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V E T E R I N A R Y M E D I C A L S E R V I C E S i n V e t e r i n a r y M e d i c i n e
Corticosteroids Help Ease the Itch
of Dermatitis
by Keith Hnilica, DVM, MS, Dipl. ACVD
C R E D E N T I A L S .
Keith Hnilica, DVM, MS, Dipl. ACVD, teaches and consults in dermatology at the University of Tennessee. His clinical and research interests are focused on clinical veterinary dermatology, the treatment of allergic dermatitis in dogs and cats, and the treatment and prevention of zoonotic So many diseases require corticosteroid therapy to restore normal dermatologic diseases. His credentials include: skin condition and good health that it would be hard to practicedermatology without it. The itching and inflammation that • Diplomate of the American College of accompany allergic dermatitis can be greatly relieved with the use of corticosteroid therapy, especially low-dose therapy. Successfulcorticosteroid use in dermatology relies on the clinician’s judgment • Co-author of Small Animal Dermatology: to maximize beneficial effects while minimizing adverse effects.
As a class, corticosteroids possess excellent anti-inflammatory and author of Advances in Allergy: properties and remain the best anti-inflammatory agents in common veterinary use.1 Yet older agents such as prednisone and prednisolonehave side effects that require discontinuation of treatment in as many • Published in journals such as Veterinary as 30% of cases. When methylprednisolone is used, that percentage Dermatology, Journal of Veterinary Allergy and Clinical Immunology, and Methylprednisolone, the active ingredient in MEDROL® Tablets credentials Compendium ofContinuing Education and DEPO-MEDROL®Sterile Aqueous Suspension,has been
shown to have 25% better inflammatory action1 than prednisolone, • Assistant professor of dermatology in the and it has even less tendency to induce sodium and water retention.
By achieving equal anti-inflammatory effect with lower doses, Department of Small Animal Clinical methylprednisolone helps to minimize annoying side effects.3,4 Services at the University of Tennessee P R U D E N T U S E .
U S E L O W E S T E F F E C T I V E D O S E .
Corticosteroid therapy is for patients with a When given at high doses over long periods of time, tentative diagnosis of allergy. For example, corticosteroids can cause numerous medical problems— instead of treating first with steroids, it is best everything from polyurea and polydipsia (PUPD) to to first control any secondary infections: kidney infection. From a dermatological standpoint, the pyoderma, yeast dermatitis, scabies, or fleas.
biggest worry is secondary bacterial pyoderma or yeast Generally it makes sense to eliminate any infection. We recommend using the lowest possible dose infectious cause of pruritus, since cortico- of corticosteroids as infrequently as possible. Dogs with steroids don’t improve these conditions and, environmental allergies often do well on a low, anti- inflammatory dose of corticosteroid. MEDROL is an the infections have been treated, remaining exceptional product that can be administered in low, symptoms are likely to be caused by pollen, oral doses. It has far fewer side effects than older oral food, insect, or environmental allergies, and corticosteroids such as prednisone and prednisolone.2 are more likely to respond to anti-inflammatory Short-acting corticosteroids can be used to achieve the same results as long-acting products, but they Oral doses of anti-inflammatory corticosteroids require more maintenance. Used properly, long-acting usually work well to control allergic symptoms.
corticosteroids such as DEPO-MEDROL provide If the steroid therapy does not control the lasting seasonal relief when injected every 2 or 3 months.
symptoms, the solution is not to increase the Overuse, however, can result in serious problems.
dose or switch to a more potent formulation,but to rule out unresponsive diseases such C H O O S E T H E R I G H T P R O D U C T .
as food allergy, scabies, contact dermatitis,or a recurrence of the secondary infections.
DEPO-MEDROL is the most commonly used long-acting Use of corticosteroids is a step on a therapeutic injectable corticosteroid, because it predictably resolves ladder. Antibiotics or antifungals can help allergic symptoms. Used as a rescue treatment once or control infections. Antihistamines and topical twice per year, it is an effective tool. A single injection can antipruritic treatments can reduce allergic provide dogs with symptomatic relief of inflamed skin that continues for weeks, without the inconvenience or therapy may be initiated as the final step.
