This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Methylprednisolone acetate + lidocaine parenteral


Parenteral formulations of methylprednisolone acetate with lidocaine

Drugs List

  • DEPO-MEDRONE 40mg/1ml WITH LIDOCAINE 10mg/1ml injection
  • DEPO-MEDRONE 80mg/2ml WITH LIDOCAINE 20mg/2ml injection
  • methylprednisolone acetate 40mg/1ml and lidocaine 10mg/1ml injection
  • methylprednisolone acetate 80mg/2ml and lidocaine 20mg/2ml injection
  • Therapeutic Indications


    Relief of pain and inflammation in osteoarthritis
    Rheumatoid disease



    Intra-articular Injection
    For a large joint
    Doses can range from 20 mg to 80 mg of steroid (0.5 ml to 2 ml).

    For a medium joint
    Doses can range from 10 mg to 40 mg of steroid (0.25 ml to 1 ml).

    For a small joint
    Doses can range from 4 mg to 10 mg of steroid (0.1 ml to 0.25 ml).

    If needed, repeat injections may be necessary at intervals of 1 to 5 or more weeks.

    Periarticular, Intrabursal and Tendon Sheath Injection
    Doses can range from 4 mg to 30 mg of steroid (0.1 ml to 0.75 ml).

    If needed, repeat injections may be necessary in chronic or recurrent conditions.


    (See Dosage; Adult)


    Administer reduced doses based on adult dosages, but overall determine doses by the severity of the condition.


    Uncontrolled systemic infection

    Precautions and Warnings

    Children under 18 years
    Family history of diabetes mellitus
    Family history of glaucoma
    Predisposition to thrombophlebitis
    Congestive cardiac failure
    Diabetes mellitus
    Epileptic disorder
    Hepatic cirrhosis
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    History of tuberculosis
    Joint infection
    Latent or healed tuberculosis
    Myasthenia gravis
    Ocular herpes simplex infection
    Peptic ulcer
    Recent gastrointestinal anastomosis
    Renal impairment
    Severe affective disorders

    Disease reactivation may occur in patients with latent TB
    May mask peritonitis or other signs or symptoms of GI disorders
    May mask symptoms or signs of infections
    Exclude joint infection before injection
    Prior to starting therapy screen for latent tuberculosis
    Contains benzyl alcohol
    Contains benzyl alcohol: Associated with Gasping Syndrome in premature baby
    Do not inject into unstable joints
    Do not mix with other drugs or substances
    Resuscitation facilities must be immediately available
    Avoid local injection into previously infected joints
    Frequent review needed to titrate dose to disease activity
    Monitor and discontinue if appropriate if psychiatric or CNS problems occur
    Possible mineralocorticoid secretion suppression & need for supplementation
    Advise patients/carers to seek medical advice if suicidal intent develops
    Antibody response to non-live vaccines may be diminished
    Breastfeeding: Risk of adrenal suppression in breastfed infant
    Consider septic arthritis post joint inj if pain,fever,swelling occur
    Corticosteroids may cause growth retardation in children under 18 years
    Patient should report worrying psychological changes esp. suicidal thoughts
    Prolonged/excessive use may lead to adrenal suppression
    Risk of adrenal suppression secondary to absorption of steroid
    Sudden withdrawal may be inadvisable -see product information/SPC
    To discontinue, reduce dose gradually
    Withdraw gradually if adrenal suppression suspected
    Do not exceed individual tolerated dose
    Dosage must be individualised for each patient, especially children
    Maintain treatment at the lowest effective dose
    Avoid long term use in elderly
    Maintain treatment for the shortest possible duration
    Advise patient not to take St John's wort concurrently
    Advise patient to rest treated joint after intra-articular injection
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    CSM (CHM) advise that all patients should receive manufacturers leaflet
    Ensure patient receives Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention

    With intra-articular administration, treatment failures are often due to failure to enter the joint space. The achilles tendon should not be injected in the absence of a true tendon sheath.

    May cause hypothalamic-pituitary-adrenal axis (HPA) suppression that could last up to 4 weeks.

    Pregnancy and Lactation


    Use methylprednisolone acetate with lidocaine with caution in pregnancy.

    The manufacturer suggests methylprednisolone with lidocaine should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the foetus.

    Animal studies have shown teratogenic effects when using corticosteroids in pregnancy including a cleft palate and affects on brain growth and development, however Schaefer (2015) states that there is limited published information regarding an increased risk of congenital abnormalities in human pregnancy. It is suggested that corticosteroids used over long periods of time during pregnancy could increase the risk of intrauterine growth retardation. Lidocaine is also known to readily cross the placenta when administered systemically. Schaefer (2015) states in high doses, Lidocaine has been associated with CNS depression and other adverse effects in neonates when used in labour.


    Use methylprednisolone acetate with lidocaine with caution in breastfeeding.

    The manufacturer suggests methylprednisolone with lidocaine should only be used during pregnancy after careful assessment and if the potential benefit to the mother outweighs the potential risk to the foetus.

    Corticosteroids are excreted into breast milk in small amounts, however it is not known whether lidocaine is excreted into breast milk. Hale (2014) states methylprednisolone acetate is unlikely to cause harm to an infant if used during breastfeeding, however it is determined by the dose and duration of exposure. Schaefer (2015) states methylprednisolone is one of the preferred drugs of choice during breastfeeding for systemic treatment. The manufacturer states the benefits of breastfeeding will most likely outweigh any potential risk to the infant if methylprednisolone has to be administered during breastfeeding.

    Side Effects

    Abdominal distension
    Abscess (sterile)
    Acute pancreatitis
    Aggravation of schizophrenia
    Allergic reaction
    Altered temperature sensation
    Aseptic necrosis
    Avascular osteonecrosis
    Blurred vision
    Bowel perforation
    Cardiac disorders
    Charcot-like arthropathy
    Congestive cardiac failure
    Corneal thinning
    Cushingoid changes
    Cutaneous atrophy
    Cutaneous lesions
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Fluid retention
    Growth suppression in infancy, childhood and adolescence
    Hyperpigmentation of skin
    Hypersensitivity reactions
    Hypokalaemic alkalosis
    Impaired carbohydrate tolerance, increased need for anti-diabetic therapy
    Impaired healing
    Increased appetite
    Increased I.C.P. with papilloedema in children (pseudotumour cerebri)
    Increased intra-ocular pressure
    Increased susceptibility and severity of infections
    Loss of consciousness (transient)
    Menstrual disturbances
    Mood changes
    Muscle weakness
    Negative calcium balance
    Negative nitrogen balance
    Oesophageal candidiasis
    Oesophageal ulceration
    Opportunistic infections
    Optic nerve damage
    Peptic ulceration with perforation and haemorrhage
    Personality change
    Proximal myopathy
    Psychological dependence
    Recurrence of dormant tuberculosis
    Respiratory disorders
    Scleral thinning
    Sodium/water retention
    Subcutaneous atrophy
    Suppression of clinical signs of infection
    Suppression of reactions to skin tests
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Thinning of skin
    Vertebral and long bone fractures
    Weight gain
    Withdrawal syndrome - see product information


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Medications and Mother's Milk, 16th edition (2014) Hale, T.W. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics:Depo-Medrone with Lidocaine. Pfizer Limited. Revised January 2019.

    NICE Evidence Services Available at: Last accessed: 30 January 2019

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.