The drug is testosterone propionate an injectable form of methylprednisolone, a synthetic corticosteroids. Methylprednisolone acetate has a pronounced and prolonged anti-inflammatory, anti-allergic and immunosuppressive activity and is used intramuscularly to achieve prolonged systemic effect, as well as in situ as a means for local therapy.Prolonged action drug due to slow release of the active substance.
Methylprednisolone acetate has the same properties as methylprednisolone, but less soluble and less actively metabolized, which explains the long duration of its validity.
GCS, penetrating through the cell membrane, form complexes with specific cytoplasmic receptors. Then, these complexes enter the cell nucleus, binds to DNA (chromatin) and stimulate the transcription of mRNA and subsequent synthesis of various proteins (including enzymes), which explains the effect of corticosteroids for systemic use. SCS not only have a significant impact on the inflammatory and immune response, but also affect the carbohydrate, protein and fat metabolism. They also influence the cardiovascular system, skeletal muscles and the central nervous system.
The effect on inflammation and immune response
The majority of indications for the use of corticosteroids due to their anti-inflammatory, immunosuppressive and anti-allergic properties. Because of these properties are achieved following therapeutic effects:
- reducing the number of immunoactive cells in the inflammation;
- reduction in vasodilation;
- stabilization of the lysosomal membranes;
- inhibition of phagocytosis;
- decrease in production of prostaglandins and related compounds.
A dose of 4.4 mg methylprednisolone acetate (4 mg of methylprednisolone) has the same antiinflammatory effect as 20 mg of hydrocortisone.
Methylprednisolone has only negligible mineralocorticoid activity (equivalent to 200 mg methylprednisolone deoxycorticosterone 1 mg).
Influence of carbohydrate and protein metabolism
GCS exert catabolic action on proteins. The released amino acids are converted into hepatic gluconeogenesis and glycogen into glucose. Glucose uptake in peripheral tissues is reduced, which may lead to hyperglycaemia and glycosuria, especially in patients at risk of developing diabetes.
Effects on lipid metabolism
corticosteroids possess lipolytic activity, which manifests itself primarily in the extremities. GCS also increase lipogenesis, which is most pronounced in the chest, neck and head. All this leads to a redistribution of body fat.
Maximum pharmacological activity is manifested not glucocorticosteroids at the peak plasma concentration, and after it, thus their effect is primarily due to the influence on the enzyme activity.
Methylprednisolone acetate is hydrolyzed under the influence of serum cholinesterase to form the active metabolite. In humans, methylprednisolone forms a weak, dissociating bond with albumin and transcortin. Approximately 40-90% of methylprednisolone is in a bound state. Due to the intracellular activity of corticosteroids revealed a pronounced difference between the plasmatic half-life and pharmacological half-life. The pharmacological activity is maintained even when the concentration is not determined in the blood methylprednisolone.
The duration of anti-inflammatory activity of corticosteroids is approximately equal to the duration of suppression of the hypothalamic-pituitary-adrenal (HPA) system.
After the / m administration at a dose of 40 mg / ml, the maximum concentration (Cmax) in the serum was achieved in a mean of 7,3 ± 1 chasa (Tmax) and averaged 1.48 ± 0.86 g / 100 ml (the period The half-life = 69.3 hours). After a single in / m injection of 40-80 mg methylprednisolone acetate, duration of HPA axis suppression system is from 4 to 8 days.
After intra-articular administration of 40 mg in each knee joint (total dose = 80 mg), the maximum serum concentration achieved after 4-8 hours and was approximately 21.5 mg / 100 ml. Receipt methylprednisolone into the systemic circulation from the joint cavity was kept for about 7 days, it evidenced a duration of suppression of the HPA systems and the results of determination of serum concentration of methylprednisolone.
Methylprednisolone metabolism in the liver, and this process is qualitatively similar to that of cortisol. The main metabolites are 20-β-gidroksimetilprednizolon and 20-β-hydroxy-6-α-metilprednizon. Metabolites derived in urine as glucuronides, sulfates and unconjugated compounds. These conjugation reactions occur primarily in the liver and in the kidneys partially.
Indications for use of
corticosteroids should be used only as a symptomatic treatment, with the exception of some endocrine disorders in which they are used as replacement therapy.
Methylprednisolone acetate (DEPO-Medrol ® ) is not used for the treatment of acute life-threatening conditions. If you want a quick hormonal effect of maximum intensity, then intravenously administered soluble methylprednisolone sodium succinate (Solu-Medrol ® ).