In cats, DEPO-MEDROL is also a valuable therapy thathas predictable and reliable efficacy for the treatment ofallergic dermatitis. Overuse can present problems for cats,and we generally recommend administering it no moreoften than every 2 or 3 months.
MEDROL, an oral, short-acting corticosteroid, has maximize results
many advantages over generic prednisone or prednisolone.
Most important, it has a lower incidence of adverse effects.
Most patients treated with oral corticosteroids will develop some degree of PUPD, but MEDROL appears to show a much lowerincidence. This is tremendously beneficial, because it helps improveowner compliance by decreasing adverse effects. MEDROL stands outas a significant improvement over older, oral steroid formulations.
W O R K W I T H T H E P E T O W N E R .
The key to success with any dermatological problem is ensuring thatthe infection is diagnosed and controlled. That is not always as easy as it sounds. When a corticosteroid has shown its value in treating thesymptoms, owners may be reluctant to treat the infection. In their eyes,the problem is solved, because the dog no longer itches. It is important,however, to insist that the appropriate medical therapies be pursued in order to treat the cause. The key is explaining to owners that corticosteroid therapy controls the symptoms effectively but does not cure the disease. Diagnosis of the underlying problem is essential in maintaining a healthy animal.
Corticosteroids are contraindicated in animals with tuberculosis,hyperadrenocorticism, and peptic ulcers, and should be used with extreme caution in pregnant bitches. Because corticosteroids R E F E R E N C E S .
suppress inflammation, patients should be watched for evidence of concurrent infection.
1. McDonald RK, Langston VC. Use of corticosteroids and nonsteroidal anti-inflammatory agents.
In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine, Diseases of the Dog and Cat.
4th ed. Vol 1. Philadelphia, Pa: WB Saunders Co;1995: 284-293.
2. Scott DW. Dermatologic therapy. In: Scott DW, Miller WH, Griffen CE, eds. Muller & Kirk's Small Animal Dermatology. 6th ed. Philadelphia, Pa:WB Saunders Co; 2001:244-273.
3. MEDROL Tablets package insert. Kalamazoo, Mich: 4. DEPO-MEDROL Sterile Aqueous Suspension package insert. Kalamazoo, Mich: Pharmacia Corp;Oct 1997.
DEPO-MEDROL®
control by the use of appropriate antibacterial measures, or administration of this preparation shouldbe discontinued. However, in infections characterized by overwhelming toxicity, methylprednisolone NDC 0009-0613-02, NDC 0009-0613-04, NDC 0009-0614-01
acetate therapy in conjunction with appropriate antibacterial therapy is effective in reducing mortality brand of methylprednisolone acetate sterile aqueous suspension
and morbidity. Without conjoint use of an antibiotic to which the invader-organism is sensitive, 20 mg per mL and 40 mg per mL
injudicious use of the adrenal hormones in animals with infections can be hazardous. As with other For Use in Animals Only
corticoids, continued or prolonged use is discouraged.
While no sodium retention or potassium depletion has been observed at the doses recommended, DESCRIPTION
animals receiving methylprednisolone acetate, as with all corticoids, should be under close observation These preparations are recommended for intramuscular and intrasynovial injection in horses and for possible untoward effects. If symptoms of hypopotassemia (hypokalemia) should occur, corticoid dogs, and intramuscular injection in cats. DEPO-MEDROL Sterile Aqueous Suspension is available in therapy should be discontinued and potassium chloride administered by continuous intravenous drip.
two concentrations, 20 mg per mL and 40 mg per mL. Each mL of these preparations contains: Since this drug lacks significant mineralocorticoid activity in usual therapeutic doses, it is not likely to afford adequate support in states of acute adrenocortical insufficiency. For treatment of the latter, the parent adrenocortical steroids, hydrocortisone or cortisone, should be used.
