Drug Interactions
The pharmacokinetic interactions listed below are potentially clinically important. Mutual inhibition of metabolism occurs with concurrent use of cyclosporin and methylprednisolone; therefore, it is possible that adverse events associated with the individual use of either drug may be more apt to occur. Convulsions have been reported with concurrent use of methylprednisolone and cyclosporin. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of methylprednisolone and may require increases in methylprednisolone dose to achieve the desired response. Drugs such as troleandomycin and ketoconazole may inhibit the metabolism of methylprednisolone and thus decrease its clearance. Therefore, the dose of methylprednisolone should be titrated to avoid steroid toxicity. Methylprednisolone may increase the clearance of chronic high dose aspirin. This could lead to decreased
salicylate serum levels or increase the risk of salicylate toxicity when methylprednisolone is withdrawn. Aspirin should be used cautiously in conjunction with corticosteroids in patients suffering from hypoprothrombinemia. The effect of methylprednisolone on oral anticoagulants is variable. There are reports of enhanced as well as diminished effects of anticoagulant when given concurrently with corticosteroids. Therefore, coagulation indices should be monitored to maintain the desired anticoagulant effect.

Information for the Patients
Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay.

Adverse Reactions
Fluid and Electrolyte Disturbances
Sodium retention
Potassium loss
Fluid retention
Hypokalemic alkalosis
Congestive heart failure in susceptible patients
Hypertension

Musculoskeletal
Muscle weakness
Aseptic necrosis of femoral and
Steroid myopathy humeral heads
Loss of muscle mass
Pathologic fracture of long bones
Severe arthralgia
Osteoporosis
Vertebral compression fractures
Tendon rupture, particularly of the Achilles tendon

Gastrointestinal
Peptic ulcer with possible perforation
Increases in alanine treatment transaminase and hemorrhage (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphatase have been observed following corticosteroid These changes are usually small, not associated with any clinical syndrome and are reversible upon discontinuation.
Pancreatitis
Abdominal distention
Ulcerative esophagitis

Dermatologic
Impaired wound healing
Facial erythema
Thin fragile skin
Increased sweating
Petechiae and ecchymoses
May suppress reactions to skin tests

Neurological
Increased intracranial pressure with papilledema (pseudo-tumor cerebri) usually after treatment
Convulsions
Vertigo
Headache

Endocrine
Development of Cushingoid state
Menstrual irregularities
Suppression of growth in children
Decreased carbohydrate tolerance
Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness
Manifestations of latent diabetes mellitus
Increased requ