Methylprednisolone Preparation For Acute Spinal Cord Injury

Intravenous methylprednisolone sodium succinate (Solu-Medrol or generic equivalent) should be commenced as soon as practicable (3 to 8 hours of injury) after injury in doses based on:

• 30 mg/kg over 15 minutes, followed by, 5.4 mg/kg/hr as a continuous infusion over 23 hours commenced 45 minutes after the completion of the initial dose.
• These doses may be approximated to the nearest 0.5 gram

Preparation

Initial dose

1. Calculate the required dose based on actual or estimated body weight (see table below).

2. Reconstitute each vial with the supplied diluent or Water for Injection (use 5 mL for a 500 mg vial, 10 mL for a 1 gram vial and 20 mL for a 2 gram vial) and allow to dissolve completely.

3. Inject into the side arm of an intravenous line over 15 minutes. OR add to a burette or to a 50 or 100 mL pack of 5% glucose or 0.9% sodium chloride and infuse over 15 minutes and flush.

Infusion

1. Calculate the required dose based on actual or estimated body weight (see table below).

2. Reconstitute each vial with the supplied diluent or Water for injection (use 5mL for a 500 mg vial, 10mL for a 1 gram vial and 20mL for a 2 gram vial) and allow to dissolve completely.

3. Add to 500mL or 1000mL of 5% glucose, 4% glucose and 0.18% sodium chloride or 0.9% sodium chloride.

4. Commence infusion within 1 hour of starting initial dose, infuse over approx. 23 hours, allowing for additional volume - approx. 10 mL/gram of methylprednisolone. 
**Max concentration:2.5-20mg/mL1

 Rates for other doses are listed below:

Dose and Infusion rates when added to 1000ml packs

Weight (kg)	Initial dose (g)	Infusion
		Dose (g)	Rate (ml/hr)
30	1.0	3.5	47
40	1.0	5.0	48
50	1.5	6.0	48
60	2.0	7.5	49
70	2.0	8.5	49
80	2.5	10.0	50
90	2.5	11.0	50
100	3.0	12.5	51

Notes

• There should be a separate intravenous site for the infusion pump. The treatment should begin within eight hours of injury.

• The administration rate for bolus injection may only be used for acute spinal cord injury, under ECG monitoring and with an available defibrillator.

• The administration of high doses methylprednisolone in bolus intravenously, (doses more than 500mg over a period of less than 10 minutes) may cause arrhythmias, circulatory collapse and cardiac arrest

• For the infusion pump, preferably choose another intravenous site than for the bolus injection.

•  Reconstituted product are stable for 48 hours.

*Due to insufficient evidence of clinical efficacy (ie, preserving or improving spinal cord function), the routine use of methylprednisolone in the treatment of acute spinal cord injury is no longer recommended.

 *If used in this setting, methylprednisolone should not be initiated >8 hours after the injury, not effective in penetrating trauma (eg, gunshot)

REFERENCE:

Product Leaflet

www.flyingdoctor.org.au

http://health.wa.gov.au/circularsnew/attachments/194.pdf

Lexicomp