If you can not hold an oral therapy with corticosteroids, the use of the drug intramuscularly is shown in the following diseases: 1. Endocrine diseases
- Primary and secondary adrenocortical insufficiency (the drug of choice -gidrokortizon or cortisone, if necessary, in combination with a mineralocorticoid, especially in pediatric patients).
- Acute adrenocortical insufficiency (the choice of drugs – hydrocortisone or cortisone, it may be necessary to add mineralocorticoid).
- Congenital adrenal hyperplasia
- Hypercalcemia on the background of cancer.
- Subacute thyroiditis
2. Rheumatic diseases
as an additional tool in maintenance therapy (non-steroidal anti-inflammatory drugs, kinesitherapy, physiotherapy, etc.) And for short-term use (to remove the patient from the acute condition or an exacerbation of the process) in the following diseases:
- Psoriatic arthritis
- Ankylosing spondylitis
In the following diseases should be possible to use the drug in situ:
- Post-traumatic osteoarthritis
- Synovitis in osteoarthritis
- Rheumatoid arthritis, including juvenile rheumatoid arthritis (in some cases may require maintenance therapy with low doses)
- Acute and subacute bursitis
- Acute nonspecific tenosynovitis
- Acute gouty arthritis
During an exacerbation, or in some cases as a maintenance therapy for the following diseases:
- Systemic lupus erythematosus
- Systemic dermatomyositis (polymyositis)
- Acute rheumatic myocarditis
4. Skin diseases
- Malignant exudative erythema (Stevens-Johnson syndrome)
- exfoliative dermatitis
- Bullous dermatitis herpetiformis (a drug of choice – sulfone, systemic administration of corticosteroids is adjuvant)
5. Allergic conditions
for control of the following severe and incapacitating allergic conditions that can not be cured by conventional methods:
- status asthmaticus
- Contact dermatitis
- Atopic dermatitis
- serum sickness
- Seasonal or perennial allergic rhinitis
- Drug allergy
- Transfusion reactions / drug administration on the type of urticaria
- Acute noninfectious laryngeal edema (drug of choice – epinephrine)
6. Ophthalmic diseases
Severe acute and chronic allergic and inflammatory processes in the eye lesions, such as:
- uveitis and inflammatory diseases of the eye, do not respond to the use of topical corticosteroids
7. Diseases of the gastrointestinal tract
to remove the patient from the critical state of the following diseases:
- Ulcerative colitis (systemic therapy)
- Crohn’s disease (systemic therapy)
8. Respiratory Diseases
- Symptomatic sarcoidosis
- Focal or disseminated pulmonary tuberculosis (used in combination with appropriate antituberculous chemotherapy)
- Loeffler’s syndrome, is not amenable to treatment by other methods
- inhalation pneumonia
9. Hematologic Disorders
- Acquired (Autoimmune) Hemolytic Anemia
- Secondary thrombocytopenia in adults
- Erythroblastopenia (thalassemia major)
- Congenital (erythroid) hypoplastic anemia
as a palliative therapy for the following diseases:
- Leukemias and lymphomas in adults
Edematous syndrome 11.
To induce a diuresis or treatment of proteinuria in the nephrotic syndrome, idiopathic type or conditioned with systemic lupus erythematosus
12. Nervous System
- Multiple sclerosis exacerbation
13. Other indications for use
- Tuberculous meningitis with subarachnoid block or the threat of the block, in combination with appropriate antituberculous chemotherapy
- Trichinosis with nervous system lesion or infarction
B. Intra-articular, periarticular, intrabursalnoe application and the introduction of the soft tissue (see section “Special instructions”.).
As adjunctive therapy for short-term use (to remove the patient from the acute condition or an exacerbation of the process) in the following diseases:
- Synovitis in osteoarthritis
- Rheumatoid arthritis
- Acute and subacute bursitis
- Acute gouty arthritis
- Acute nonspecific tenosynovitis
B. Introduction to the pathological focus
Keloids and localized foci of inflammation in:
- Lichen planus (Wilson)
- psoriatic plaques
- granuloma annulare
- Simple chronic zoster (neurodermatitis)
- Discoid lupus erythematosus
- Diabetes lipodystrophy
- alopecia areata
It is also effective for cystic tumors of the tendon or aponeurosis (tendon sheath cyst).
- Intrathecal administration.
- Intravenous administration.
- Systemic fungal infections.
