As stated previously, the primary use of<unk>  is to suppress inflammatory and immune responses.<unk>  achieves this primarily by regulating the number and function of leukocytes, cytokines and chemokines. Its widespread inflammatory control is conducive in use across multiple disorders regardless of pathology.<unk>  is commonly prescribed as short-term therapy for acute flares, as seen with acute gouty arthritis. It can be prescribed during on-going therapy in lower doses contingent upon monitorization of adverse effects. Dosage strength and formulation are optimized per medical use. Asthma In 2001–2002, 11.4% of patients diagnosed with asthma and seen at an outpatient visit were prescribed oral corticosteroids as a long-term control therapy. The National Asthma Education and Prevention Program (NAEPP) indicates systemic<unk>  in both short and long term therapies to quickly control and to suppress persistent asthma, respectively. For exacerbations that result in a visit to the Emergency Department (ED), oral<unk>  is preferred over intravenous administration, unless there are issues with adherence or vomiting. Oral<unk>  is less invasive and studies have shown that equivalent efficacy compared to intravenous<unk> . Dosage above 60–80 mg/day or 2 mg/kg/day is not recommended as it has not been shown to alter pulmonary function, rate of admission, or length of stay in the hospital compared to lower doses. Following ED discharge, it is advised to prescribed a five-day course of<unk>  to decrease the probability of relapse or withdrawal symptoms. Rheumatic diseases<unk>  is used to treat several rheumatic diseases, such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA).<unk>  dosage and administration for these diseases is highly variable due to varied pathophysiology between the diseases and within patients diagnosed with a given disease. In Lupus Nephritis, a common manifestation of SLE, patients are often prescribed<unk>  concomitantly with immunosuppressants. Severe manifestations are often treated with Cyclophosphamide or Rituximab and three doses of<unk>  IV-pulse treatment (as recommended by ACR guidelines) prior to switching to oral prednisolone and azathioprine for maintenance. Intra-articular corticosteroid injections (IACI) are a second line therapy to relieve joint pain resulting from rheumatoid arthritis. It is most commonly injected into the joints of the knees and shoulders. Although the injection is local, studies have shown systemic absorption as evidenced by beneficial effects on distant joints. In an attempt to minimize HPA suppression, FDA guidelines have restricted IACIs to three per year, with a minimum of 30 days in between injections. Primary or secondary adrenocortical insufficiency<unk>  is not typically recommended for primary or secondary adrenocortical insufficiency compared to other corticosteroids which have a higher affinity for mineralocorticoid receptor and salt retaining properties. Labeled indications The labeled indications below are categorized by route of administration then by medical discipline. Oral<unk>  * Allergy and Immunology: angioneurotic edema, asthma, urticaria, seasonal or perennial allergic rhinitis, drug hypersensitivity reactions, and serum sickness. * Dermatology: toxic epidermal necrolysis, atopic dermatitis, contact dermatitis, pemphigus, erythema multiforme, Steven-Johnson syndrome, bullous dermatitis herpetiformis, severe seborrheic dermatitis, exfoliative dermatitis, mycosis fungoides, and severe psoriasis. * Endocrinology: congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis, and primary or secondary adrenocortical insufficiency. * Gastroenterology: inflammatory bowel disease and ulcerative colitis. * Hematology: acquired (autoimmune) hemolytic anemia, idiopathic thrombocytopenic purpura, secondary thrombocytopenia, erythroblastopenia, leukemia, lymphoma and congenital (erythroid) hypoplastic anemia. * Pulmonary: aspiration pneumonitis, chronic beryllium disease, eosinophilic pneumonia, symptomatic sarcoidosis, and pulmonary tuberculosis in conjunction with antituberculosis chemotherapy. * Nephrology: nephrotic syndrome, idiopathic type or secondary to lupus nephritis. * Neurology: multiple sclerosis. * Ophthalmology: scleritis, retinal vasculitis, uveitis, choroiditis, iritis, iridocyclitis, keratitis, optic neuritis, allergic conjunctivitis, allergic corneal marginal ulcers, herpes zoster ophthalmicus, sympathetic ophthalmia, and chorioretinitis. * Rheumatology: rheumatoid arthritis, rheumatic carditis, acute gouty arthritis, ankylosing spondylitis, dermatomyositis and polymyositis, psoriatic arthritis, systemic lupus erythematosus, acute and subacute bursitis, synovitis of osteoarthritis, post-traumatic osteoarthritis, and epicondylitis. * Miscellaneous: trichinosis with neurologic or myocardial involvement. Parenteral<unk>  * Intra-articular or soft tissue injections: acute gouty arthritis, acute and subacute bursitis, acute tenosynovitis, epicondylitis, and synovitis of osteoarthritis. * Intralesional injections: alopecia areata, discoid lupus erythematosus, keloids, granuloma annulare, lichen planus, lichen simplex chronicus, psoriatic plaques, necrobiosis lipoidica diabeticorum. * Intramuscular injections are prescribed treat many of the same conditions indicated for oral administration. Intramuscular injections are administered as an alternative to oral therapy. Off-label indications Some of the off-label indications of<unk>  include acute spinal cord injury, acute respiratory distress syndrome, alcoholic hepatitis, hormonal resuscitation in cadaveric organ recovery, and chronic obstructive pulmonary disease. Available forms +Available Forms of<unk>  Active Ingredient Brand Name ROA Form Strength1 Inactive Ingredients<unk>  Medrol Oral tablet 2, 4, 8, 16, 32 mg calcium stearate, cornstarch, lactose, mineral oil, sorbic acid, sucrose and erythrosine sodium (2 mg only), FD&C yellow No. 6 (8 and 32 mg only)<unk>  Medrol Oral tablet 4 mg; 21 pills (dose-pack) calcium stearate, cornstarch, lactose, sucrose<unk>  acetate Depo-Medrol Parenteral: intra-articular or soft tissue, intralesional or intramuscular suspension 20, 40, 80 mg/ml Polyethylene glycol 3350, Polysorbate 80, Monobasic sodium phosphate, Dibasic sodium phosphate USP, Benzyl alcohol2 added as a preservative<unk>  acetate3 Depo-Medrol Parenteral: intra-articular or soft tissue, intralesional or intramuscular suspension 40 or 80 mg/ml (single dose vial) Polyethylene glycol 3350 Myristyl-gamma-picolinium chloride<unk>  succinate Solu-Medrol Parenteral: intravenous or intramuscular solution, reconstituted 500, 1000, 2000 mg/vial, 2000 mg with diluent (multi-dose vial) monobasic sodium phosphate anhydrous, dibasic sodium phosphate dried, and lactose hydrous. Bacteriostatic water added as diluent with Benzyl alcohol2 added as a preservative<unk>  succinate3 Solu-Medrol Parenteral: intravenous or intramuscular solution, reconstituted 40, 125, 500, 1000 mg/vial (single dose vial) monobasic sodium phosphate anhydrous, dibasic sodium phosphate dried, and lactose hydrous. Footnotes: 1Signifies varying strengths of available forms. Is not indicative of frequency nor daily cumulative dose; varies per patient and condition. 2Benzyl alcohol should not to be used on neonates 3Preservative free formulation
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