INTRAMUSCULAR ADMINISTRATION AND DOSAGE
Following intramuscular injection of methylprednisolone acetate, a prolonged systemic effect results. The dose varies with the size of the animal patient, the severity of the condition undertreatment, and the animal’s response to therapy.
Myristyl-gamma-picolinium chloride added as preservative Dogs and Cats. The average intramuscular dose for dogs is 20 mg. In accordance with the size
When necessary, pH was adjusted with sodium hydroxide and/or hydrochloric acid.
of the dog and severity of the condition under treatment, the dose may range from 2 mg in miniature METABOLIC AND HORMONAL EFFECTS
breeds to 40 mg in medium breeds, and even as high as 120 mg in extremely large breeds or dogs Methylprednisolone, an anti-inflammatory steroid synthesized and developed in the Research Laboratories of The Upjohn Company, is the 6-methyl derivative of prednisolone. Exceeding prednisolone The average intramuscular dose for cats is 10 mg with a range up to 20 mg.
in anti-inflammatory potency and having even less tendency than prednisolone to induce sodium and Injections may be made at weekly intervals or in accordance with the severity of the condition water retention, methylprednisolone offers the advantage over older corticosteroids of affording equally satisfactory anti-inflammatory effect with the use of lower doses and with an enhanced split between Horses. The usual intramuscular dose for horses is 200 mg repeated as necessary.
anti-inflammatory and mineralocorticoid activities. Estimates of the relative potencies of methylprednisolone For maintenance therapy in chronic conditions, initial doses should be reduced gradually until and prednisolone range from 1.13 to 2.1, with an average of 1.5. In anti-inflammatory activity, as the smallest effective (ie, individualized) dose is established. MEDROL® Tablets containing measured by the granuloma pouch assay, methylprednisolone is twice as active as prednisolone. In methylprednisolone may also be used for maintenance in dogs and cats, administered according mineralocorticoid activity (ie, the capacity to induce retention of sodium and water in the adrenalectomized rat) methylprednisolone is slightly less active than prednisolone. The duration of plasma steroid levels When treatment is to be withdrawn after prolonged and intensive therapy, the dose should be following rapid intravenous injection in intact dogs is appreciably longer for methylprednisolone than for prednisolone, the respective “half-life” value for the two steroids being 80.9±7.5 minutes for methyl- If signs of stress are associated with the condition being treated, the dose should be increased.
prednisolone and 71.3±1.7 minutes for prednisolone.
If a rapid hormonal effect of maximum intensity is required, as in anaphylactic shock, the intravenous While the effect of parenterally administered DEPO-MEDROL is prolonged, it has the same metabolic administration of highly soluble SOLU-DELTA-CORTEF® Sterile Powder containing prednisolone and anti-inflammatory actions as orally administered methylprednisolone acetate.
INDICATIONS
INTRASYNOVIAL ADMINISTRATION AND DOSAGE
Musculoskeletal Conditions. As with other adrenal steroids, DEPO-MEDROL Sterile Aqueous
Methylprednisolone acetate, a slightly soluble ester of methylprednisolone, is capable of producing Suspension has been found useful in alleviating the pain and lameness associated with acute localized a more prolonged local anti-inflammatory effect than equimolar doses of hydrocortisone acetate.
arthritic conditions and generalized arthritic conditions. It has been used successfully to treat rheumatoid Following intrasynovial injection, relief from pain may be experienced within 12 to 24 hours. The arthritis, traumatic arthritis, osteoarthritis, periostitis, tendinitis, synovitis, tenosynovitis, bursitis, and duration of relief varies, but averages three to four weeks, with a range of one to five or more weeks.
myositis of horses; traumatic arthritis, osteoarthritis, and generalized arthritic conditions of dogs.
Injections of methylprednisolone acetate have been well tolerated. Intrasynovial (intra-articular) Remission of musculoskeletal conditions may be permanent, or symptoms may recur, depending on injections may occasionally result in an increased localized inflammatory response. the cause and extent of structural degeneration.