- Installed hypersensitivity to any component of the drug.
in lesions of the eye caused by the herpes simplex virus; as this may lead to perforation of the cornea; ulcerative colitis, if there is a threat of the perforation, the development of an abscess or other purulent infection, as well as diverticulitis; in the presence of testosterone propionate fresh intestinal anastomoses; with active or latent peptic ulcer; renal failure; diabetes; hypertension; osteoporosis; myasthenia gravis, when corticosteroids are used as primary or adjunctive therapy; for mental disorders in history; in children.
Pregnancy and lactation:
A number of animal studies have shown that administration of corticosteroids females in high doses can lead to the emergence of a teratogenic effect. There are no adequate studies of the effect of GCS on the reproductive function in humans has not been, so when deciding on the appointment of corticosteroids to pregnant women, nursing mothers, or women who may become pregnant, should correlate the potential benefits of the drug to the mother (future mother) and the potential risk to the fetus or child. Corticosteroids should be prescribed during pregnancy is strictly on the testimony.
SCS can easily penetrate through the placenta. Children born to mothers who received relatively high doses of corticosteroids during pregnancy should be monitored carefully, so that you can quickly identify the signs of adrenal insufficiency. Effect of corticosteroids on the course and outcome of birth is unknown. GCS allocated into breast milk.
Dosing and Administration
- intraarticular, periarticular, intrabursalnoe administration or in the soft tissues
- introduction to the pathological focus
Introduction to a pathologic nidus to achieve local effect
Despite the fact that treatment with DEPO-Medrol ® leads to a decrease of symptoms, it has no effect on the cause of the inflammatory process, so it is necessary to carry out a conventional therapy for any particular disease. Rheumatoid arthritis and osteoarthritis. The dose for intra-articular administration depends on the size of the joint as well as the severity of the condition of the patient. In the case of chronic disease the number of injections can vary from one to five or more per week, depending on the degree of improvement achieved after the first injection. The following dose (. See table) are given as a general guideline:
|joint Size||The name of the joint||dose range|
|Average||The elbow joint
of the wrist
Procedure. It is recommended to evaluate the anatomy of the affected joint before performing intra-articular injection. For the full anti-inflammatory effect it is important that the injection was carried out in the synovial cavity. It is necessary to observe the rules of aseptic and antiseptic as well as for a lumbar puncture. A sterile needle 20-24 G (worn on a dry syringe) is rapidly injected into the synovial cavity. The method of choice is the infiltration anesthesia procaine. To control the needle entering into the joint cavity aspiration produced a few drops of synovial fluid. When choosing injection venue, which individually for each joint is recorded nearness synovial cavity to the surface (as close as possible), and the path of the major blood vessels and nerves (as far as possible). The needle is left in place, the syringe with the aspirated fluid is removed and replaced with another syringe containing the desired amount of DEPO-Medrol drug. This is followed by slowly pulling the plunger to aspirate synovial fluid and to make sure that the needle is still in the synovial cavity. After the injection should be done in several lung joint movements, thereby mixing the slurry with the synovial fluid. Venue injection close small sterile dressing.
The drug can be administered into the knee, ankle, elbow, shoulder, metacarpophalangeal, interphalangeal joints and the hip. Sometimes there are difficulties with the introduction of the hip joint, as to avoid falling into the large blood vessels. The following injection joints are not made: anatomically inaccessible joints, for example, the intervertebral joints, including the sacroiliac joint, which lacks the synovial cavity. The ineffectiveness of therapy most often the result of an unsuccessful attempt to penetrate into the joint cavity. With the drug effect in the surrounding tissue is negligible or non-existent. If treatment is not given positive results when getting into the synovial cavity is not in doubt, as confirmed by aspiration of synovial fluid, repeated injections are usually futile.
Local therapy does not affect the process of underlying disease, therefore it is necessary to carry out a complex therapy, including basic anti-inflammatory therapy, physiotherapy and orthopedic correction.
After intraarticular injection of corticosteroids should be careful not to overload the joints in which symptomatic improvement observed in order to avoid more severe joint damage compared to what it was before the beginning of therapy Valium.
GKS can not enter into unstable joints. In some cases repeated intraarticular injections can lead to instability of the joint. In some cases, it is recommended to carry out X-ray control to detect damage.
If prior to the introduction of the drug depot-Medrol ® applies a local anesthetic, you should carefully read the instructions for use of the anesthetic to comply with all necessary precautions.
Bursitis. After treatment, the area around the site of injection a suitable antiseptic conduct local infiltration anesthesia 1% solution of procaine. On a dry syringe needle put on 20-24 G, which is injected into the joint capsule, and then produce a fluid aspiration. The needle is left in place, and a syringe with the aspirated fluid is removed and in its place establish a syringe containing the desired dose of the drug.After the injection, the needle is removed and a bandage.
