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Methylprednisolone pulses and urine electrolyte excretion
D G Waller1, D F Barrett, A Polak
1Department of Medicine, University of Southampton, St. Mary's Hospital, Portsmouth, Great Britain.
Archives Internationales De Pharmacodynamie Et De Therapie
|March 1, 1988
Summary
Alternate day methylprednisolone pulsing does not prevent sodium retention, even in patients not taking other steroids. This indicates a continued risk of mineralocorticoid side effects with this dosing regimen.
Area of Science:
- Endocrinology
- Pharmacology
- Nephrology
Background:
- High-dose glucocorticoids, like methylprednisolone, can exhibit mineralocorticoid activity.
- Alternate-day corticosteroid therapy is sometimes used to reduce side effects.
Purpose of the Study:
- To assess the mineralocorticoid activity of alternate-day methylprednisolone pulses.
- To evaluate the risk of sodium retention with this pulsed steroid regimen.
Main Methods:
- Urine electrolyte excretion was measured before and during alternate-day methylprednisolone pulsing.
- Two patient groups were studied: one receiving only pulses, the other receiving pulses plus oral prednisolone.
- 24-hour and 4-hour urine collections were analyzed for sodium excretion.
Main Results:
- Urine sodium excretion was suppressed during pulsing in both groups.
- A gradual "escape" from sodium retention occurred with continued pulsing.
- Sodium excretion recovery between pulses was insufficient to counteract preceding retention.
- Suppression of sodium excretion lasted up to 32 hours post-pulse.
Conclusions:
- Alternate-day methylprednisolone pulsing does not mitigate the risk of sodium retention.
- The mineralocorticoid effects of methylprednisolone persist despite alternate-day administration.
- This pulsed regimen may not reduce the risk of adverse events associated with sodium retention.