Intrasynovial injection is recommended as an adjuvant to general therapeutic measures to effect Allergic Conditions. This preparation is especially beneficial in relieving pruritus and inflammation
suppression of inflammation in one or a few peripheral structures when (1) the disease is limited of allergic dermatitis, acute moist dermatitis, dry eczema, urticaria, bronchial asthma, pollen sensitivities to one or a few peripheral structures; (2) the disease is widespread with one or a few peripheral and otitis externa in dogs; allergic dermatitis and moist and dry eczema in cats. Onset of relief may structures actively inflamed; (3) systemic therapy with other corticoids or corticotropin controls all begin within a few hours to a few days following injection and may persist for a few days to six weeks.
but a few of the more actively involved structures; (4) systemic therapy with cortisone, hydrocortisone, Symptoms may be expected to recur if the cause of the allergic reaction is still present, in which case or corticotropin is contraindicated; (5) joints show early but actively progressing deformity (to retreatment may be indicated. In treating acute hypersensitivity reactions, such as anaphylactic shock, enhance the effect of physiotherapy and corrective procedures); and (6) surgical or other orthopedic intravenous SOLU-DELTA-CORTEF® Sterile Powder containing prednisolone sodium succinate, as corrective measures are to be or have been done.
well as other appropriate treatments, should be used.
The action of DEPO-MEDROL Sterile Aqueous Suspension injected intrasynovially appears to Overwhelming Infections with Severe Toxicity. In dogs and cats moribund from overwhelmingly
be well localized since significant metabolic effects characteristic of systemic administration of severe infections for which antibacterial therapy is available (eg, critical pneumonia, pyometritis), DEPO- adrenal steroids have not been observed. In a few instances mild and transient improvement of MEDROL may be lifesaving, acting to inhibit the inflammatory reaction, which itself may be lethal; structures other than those injected have been reported. No other systemic effects have been preventing vascular collapse and preserving the integrity of the blood vessels; modifying the patient’s noted. However, it is possible that mild systemic effects may occur following intrasynovial administration, reaction to drugs; and preventing or reducing the exudative reaction which often complicates certain and this possibility is greater the larger the number of structures injected and the higher the total infections. As supportive therapy, it improves the general attitude of the animal being treated. All necessary procedures for the establishment of a bacterial diagnosis should be carried out whenever Procedure for Intrasynovial Injection. The anatomy of the area to be injected should be reviewed
possible before institution of therapy. Corticosteroid therapy in the presence of infection should be in order to assure that the suspension is properly placed and to determine that large blood vessels administered for the shortest possible time compatible with maintenance of an adequate response, or nerves are avoided. The injection site is located where the synovial cavity is most superficial.
and antibacterial therapy should be continued for at least three days after the hormone has been The area is prepared for aseptic injection of the medicament by the removal of hair and cleansing withdrawn. Combined hormone and antibacterial therapy does not obviate the need for indicated surgical of the skin with alcohol or Mercresin® tincture. A sterile 18- to 21-gauge needle for horses, 20- to 22-gauge needle for dogs, on a dry syringe is quickly inserted into the synovial space and a small Other Conditions. In certain conditions where it is desired to reduce inflammation, vascularization,
amount of synovial fluid withdrawn. If there is an excess of synovia and more than 1 mL of suspension fibroblastic infiltration, and scar tissue, the use of DEPO-MEDROL should be considered. Snakebite is to be injected, it is well to aspirate a volume of fluid comparable to that which is to be injected.
of dogs also is an indication for the use of this suspension because of its anti-toxemic, anti-shock, and With the needle in place, the aspirating syringe is removed and replaced by a second syringe anti-inflammatory activity. It is particularly effective in reducing swelling and preventing sloughing. Its containing the proper amount of suspension which is then injected. In some animals a transient employment in the treatment of such conditions is recommended as a supportive measure to standard pain is elicited immediately upon injection into the affected cavity. This pain varies from mild to procedures and time-honored treatments and will give comfort to the animal and hasten complete severe and may last for a few minutes up to 12 hours. After injection, the structure may be moved gently a few times to aid mixing of the synovial fluid and the suspension. The site may be coveredwith a small sterile dressing.
