Since the complications of therapy with Metizred drug depend on the dose and duration of treatment, in each case, based on the analysis of the risk / benefit ratio, a decision is made on the need for such treatment, and also determines the duration of treatment and the frequency of admission.
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 undergo a regular examination (radiography bodies thoracic cells, the concentration of glucose in the blood plasma after 2 hours after eating, a general urine test,blood pressure, body weight control, it is desirable to conduct an X-ray or endoscopic examination in the presence of a history of gastrointestinal ulcer diseases).
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 long-term 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 in the group at increased risk of developing intracranial hypertension.
The drug Metipred should also be prescribed from big caution 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 a widespread migration of larvae,often with development heavy forms 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.
Patients, which may be exposed to stress on the background of therapy with Metizred, an increase in the dose of the drug before, during and after a stressful situation is shown.
Against the background of therapy with Metizred, susceptibility to infections may increase, some infections can occur in an erased form, in addition, new infections can develop. In addition, the ability of the organism to localize decreases infectious process. The development of infections caused by various pathogens, such as viruses, bacteria, fungi, protozoa or helminths that are localized in various human body systems, can be associated with the use of Metipred, both as monotherapy and in combination with other immunosuppressants, affecting the cellular immunity, humoral immunity or the function of neutrophils. These infections can be non-lethal, however, in some cases it is possible severe current and even death. 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, who receive treatment with Meti-Drug in doses that do not have immunosuppressive action, immunization can be performed according to the appropriate indications. The use of Metipred with active tuberculosis should be limited to cases of fulminant and disseminated tuberculosis, when Metipred is used to treat the disease in combination with the relevant antituberculous chemotherapy.
If the preparation of Metipred is prescribed 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 appropriate 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.
When Meti-prescription is used in therapeutic doses for a long period, suppression of the hypothalamic-pituitary-adrenal system may occur (secondary cortical insufficiency adrenal glands). The degree and duration of insufficiency of the adrenal cortex are individual for each patient and depend on the dose, frequency of administration, time of administration and duration therapy.
The severity of this effect can be reduced by using the drug every other day or a gradual decrease in 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.
The development of acute adrenal insufficiency, leading to a lethal outcome, is possible with a sharp cancellation of Metizred. The "cancellation" syndrome, apparently not related to adrenal insufficiency, can also arise due to the sharp cancellation of the Metipred preparation. This syndrome includes symptoms such as anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, skin peeling, myalgia, weight loss and lowering blood 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 liver noted gain effect preparation Metizred.
The use of Metizred can lead to an increase in the concentration of glucose in the blood plasma, worsening currents existing diabetes mellitus. Patients receiving long-term therapy with Meti-prescription may be predisposed to the development of diabetes mellitus.
Against the background of therapy with the drug Metipred may develop various mental disorders: from euphoria, insomnia, instability mood, changes personality and severe depression to acute mental manifestations. Besides addition, can the already existing emotional instability or inclination to psychotic reactions.
Potentially severe mental disorders can occur with the use of the drug 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, it may be necessary specific treatment.
Patients and / or their relatives should be warned that if changes at psychological status of the patient (especially at development of depressive state and suicidal attempts) it is necessary to seek medical help. 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 addition of secondary eye 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 blood pressure may provoke new reactions in predisposed patients in the case of application of high doses of the drug Metipred and long-term treatment. AT connection with this drug Metipred should be used with caution in patients with risk factors cardiovascular diseases. Regular monitoring is required function of the heart. Application of low Metizred doses every other day can reduce the severity of these side effects.
Patients who take Metipred should be cautioned to prescribe analgesics based on acetylsalicylic acid and non-steroidal anti-inflammatory drugs. Allergic reactions are possible. Due to the fact that such phenomena as skin irritations and anaphylactic or pseudo-anaphylactic reactions were rarely observed in patients receiving SCS, the necessary measures should be taken before the appointment of the SCS, especially if the history of the patient has a history of allergic reactions to medications. Due to the existing risk of corneal perforation, prescribe GCS with the treatment of eye infection caused by the herpes simplex virus (ophthalmoherpes) with caution. High doses of GCS can cause acute pancreatitis.
Therapy with high doses of GCS can cause acute myopathy; with the disease most affected Patients from violations neuromuscular transmission (eg, myasthenia gravis gravis), as well as patients receiving concomitant therapy holinolitikami, for example, 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 a frequent (but rarely detectable) complication of long-term treatment with high doses of corticosteroids.
SCS is cautiously prescribed for prolonged therapy in elderly patients age of due to increased risk of osteoporosis, and the delay in the body fluids, which potentially causes increased blood pressure. Simultaneous treatment methylprednisolone and fluoroquinolones increases the risk of rupture of tendons, especially in elderly patients. High doses of GCS can cause pancreatitis in children. High doses of methylprednisolone should not be used in cases of brain damage due to head trauma.
As methylprednisolone may enhance the clinical manifestations of Cushing's syndrome, methylprednisolone should be avoided in patients with Isenko-Cushing's disease. It is necessary to closely monitor patients receiving systemic GCS, and recently undergoing myocardial infarction. Careful observation is necessary for patients who have a history or present thrombosis or thromboembolic complications.