Cyst tendon sheath, tendinitis, epicondylitis. In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken that the slurry was introduced into the tendon sheath rather than into the tendon tissue. The tendon is easily palpated, if you hold your hand along it. When treating conditions such as epicondylitis, should be to identify the most painful area and put in her suspension by the creeping infiltration. When cysts tendon sheaths suspension is injected directly into the cyst. In many cases it is possible to achieve a significant reduction in the size of the cystic tumor and even its disappearance after a single injection of the drug. Each injection should be done in compliance with the rules of aseptic and antiseptic (suitable antiseptic skin treatment).
The dose is chosen according to the nature of the process and is 4-30 mg. Repeated injections may be required In recurrent or chronic course of the process.
Skin diseases. After appropriate treatment of the skin with an antiseptic, such as 70% alcohol, 20-60 mg of suspension are introduced into the lesion. When high surface dose of 20-40 mg lesions are divided into several portions and administered at different sites of the affected surface. With the introduction of the drug should be careful as to avoid skin whitening, which can subsequently lead to peeling. 1-4 generally carried injection interval between the injections depends on the type of pathological process and the duration of the periods of clinical improvement achieved since the first injection.
Intramuscular administration to achieve a systemic effect
dose for i / m administration depends on the disease to be therapy. For prolonged effect weekly dose is calculated by multiplying the daily dose for oral administration of 7, and it is administered in the form of audio / m injection.
The dose should be individualized according to the severity of the disease and the patient’s response to therapy. In children (including infants), a lower dose, which is selected primarily according to the severity of the disease, rather than using circuit constants calculated on the basis of the age or body weight. The course of treatment should be as short as possible. Treatment is carried out under constant medical supervision.
Hormone therapy is a supplement to conventional therapy, but does not replace it. The dose should be reduced gradually, the abolition of the drug also hold gradually, if it was administered for longer than a few days. The main factors determining the choice of dose, are the severity of the disease, the prognosis, the estimated duration of the disease and the patient’s response to therapy. If chronic illness arose during spontaneous remission, treatment should be interrupted. During prolonged therapy routine laboratory tests, such as urinalysis, determining the concentration of blood glucose 2 hours after a meal, the definition of blood pressure, body weight, chest x-ray should be performed at regular intervals. Patients with gastric ulcer and duodenal ulcer or a history of a severe dyspepsia, it is desirable to conduct X-ray examination of the upper gastrointestinal tract.
Patients with adrenal syndrome enough to enter a / m to 40 mg every 2 weeks. For maintenance therapy to patients with rheumatoid arthritis drug is administered once a week / m to 40-120 mg. The usual dose systemic corticosteroids therapy in patients with diseases of the skin, which allows to achieve a good clinical effect is 40-120 mg / m 1 times a week for 1-4 weeks. In acute severe dermatitis due to poison contained in the ivy, can eliminate the manifestations within 8-12 hours after a single i / m administration of 80-120 mg. In chronic contact dermatitis may be effective repeated injections with an interval of 5-10 days. In seborrheic dermatitis for control of enough introduce 80 mg 1 time per week.
After the / m of 80-120 mg in patients with bronchial asthma symptoms disappearance occurs within 6-48 hours and the effect lasts for a few days or 2 weeks. Patients with allergic rhinitis (hay fever) / m for 80-120 mg injection can also result in the elimination of symptoms coryza for 6 hours while the effect lasts from a few days up to 3 weeks.
If the disease targeted by the therapy, also develops stress symptoms, the dose should be increased slurry. For maximum effect shown rapid intravenous methylprednisolone sodium succinate, characterized by rapid dissolution.
Side effects The following side effects are typical for all GCS with parenteral use. Inclusion in the list does not mean that these effects are specific to a given drug.
- Disturbances of water and electrolyte balance: Sodium retention, congestive heart failure in patients with the appropriate predisposition, high blood pressure, fluid retention, hypokalemia, hypokalemic alkalosis.
When using synthetic derivatives such as methylprednisolone acetate, mineralocorticoid effects are less common than with cortisone or hydrocortisone.
- Musculoskeletal: “steroid” myopathy, muscle weakness, osteoporosis, pathologic fractures, vertebral compression fractures, aseptic necrosis of femoral and humeral bone, tendon rupture, particularly of the Achilles tendon, decreased muscle mass.