CONTRAINDICATIONS
Areas not suitable for injection are those that are anatomically inaccessible such as spinal joints Systemic therapy with methylprednisolone acetate, as with other corticoids, is contraindicated in and those like the sacroiliac joints, which are devoid of synovial space. Treatment failures are most animals with arrested tuberculosis, peptic ulcer, and Cushing’s syndrome. The presence of active frequently the result of failure to enter the synovial space. If failures occur when injections into the tuberculosis, diabetes mellitus, osteoporosis, renal insufficiency, predisposition to thrombophlebitis, synovial spaces are certain, as determined by aspiration of fluid, repeated injections are usually hypertension, or congestive heart failure necessitates carefully controlled use of corticosteroids.
futile. Local therapy does not alter the underlying disease process, and whenever possible Intrasynovial, intratendinous, or other injections of corticosteroids for local effect are contraindicated comprehensive therapy including physiotherapy and orthopedic correction should be employed.
in the presence of acute infectious conditions. Exacerbation of pain, further loss of joint motion, with The single intrasynovial dose depends on the size of the part, which corresponds to the size of fever and malaise following injection may indicate that the condition has become septic. Appropriate the animal. The interval between repeated injections depends on the duration of relief obtained.
antibacterial therapy should be instituted immediately.
Horses. The average initial dose for a large synovial space in horses is 120 mg with a range
from 40 to 240 mg. Smaller spaces will require a correspondingly lesser dose.
Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally Dogs. The average initial dose for a large synovial space in dogs is 20 mg. Smaller spaces will
to animals may induce the first stage of parturition when administered during the last trimester of require a correspondingly lesser dose.
pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta HOW SUPPLIED
DEPO-MEDROL Sterile Aqueous Suspension, 20 mg/mL, is available in 10 mL and 20 mL vials, Additionally, corticosteroids administered to dogs, rabbits, and rodents during pregnancy have resulted and 40 mg/mL is available in 5 mL vials.
in cleft palate in offspring. Corticosteroids administered to dogs during pregnancy have also resulted Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP].
in other congenital anomalies, including deformed forelegs, phocomelia, and anasarca.
Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.
Pharmacia & Upjohn Company
PRECAUTIONS
DEPO-MEDROL Sterile Aqueous Suspension exerts an inhibitory influence on the mechanisms and 811 350 108
the tissue changes associated with inflammation. Vascular permeability is decreased, exudation diminished, and migration of the inflammatory cells markedly inhibited. In addition, systemic manifestations DEPO-MEDROL is a registered trademark of Pharmacia & Upjohn Company.
such as fever and signs of toxemia may also be suppressed. While certain aspects of this alteration of Copyright 2002 Pharmacia Corporation. All rights reserved.
the inflammatory reaction may be beneficial, the suppression of inflammation may mask the signs ofinfection and tend to facilitate spread of microorganisms. Hence, all patients receiving this drug shouldbe watched for evidence of intercurrent infection. Should infection occur, it must be brought under www.pharmaciaAH.com
MEDROL®
indicated, of a suitable anabolic agent. Excessive loss of potassium, like excessiveretention of sodium, is not likely to be induced by effective maintenance doses NDC 0009-3547-01
of MEDROL. However, these effects should be kept in mind and the usual regulatory brand of methylprednisolone tablets
measures employed as indicated. Ecchymotic manifestations, while not notedduring the clinical evaluation in dogs and cats, may occur. If such reactions do For Oral Use in Dogs and Cats
occur and are serious, reduction in dosage or discontinuance of methylprednisolone Methylprednisolone, a potent anti-inflammatory steroid synthesized and developed therapy may be indicated. Concurrent use of daily oral supplements of ascorbic in the Research Laboratories of The Upjohn Company is the 6-methyl derivative acid may be of value in helping to control ecchymotic tendencies.
