Because complications of therapy with Metizred depends on dose and duration values treatment, then in each specific case based on analysis risk / benefit ratios decision on the need for such treatment, as well as determine duration of treatment and frequency of administration.
In order to better control the patient's condition, the lowest dose of Metipred should be used. When the effect is achieved, if possible, gradually reduce the dose to a maintenance dose or discontinue treatment.
In view of the risk of arrhythmia, the use of Metipred in high doses should be carried out in a hospital equipped with the necessary equipment (electrocardiograph, defibrillator).
If long-term spontaneous remission occurs, treatment should be discontinued.
With prolonged treatment, the patient should go through regular examination (radiography of thoracic organs cells, concentration glucose in blood plasma after 2 hours after eating, general urine analysis, blood pressure, body weight control, it is desirable to conduct a radiographic or endoscopic examination with presence in the anamnesis of ulcerative diseases of the gastrointestinal tract).
It is necessary to carefully monitor the growth and development of children who are on long-term therapy with Metipred. Growth retardation can be observed in children receiving a long daily divided into several doses of therapy. Daily use of methylprednisolone for a long time in children is possible only on absolute indications. The use of the drug every other day may reduce the risk of developing this side effect or avoid it altogether.
Children receiving long-term therapy with Metipred are at increased risk for developing intracranial hypertension.
The drug Metipred should also be administered with great care to patients with confirmed or suspected parasitic infections, such as, strongyloidiasis. Caused methylprednisolone immunosuppression, in such patients leads to strongyloid hyperinfection and dissemination of the process with widespread migration of larvae, often with the development of severe forms of enterocolitis and gram-negative septicemia with possible fatal outcome.Patients receiving drugs that suppress the immune system are more susceptible to infections than healthy individuals. For example, chickenpox and measles can have a more severe course, up to lethal outcome the nonimmunized children or in adults receiving Metipred.
The efficacy of Metipred in septic shock is questionable. The results of a systematic review of the use of the drug in short courses in high doses do not support the possibility of their use in this mode.
Patients, which may to be exposed to stress on the background of therapy with Metizred, shows an increase in the dose of the drug before, during and after a stressful situation.
Due to the fact that it is revealed increased mortality after 2 weeks or 6 months after injury head in patients who received treatment of methylprednisolone sodium succinate, compared with placebo, Metipred should not be used when brain edema caused by head trauma. Causal communication deaths using methylprednisolone sodium succinate not installed. Against the background of drug therapy The meta-map may increase susceptibility to infections, some infections may occur in an erased form, in addition, can develop new infections. Besides addition, the ability organism to localization infectious process. Development infections caused by various pathogenic organisms, such as viruses, bacteria, fungi, protozoa or helminths that are localized in various body systems person, may be due to using Metizred as a as a monotherapy, and in combination with other immunosuppressants, affecting the cellular immunity, humoral immunity or the function of neutrophils. These infections can be mild, however, in some cases, a severe course and even a lethal outcome is possible. Moreover, higher doses of the drug are used, the higher the probability of developing infectious complications.
Patients receiving treatment with Metiredent in doses that have an immunosuppressive effect are prohibited from administering live or live attenuated vaccines, but it is possible to administer killed or inactivated vaccines, however, the response to the introduction of such vaccines may be reduced or even absent. Patients receiving treatment with Metizred in doses do not providing immunosuppressive action, according to the relevant indications, immunization can be carried out.
The use of the Metipred preparation with active tuberculosis should be limited to cases of fulminant and disseminated tuberculosis, when Metipred is used for the treatment of the disease in combination with the corresponding antituberculous chemotherapy. If Metizred is prescribed for patients with latent tuberculosis or from positive tuberculin tests, then treatment should be carried out under strict medical supervision, since it is possible to reactivate the disease. During prolonged therapy with the drug, such patients should receive the corresponding preventive treatment. It is reported that patients who received therapy with Metizred, had Kaposi's sarcoma. With the withdrawal of the drug may come a clinical remission. Since in patients receiving parenteral therapy with Metired preparation, in rare cases it is possible to develop skin reactions and anaphylactic / anaphylactoid reactions, before the drug should be administered undertake appropriate preventive measures, especially if a given patient has a history allergic reactions to any medications. In applying metipred drug at therapeutic doses over a long period can develop suppression of the hypothalamic-pituitary-adrenal system (secondary failure bark adrenal glands). Power and duration of insufficiency of adrenal cortex are individual for each patient and depend on dose, frequency of application, time of admission and duration therapy.
The severity of this effect can be reduced by using the drug every other day or by gradually reducing the dose. This type of relative insufficiency of the adrenal cortex can continue for several months after the end of treatment, therefore, under any stressful situations during this period, Metizred should again be prescribed. Since the secretion of mineralocorticosteroids may be impaired, concomitant the appointment of electrolytes and / or mineralocorticosteroids.Development of acute adrenal insufficiency, leading to lethal outcome, possibly with a sharp cancellation of the drug Metired. The withdrawal syndrome, apparently not related to adrenal insufficiency, can also arise due to the sharp cancellation of the drug Metired. This syndrome includes such symptoms like anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, skin peeling, myalgia, weight loss and lowering of arterial pressure.
It is assumed that these effects arise in connection with a sharp fluctuation concentrations methylprednisolone in the blood plasma, and not because of a decrease in the concentration of methylprednisolone in the blood plasma.
In patients with hypothyroidism or cirrhosis of the liver, the effect of Metipred is noted. The use of Metizred can lead to an increase in the concentration of glucose in the blood plasma, worsening of the current diabetes mellitus. Patients receiving long-term therapy with Metizod be predisposed to the development of diabetes.
