Drugs List

Therapeutic Indications

Uses

Bursitis
Epicondylitis
Relief of pain and inflammation in osteoarthritis
Rheumatoid disease
Tendinitis
Tenosynovitis

Contraindications

Uncontrolled systemic infection

Precautions and Warnings

Abscess
Children under 18 years
Elderly
Family history of diabetes mellitus
Family history of glaucoma
Predisposition to thrombophlebitis
Breastfeeding
Congestive cardiac failure
Diabetes mellitus
Diverticulitis
Epileptic disorder
Glaucoma
Hepatic cirrhosis
History of severe affective disorders
History of steroid myopathy
History of steroid-induced psychosis
History of tuberculosis
Hypertension
Hypothyroidism
Joint infection
Latent or healed tuberculosis
Myasthenia gravis
Ocular herpes simplex infection
Osteoporosis
Peptic ulcer
Pregnancy
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

Pregnancy

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.

Lactation

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)
Acne
Acute pancreatitis
Aggravation of schizophrenia
Allergic reaction
Altered temperature sensation
Amenorrhoea
Anaphylaxis
Apprehension
Aseptic necrosis
Avascular osteonecrosis
Blurred vision
Bowel perforation
Bruising
Cardiac disorders
Cataracts
Charcot-like arthropathy
Chorioretinopathy
Confusion
Congestive cardiac failure
Convulsions
Corneal thinning
Cushingoid changes
Cutaneous atrophy
Cutaneous lesions
Depression
Dizziness
Drowsiness
Dyspepsia
Ecchymosis
Euphoria
Exacerbation of ophthalmic fungal disease
Exacerbation of ophthalmic viral disease
Exophthalmos
Fluid retention
Glaucoma
Growth suppression in infancy, childhood and adolescence
Hirsutism
Hyperpigmentation of skin
Hypersensitivity reactions
Hypertension
Hypokalaemia
Hypokalaemic alkalosis
Hypopigmentation
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
Insomnia
Leucocytosis
Loss of consciousness (transient)
Menstrual disturbances
Mood changes
Muscle weakness
Nausea
Negative calcium balance
Negative nitrogen balance
Nervousness
Numbness
Oedema
Oesophageal candidiasis
Oesophageal ulceration
Opportunistic infections
Optic nerve damage
Osteoporosis
Papilloedema
Peptic ulceration with perforation and haemorrhage
Peritonitis
Personality change
Petechiae
Proximal myopathy
Psychological dependence
Psychosis
Recurrence of dormant tuberculosis
Respiratory disorders
Scleral thinning
Sodium/water retention
Striae
Subcutaneous atrophy
Suppression of clinical signs of infection
Suppression of reactions to skin tests
Suppression of the hypothalamic-pituitary-adrenal axis
Telangiectasia
Tendon rupture
Thinning of skin
Thromboembolism
Tinnitus
Tremor
Twitching
Urticaria
Vertebral and long bone fractures
Vertigo
Vomiting
Weight gain
Withdrawal syndrome - see product information

Presentation

Parenteral formulations of methylprednisolone acetate with lidocaine

Drugs List

Therapeutic Indications

Uses

Bursitis
Epicondylitis
Relief of pain and inflammation in osteoarthritis
Rheumatoid disease
Tendinitis
Tenosynovitis

Dosage

Adults

Elderly

Children

Contraindications

Uncontrolled systemic infection

Precautions and Warnings

Abscess
Children under 18 years
Elderly
Family history of diabetes mellitus
Family history of glaucoma
Predisposition to thrombophlebitis
Breastfeeding
Congestive cardiac failure
Diabetes mellitus
Diverticulitis
Epileptic disorder
Glaucoma
Hepatic cirrhosis
History of severe affective disorders
History of steroid myopathy
History of steroid-induced psychosis
History of tuberculosis
Hypertension
Hypothyroidism
Joint infection
Latent or healed tuberculosis
Myasthenia gravis
Ocular herpes simplex infection
Osteoporosis
Peptic ulcer
Pregnancy
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

Pregnancy

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.

Lactation

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)
Acne
Acute pancreatitis
Aggravation of schizophrenia
Allergic reaction
Altered temperature sensation
Amenorrhoea
Anaphylaxis
Apprehension
Aseptic necrosis
Avascular osteonecrosis
Blurred vision
Bowel perforation
Bruising
Cardiac disorders
Cataracts
Charcot-like arthropathy
Chorioretinopathy
Confusion
Congestive cardiac failure
Convulsions
Corneal thinning
Cushingoid changes
Cutaneous atrophy
Cutaneous lesions
Depression
Dizziness
Drowsiness
Dyspepsia
Ecchymosis
Euphoria
Exacerbation of ophthalmic fungal disease
Exacerbation of ophthalmic viral disease
Exophthalmos
Fluid retention
Glaucoma
Growth suppression in infancy, childhood and adolescence
Hirsutism
Hyperpigmentation of skin
Hypersensitivity reactions
Hypertension
Hypokalaemia
Hypokalaemic alkalosis
Hypopigmentation
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
Insomnia
Leucocytosis
Loss of consciousness (transient)
Menstrual disturbances
Mood changes
Muscle weakness
Nausea
Negative calcium balance
Negative nitrogen balance
Nervousness
Numbness
Oedema
Oesophageal candidiasis
Oesophageal ulceration
Opportunistic infections
Optic nerve damage
Osteoporosis
Papilloedema
Peptic ulceration with perforation and haemorrhage
Peritonitis
Personality change
Petechiae
Proximal myopathy
Psychological dependence
Psychosis
Recurrence of dormant tuberculosis
Respiratory disorders
Scleral thinning
Sodium/water retention
Striae
Subcutaneous atrophy
Suppression of clinical signs of infection
Suppression of reactions to skin tests
Suppression of the hypothalamic-pituitary-adrenal axis
Telangiectasia
Tendon rupture
Thinning of skin
Thromboembolism
Tinnitus
Tremor
Twitching
Urticaria
Vertebral and long bone fractures
Vertigo
Vomiting
Weight gain
Withdrawal syndrome - see product information

Overdosage

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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

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: www.nice.org.uk Last accessed: 30 January 2019