- Gastrointestinal / liver: peptic ulcer (possible perforation and hemorrhage), gastric bleeding, pancreatitis, ulcerative esophagitis, perforation of the intestine.There may be temporary and moderate increase in transaminases and alkaline phosphatase in the serum, but it is not associated with any clinical syndrome and reversible remove the drug.
- For the skin: impaired wound healing, petechiae and ecchymosis, thinning and fragility of the skin.
- Metabolic: negative nitrogen balance due to protein catabolism.
- Neurological: increased intracranial pressure, cerebral testosterone propionate pseudotumor, mental illness, seizures.
- Endocrine: menstrual irregularities, development of the syndrome of Cushing, suppression of hypothalamic-pituitary-adrenal axis (HPA), impaired glucose tolerance, manifestation of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents in patients with diabetes, growth retardation in children.
- Ophthalmic: posterior subcapsular cataracts, increased intraocular pressure, exophthalmos.
- Immune System: erased the clinical picture of infectious diseases, activation of latent infections, infections caused by opportunistic pathogens, hypersensitivity reactions, including anaphylaxis, may suppress reactions during skin tests.
Additional reactions associated with parenteral GCS therapy:
- Cases of blindness associated with local drug administration in pathological lesions located on the face and head.
- Anaphylactic or allergic reactions.
- Hyperpigmentation or hypopigmentation.
- Atrophy of the skin and subcutaneous tissue.
- Postinjection exacerbation after injection into the synovial fluid.
- Charcot arthropathy by type.
- Infection venue injection following standardization of aseptic and antiseptic.
- Sterile abscess.
The clinical syndrome of acute overdose of methylprednisolone acetate does not exist. Repeated use of the drug frequent (daily or several times a week) for a long period may lead to development of Cushing’s syndrome. Should stop using the product; but be aware that his abrupt withdrawal can lead to “rebound” adrenal insufficiency. No specific treatment is required.
Interaction with other medicinal products
In connection with pharmaceutical incompatibilities DEPO-Medrol drug ® should not be diluted or mixed with other solutions.
The following examples of drug interactions may have important clinical implications. The combined use of methylprednisolone and cyclosporine is mutual inhibition of metabolism of these drugs, therefore, likely that the side effects associated with the use of each of these drugs as monotherapy, when used together can occur more frequently. In a joint application of these drugs cases of seizures have been observed. Inductors microsomal enzymes such as phenobarbital, phenytoin, and rifampin may increase the clearance of methylprednisolone, which may require increasing doses of the drug to produce the desired effect.
Such preparations as oleandomycin and ketoconazole may inhibit the metabolism of corticosteroids, so it is necessary to make the selection of a dose corticosteroids to prevent overdose.Methylprednisolone may increase the clearance of acetylsalicylic acid in the received high doses for long periods, which can lead to reduced serum concentrations of salicylates or salicylate to increase the risk of toxicity when canceling methylprednisolone. Patients with gipoprotrombinemiey appoint acetylsalicylic acid in combination with corticosteroids should be cautious.
Methylprednisolone has a varied impact on the effect of indirect anticoagulants. It is reported as an enhancement, and to reduce the effect of indirect anticoagulants, taken together with methylprednisolone.To maintain the desired effect of indirect anticoagulants need constant determination of coagulation parameters (including international normalized ratio).
Special instructions apply strictly prescribed by a doctor to avoid complications.
- Preparations for parenteral administration before use should be subject to visual inspection to identify the foreign particles and change the color of the drug.
- The vials must not be stored upside down! Shake well before use.
- One vial can not be used for administration of multiple doses; after administration of the required dose vial slurry residues should be destroyed.
- DEPO-Medrol ® should not be administered by any other means, other than those listed in the “Dosing and administration”. The introduction of the drug in any way not approved by the developer, is associated with the occurrence of serious adverse events including: arachnoiditis, meningitis, paraparesis / paraplegia, disorders of the sense organs, disorders of bowel and bladder function, seizures, visual impairment, including blindness, eye inflammation and its appendages, residual effects or rejection of necrotic tissue lesions at the injection site.
- Since the crystals corticosteroids suppress inflammation reactions, their presence can cause degradation of cellular and extracellular connective tissue cells that rarely appears as a deformation of the skin at the injection site. The degree of these changes depends on the amount of injected corticosteroids. After the complete absorption of the drug (usually after a few months), there is a complete regeneration of the skin at the injection site.