On the background of therapy drug Meti perhaps development various mental disorders: from euphoria, insomnia, instability mood, changes in personality and severe depression to acute psychotic manifestations. In addition, they may intensify already the available emotional instability or propensity to psychotic reactions.
Potentially heavy mental disorders can occur when applying preparation Metizred.
Symptoms usually appear within a few days or weeks after the start of therapy. Most reactions disappear either after a dose reduction or after the drug is discontinued. Despite this, specific treatment may be required.
Patients and / or their relatives should be warned that if changes at the psychological status of the patient (especially with the development of a depressive state and suicidal attempts)is necessary turn to behind medical care. Also, patients or their relatives should be warned about the possibility of developing mental disorders during or immediately after lowering the dose of the drug or completely canceling it. Prolonged use of Metizred can lead to the emergence of rear subcapsular cataract and nuclear cataract (especially in children),exophthalmos or glaucoma with possible damage to the optic nerve and provoke the attachment of a secondary ophthalmic fungal or viral infection.
With the use of Metipred, there is an increase in blood pressure, fluid and salt retention in the body, loss of potassium, hypokalemic alkalosis. These effects are less pronounced when using synthetic derivatives, except for cases when they are used in large doses. It may be necessary limitation needs of salt and products containing sodium.
Therapy with Metizred can mask the symptoms of peptic ulceration and in this case perforation or bleeding can develop without a significant pain syndrome. Such adverse reactions of Metizred from the side of cardiovascular system, as dyslipidemia, rise arterial pressure, can provoke new patients in predisposed patients in case of high doses of Metipred and long-term treatment. In this regard, Metipred should be used with caution in patients with risk factors for cardiovascular disease.Regular monitoring of heart function is necessary. The use of low doses of Metipred every other day can reduce the severity of these side effects.
Patients, host glucocorticosteroids, caution should be given to analgesics based on acetylsalicylic acid and nonsteroidal anti-inflammatory drugs. Allergic reactions are possible. AT the fact that patients who received glucocorticosteroids rarely noticed such phenomena as skin irritations and anaphylactic or pseudo-anaphylactic reactions, before appointment glucocorticosteroids should be take the necessary measures, especially if the history of the patient has a history of allergic reactions to medications.
If during the treatment with Meti-preparation the patient developed adrenocortical insufficiency, it should be tried to eliminate by gradually reducing the dosage. This deficiency occurs in parallel with treatment and can last up to several months after its completion. In order to eliminate this effect, patients experiencing stress after completion of treatment are prescribed hormone therapy.In process of deducing mineralocorticosteroids, concomitant treatment in the form of preparations of salt and (or) mineralocorticosteroids is prescribed.
Glucocorticosteroids from use caution when possible risk of perforation of an ulcer, abscess or any purulent infection if the patient suffers from ulcerative colitis, diverticulitis, open intestinal anastomosis, or an active (or latent) ulcer. High doses of glucocorticosteroids can cause acute pancreatitis. Therapy high doses glucocorticosteroids can cause acute myopathy; The disease is most likely to affect patients from violations neuromuscular transmission (eg, myasthenia gravis), as well as patients receiving concomitant anticholinergic therapy, eg, blockers neuromuscular transfer. Myopathy of this kind is generalized; it can affect the muscles of the eyes or the respiratory system and even lead to paralysis of all limbs. In addition, the level of creatine kinase may increase. In such cases, clinical recovery may take weeks or even years.
Osteoporosis is often meeting (but rarely detectable) complication of long-term therapy with high doses of glucocorticosteroids.
Glucocorticosteroids are cautiously prescribed for prolonged therapy in elderly patients because of the increased risk of osteoporosis and fluid retention in the body, potentially causing an increase in blood pressure. Simultaneous treatment methylprednisolone and fluoroquinolones increases the risk of rupture of tendons, especially in elderly patients.
High doses of glucocorticosteroids can cause pancreatitis in children.
After rapid intravenous administration large doses Methylprednisolone (more than 500 mg, administered in less than 10 minutes), there were cases of cardiac arrhythmia, vascular insufficiency, and cardiac arrest. During or after the administration of large doses of methylprednisolone sodium succinate, bradycardia may occur; However, there is no evidence that its occurrence is associated with the speed and duration of the infusion.
Since the intake of glucocorticosteroids can cause or exacerbate the Itenko-Cushing syndrome, patients, suffering from Isenko-Cushing's disease, is necessary to avoid application of glucocorticosteroids. Patients from renal Insufficiency should be prescribed glucocorticosteroids from caution.
Patients with chronic heart failure system Glucocorticosteroids are administered with extreme caution and only in critical cases.
Patients with elevated blood pressure, glucocorticosteroids are also administered with caution.
Against the background of intravenous pulse therapy high doses of methylprednisolone may develop acute hepatitis. With prolonged therapy with high doses perhaps development epidural lipomatosis.
With the introduction of methylprednisolone intrathecally or epidurally, severe complications can develop.
In patients with pheochromocytoma, it is possible to develop sympathetic adrenal crises (including fatal outcome).
Therapy with methylprednisolone may lead to the development of central serous chorioretinopathy, which in turn can lead to detachment of the retina.
Required use Methylprednisolone with caution in patients with venous thromboembolism or thromboembolic complications at the present time or having a predisposition to their development, t. cases of thrombosis development are possible.
With the simultaneous use of methylprednisolone with cyclosporine, it is possible to develop a convulsive syndrome.