of prednisolone. It has a greater anti-inflammatory potency than prednisolone Since methylprednisolone, like prednisolone, suppresses endogenous and even less tendency than prednisolone to induce sodium and water retention.
adrenocortical activity, it is highly important that the animal patient receiving Its advantage over the older corticoids lies in its ability to achieve equal anti- MEDROL be under careful observation, not only during the course of treatment inflammatory effect with lower dose, while at the same time enhancing the split but for some time after treatment is terminated. Adequate adrenocortical supportive between anti-inflammatory and mineralocorticoid activities.
therapy with cortisone or hydrocortisone, and including ACTH, must be employed INDICATIONS
promptly if the animal is subjected to any unusual stress such as surgery, trauma,or severe infection. The indications for MEDROL Tablets are the same as those for other anti-inflammatory steroids and comprise the various collagen, dermal, allergic, ocular, ADMINISTRATION
otic, and musculoskeletal conditions known to be responsive to the anti-inflammatory The keystone of satisfactory therapeutic management with MEDROL Tablets, as corticosteroids. Representative of the conditions in which the use of steroid with its steroid predecessors, is individualization of dosage in reference to the therapy and the benefits to be derived therefrom have had repeated confirmation severity of the disease, the anticipated duration of steroid therapy, and the animal in the veterinary literature are: (1) dermal conditions, such as non-specific eczema, patient’s threshold or tolerance for steroid excess. The prime objective of steroid summer dermatitis, and burns; (2) allergic manifestations, such as acute urticaria, therapy should be to achieve a satisfactory degree of control with a minimum allergic dermatitis, drug and serum reactions, bronchial asthma, and pollen sensitivities; (3) ocular conditions, such as iritis, iridocyclitis, secondary glaucoma,uveitis, and chorioretinitis; (4) otic conditions, such as otitis externa; (5) The dosage recommendations are suggested average total daily doses and
musculoskeletal conditions, such as myositis, rheumatoid arthritis, osteoarthritis, are intended as guides. As with other orally administered corticosteroids, the and bursitis; (6) various chronic or recurrent diseases of unknown etiology such total daily dose of MEDROL should be given in equally divided doses. The initial as ulcerative colitis and nephrosis.
suppressive dose level is continued until a satisfactory clinical response is obtained,a period usually of 2 to 7 days in the case of musculoskeletal diseases, allergic In acute adrenal insufficiency, MEDROL may be effective because of its ability conditions affecting the skin or respiratory tract, and ocular inflammatory diseases.
to correct the defect in carbohydrate metabolism and relieve the impaired diuretic If a satisfactory response is not obtained in 7 days, reevaluation of the case to response to water characteristic of primary or secondary adrenal insufficiency.
confirm the original diagnosis should be made. As soon as a satisfactory clinical However, because this agent lacks significant mineralocorticoid activity, the parent response is obtained, the daily dose should be reduced gradually, either to hormones, SOLU-CORTEF® containing hydrocortisone sodium succinate, termination of treatment in the case of acute conditions (eg, seasonal asthma, CORTEF® containing hydrocortisone, or cortisone should be used when salt dermatitis, acute ocular inflammations) or to the minimal effective maintenance dose level in the case of chronic conditions (eg, rheumatoid arthritis). In chronic CONTRAINDICATIONS
conditions, and in rheumatoid arthritis especially, it is important that the reductionin dosage from initial to maintenance dose levels be accomplished slowly. The MEDROL Tablets like prednisolone, are contraindicated in animals with arrested maintenance dose level should be adjusted from time to time as required by tuberculosis, peptic ulcer, acute psychoses, and Cushingoid syndrome. The fluctuation in the activity of the disease and the animal’s general status. Accumulated presence of diabetes, osteoporosis, chronic psychotic reactions, predisposition experience has shown that the long-term benefits to be gained from continued to thrombophlebitis, hypertension, congestive heart failure, renal insufficiency, steroid maintenance are probably greater the lower the maintenance dose level.
and active tuberculosis necessitates carefully controlled use. Some of the above In rheumatoid arthritis in particular, maintenance steroid therapy should be at conditions occur only rarely in dogs and cats but should be kept in mind.