- To minimize the likelihood of skin or subcutaneous tissue atrophy, care should be taken not to exceed the recommended dose for parenteral administration. If possible, the affected area should be mentally divided into several sections, and each part of the total administered dose. During the intra-articular or intramuscular injection care should be taken not to introduce the drug into the skin, or to avoid contact with the drug in the skin, and not to accidentally introduce a drug into the deltoid muscle, as this can lead to atrophy of subcutaneous fat.
- If patients receiving corticosteroids therapy, may be exposed or already exposed to severe stress, should be given higher doses of fast-acting corticosteroids before, during and after the impact.
- GCS can erase the clinical picture of infectious disease, in their application can develop a new infection. Against the background of SCS therapy may reduce the body’s resistance to infection, and impaired the ability of the body to the localization of the infection process. The development of infections caused by various pathogens, such as viruses, bacteria, fungi, protozoa and helminths, which are located in the various systems of the human body, can be associated with the use of corticosteroids, both as monotherapy and in combination with other drugs – immunosuppressive acting on cell-mediated immunity, humoral immunity, or neutrophil function. These infections can occur not heavy, but in some cases it is possible for severe and even fatal. Moreover, the higher doses of corticosteroids are used, the higher the probability of infectious complications. In acute infections should not be administered intra-articularly drug in the joint capsule and tendon sheath muscles; in / m introduction is only possible after selecting a suitable antimicrobial / antiparasitic therapy.
- Prolonged use of corticosteroids may develop posterior subcapsular cataracts, glaucoma with possible lesions of the optic nerve; It increases the likelihood of secondary infections caused by fungi and viruses.
- In children receiving corticosteroids therapy for a long time every day, there may be a slowdown. This mode of administration should only be used under the most severe conditions.
- Patients receiving treatment with corticosteroids at the doses that have an immunosuppressive effect, is contraindicated the introduction of live or live-attenuated vaccines. However, patients receiving treatment with corticosteroids at the doses that have an immunosuppressive effect, may be administered to killed or inactivated vaccines; however, the response to the administration of such vaccines can be reduced. Patients receiving treatment with corticosteroids at doses that do not produce an immunosuppressive action, immunization can be carried out by the appropriate indications.
- The use of DEPO-Medrol drug ® with active tuberculosis is shown only in cases of focal or disseminated tuberculosis when corticosteroids are administered in combination with an appropriate anti-tuberculosis chemotherapy. If corticosteroids are appointed with latent TB patients, or between a bend tuberculin tests, the dose should be chosen carefully, because reactivation of the disease may occur.During long-term GCS therapy, these patients should receive TB chemoprophylaxis.
- Since patients receiving corticosteroids therapy, in rare cases of anaphylactic reaction, appropriate precautions should be taken prior to administration, especially if the patient had a history of allergic reactions to any drug. Allergic skin reaction observed was apparently due to inactive components. In rare cases, a skin test reaction revealed itself to methylprednisolone.
- The therapy of GCS may develop a variety of mental disorders from euphoria, insomnia, mood swings, personality disorders and severe depression to acute psychotic symptoms.
For parenteral administration GCS should be observed additional precautions:
- With intraarticular injection corticosteroids may occur as systemic and local side effects.
- It is necessary to carry out a study of aspirated joint fluid, to exclude a septic process.
- A significant increase in pain accompanied by local swelling, further restriction of joint movement, fever and pain are signs of septic arthritis. When developing such complications, and the diagnosis of sepsis confirmed, topical administration of corticosteroids should be discontinued and assign adequate antimicrobial therapy.
- You can not enter corticosteroids into the joint, which was once the infectious process.
- GKS can not enter into unstable joints.
- It should be compliance with the rules of aseptic and antiseptic to prevent infection and contamination.
- It should be noted that the absorption of methylprednisolone administered intramuscularly is slower.
- Although controlled clinical trials have shown that corticosteroids effectively accelerate the healing process of an exacerbation of multiple sclerosis, it is established that corticosteroids affect the outcome and the pathogenesis of this disease. Studies have also shown that in order to achieve a significant effect should be administered relatively high doses of corticosteroids.
- Since the severity of complications in the treatment of corticosteroids depends on the dose and duration of therapy in each case should be weighed against testosterone propionate the potential risk and the alleged positive effect on the choice of dose and duration of treatment, as well as the choice between daily administration and intermittent administration of the course.
- It is reported that in patients treated with corticosteroids, there was a Kaposi’s sarcoma. However, clinical remission may occur when you cancel GCS.
- There is no evidence that corticosteroids are carcinogenic or mutagenic effect or influence on reproduction.