: ritonavir, cobicistat).
Corticosteroid therapy affects the results of many tests and biological parameters (e.g., skin tests, thyroid hormone levels).
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 their doctor or pharmacist about all medicines they are currently taking or plan to take. 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: blocking neuromuscular conduction. 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 agents: cyclosporine. When cyclosporine and SOLU-MEDROL are used concomitantly, mutual inhibition of metabolism occurs, which may increase the plasma concentration of one or both medicines. 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. During concomitant use, cases of seizures have been reported.
immunosuppressive agents: cyclophosphamide, tacrolimus
macrolide antibacterial agents: clarithromycin, erythromycin, troleandomycin

• non-steroidal anti-inflammatory drugs (NSAIDs): high doses of acetylsalicylic acid. Concomitant use of anti-inflammatory medicines with SOLU-MEDROL may increase the frequency of bleeding and peptic ulcer disease. Caution should be exercised when using acetylsalicylic acid in combination with SOLU-MEDROL potassium-depleting medicines: during concomitant use of SOLU-MEDROL with potassium-depleting 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 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 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-risk ratio for the mother and fetus has been made.
SOLU-MEDROL crosses the placenta. In one retrospective study, an increased frequency of low birth weight infants was found in mothers who took corticosteroids. In humans, the risk of low birth weight is dose-dependent. This risk may be reduced by administering lower doses of corticosteroids.
Although rare, newborn adrenal insufficiency may occur in infants exposed to SOLU-MEDROL in utero. 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 unknown.
In infants 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 careful assessment of the benefit-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, visual disturbances, and fatigue during treatment with SOLU-MEDROL should not drive or operate machines.

SOLU-MEDROL 500 mg and 1000 mg contains benzyl alcohol

SOLU-MEDROL, 500 mg and 1000 mg, in the form of 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 infants 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 a week without a doctor's recommendation. The patient should consult their doctor or pharmacist if they have liver or kidney disease, or if they are 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, which means 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 common salt) per vial. This corresponds to 2.92% of the maximum recommended daily intake of sodium 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 common salt) per vial. This corresponds to 5.84% of the maximum recommended daily intake of sodium in the diet for adults.

3. How to use SOLU-MEDROL

This medicine should be used as directed by the doctor, who will adjust the dose individually for each patient. In case of doubts, the patient should consult their doctor.
During treatment with SOLU-MEDROL, and in case of 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 should be based on the patient's condition and response to treatment, rather than age or body weight (not 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-risk ratio should be made on an ongoing basis.
It is recommended to use the smallest effective dose of corticosteroid, which 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 at appropriate time intervals until the smallest dose that provides an adequate clinical response is reached.
If treatment is to be discontinued after a long period of use, the medicine should be gradually discontinued; treatment should not be stopped abruptly.
After the initial period of use in emergency situations, it may be necessary 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 intravenous pulses at a dose of 250 mg/day or higher for several days (usually ≤ 5 days) may be effective in treating episodes of exacerbation or diseases that do not respond to standard therapy. These include rheumatic diseases, systemic lupus erythematosus, edematous conditions such as nephrotic syndrome or lupus nephritis. In patients with multiple sclerosis, who have not responded to standard therapy (or have relapsing-remitting multiple sclerosis), 30-minute intravenous pulses at doses of 500 mg/day or 1000 mg/day for 3 or 5 days may be administered.
If the medicine is used as supportive treatment for other diseases, the initial intravenous dose will range from 10 to 500 mg, depending on the patient's clinical condition.
In 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 should be performed regularly, such as urinalysis, postprandial glucose levels, blood pressure measurement, body weight measurement, and chest X-ray. Radiological images of the upper gastrointestinal tract are required in patients with a history of ulcers or significant gastrointestinal upset.
If the patient feels that the effect of SOLU-MEDROL is too strong or too weak, they should consult their doctor.

Use of a higher than recommended dose of SOLU-MEDROL

In case of overdose, the patient should immediately consult their doctor or pharmacist. There are no clinical symptoms of acute overdose of SOLU-MEDROL. 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

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

Discontinuation of SOLU-MEDROL

In case of any further doubts related to the use of this medicine, the patient should consult their 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, or paresis/paraplegia.
If the patient experiences any of the following symptoms, they should immediately inform their 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 exclusively for healthcare professionals".
The medicinal product should be stored out of 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 that are no longer required. This will help protect the environment.

6. Contents of the pack 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.

Pack 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:

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Information intended exclusively for healthcare professionals

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, doxapram hydrochloride, tigecycline, diltiazem hydrochloride, calcium gluconate, vecuronium bromide, rocuronium bromide, cisatracurium besylate, glycopyrrolate, propofol.
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 solvent specifically intended for this purpose. 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 higher). 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, it should be used 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, it should be used 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 for particles and discoloration prior to administration, whenever the solution and container permit.