Methylprednisolone acetate + lidocaine parenteral
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Parenteral formulations of methylprednisolone acetate with lidocaine
Relief of pain and inflammation in osteoarthritis
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
History of severe affective disorders
History of steroid myopathy
History of steroid-induced psychosis
History of tuberculosis
Latent or healed tuberculosis
Ocular herpes simplex infection
Recent gastrointestinal anastomosis
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.
Aggravation of schizophrenia
Altered temperature sensation
Congestive cardiac failure
Exacerbation of ophthalmic fungal disease
Exacerbation of ophthalmic viral disease
Growth suppression in infancy, childhood and adolescence
Hyperpigmentation of skin
Impaired carbohydrate tolerance, increased need for anti-diabetic therapy
Increased I.C.P. with papilloedema in children (pseudotumour cerebri)
Increased intra-ocular pressure
Increased susceptibility and severity of infections
Loss of consciousness (transient)
Negative calcium balance
Negative nitrogen balance
Optic nerve damage
Peptic ulceration with perforation and haemorrhage
Recurrence of dormant tuberculosis
Suppression of clinical signs of infection
Suppression of reactions to skin tests
Suppression of the hypothalamic-pituitary-adrenal axis
Thinning of skin
Vertebral and long bone fractures
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: February 2017
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
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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