CAUTIONS
Important: In the therapeutic management of animal patients with chronic diseases
Because of its inhibitory effect on fibroplasia, methylprednisolone may mask the such as rheumatoid arthritis, methylprednisolone should be regarded as a highly signs of infection and enhance dissemination of the infecting organism. Hence, valuable adjunct, to be used in conjunction with but not as replacement for standard all animal patients receiving methylprednisolone should be watched for evidence of intercurrent infection. Should infection occur, it must be brought under control by use of appropriate antibacterial measures, or administration ofmethylprednisolone should be discontinued.
Average total daily oral doses for dogs and cats are as follows: Warning: Not for human use. Clinical and experimental data have demonstrated
5 to 15 lb body wt . . . . . . . . . . . . . . . . . . . . . . 2 mg that corticosteroids administered orally or parenterally to animals may induce the 15 to 40 lb body wt . . . . . . . . . . . . . . . . . . 2 to 4 mg first stage of parturition when administered during the last trimester of pregnancy 40 to 80 lb body wt . . . . . . . . . . . . . . . . . . 4 to 8 mg and may precipitate premature parturition followed by dystocia, fetal death, The total daily dose should be given in divided doses, 6 to 10 hours apart.
HOW SUPPLIED
Additionally, corticosteroids administered to dogs, rabbits and rodents duringpregnancy have resulted in cleft palate in offspring. Corticosteroids administered Veterinary MEDROL Tablets are compressed cross-scored tablets available in to dogs during pregnancy have also resulted in other congenital anomalies including deformed forelegs, phocomelia, and anasarca.
Bottles of 500 . . . . . . . . . . . . . . . NDC 0009-3547-01
PRECAUTIONS
Each 4 mg tablet contains 4 mg methylprednisolone.
MEDROL Tablets, like prednisolone and other adrenocortical steroids is a potent Store at controlled room temperature 20° to 25° C (68° to 77° F) [see USP].
therapeutic agent influencing the biochemical behavior of most, if not all, tissues Caution: Federal (USA) law restricts this drug to use by or on the order of a
of the body. Because this anti-inflammatory steroid manifests little sodium-retaining activity, the usual early sign of cortisone or hydrocortisone overdosage (ie, increasein body weight due to fluid retention) is not a reliable index of overdosage. Hence, Pharmacia & Upjohn Company
recommended dose levels should not be exceeded, and all animal patients receiving MEDROL should be under close medical supervision. All precautions 812 602 308
pertinent to the use of prednisolone apply to methylprednisolone. Moreover, the veterinarian should endeavor to keep informed of current studies with MEDROLas they are reported in the veterinary literature.
ADVERSE REACTIONS
MEDROL and DEPO-MEDROL are registered trademarks of Pharmacia & Upjohn Company.
Copyright 2002 Pharmacia Corporation. All rights reserved.
With therapeutically equivalent doses, the likelihood of occurrence of troublesomeside effects is less with methylprednisolone than with prednisolone; moreover,side effects actually have been conspicuously absent during clinical trials withMEDROL Tablets in dogs and cats. However, methylprednisolone is similar toprednisolone in regard to kinds of side effects and metabolic alterations to beanticipated when treatment is intensive or prolonged. In animal patients withdiabetes mellitus, use of methylprednisolone may be associated with an increasein the insulin requirement. Negative nitrogen balance may occur, particularly in www.pharmaciaAH.com
animals that require protracted maintenance therapy; measures to counteractpersistent nitrogen loss include a high protein intake and the administration when

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