Leitura clínica
Comentário
É um corticosteroide usado para tratar a inflamação e as reações imunitárias em doenças muito diversas. Administração oral, intramuscular, intravenosa, tópica, oftalmológica, intra-articular e intralesional. É excretada no leite materno em quantidades não significativas (Zengin 2020, Boz 2018, Gunduz 2016, Cooper 2015, Strijbos 2015) e não foram observados problemas em lactentes de mães que a tomavam, inclusive por períodos prolongados de tempo. (Costanzo 2020, Zengin 2020, Grekas 1984) Após megadoses de metilprednisolona (1 g ao dia), a dose máxima que o lactente pode ingerir através do leite materno é menos da metade da dose terapêutica do lactente e com dose relativa menor que 3% (Zengin 2020, Boz 2018, Gunduz 2016, Cooper 2015, Strijbos 2015) . Se se desejar minimizar a exposição do lactente após a megadose ou em tratamentos crônicos com doses maiores que 40 mg/dia, pode-se esperar 2 a 4 horas após a administração do medicamento. (Zengin 2020, Boz 2018, Gunduz 2016, Cooper 2015, Strijbos 2015) Injeções intra-articulares de metilprednisolona podem diminuir transitoriamente a produção de leite. (Babwah 2013) Corticoides como a betametasona, administrados no pré-parto, podem provocar atraso na lactogênese II (descida do leite, apojadura) e diminuir a quantidade de leite na primeira semana. (Henderson 2008) Os corticoides são de uso habitual em Pediatria e carecem de efeitos secundários quando utilizados isoladamente ou em tratamentos curtos.
Encontrabilidade
Outros nomes e marcas
Sinônimos e grafias 6
- Metilprednisolona Acetato /Hidrogenosuccinato / Succinato sódico
- Μεθυλπρεδνιζολόνη
- Метилпреднизолон
- 甲泼尼龙
- メチルプレドニゾロン
- D07AA01; H02AB04
Marcas comerciais na fonte 37
- A-Methapred
- Advantan
- Adventan
- Asmacortone
- Avancort
- Cryosolona
- DepMedalone
- Depo Moderin
- Depo-Medrate
- Depo-Medrol
- Depo-Medrone
- Depo-Nisolone
- Depoject
- Duralone
- Esametone
- Firmacort
- Lexxema
- M-Prednisol
- Medralone
- Medrate
- Medrol
- Medrone
- Metilbetasone Solubile
- Metilpren
- Metisona
- Metypred
- Metypresol
- Metysolon
- Predni M
- Prednilem
- Radilem
- Solomet
- Solsolona
- Solu-Medrol
- Solu-Medrone
- Solu-Moderin
- Urbason
Dados da fonte
Farmacocinética
| Variável | Valor | Unidade |
|---|---|---|
| Biodisp. oral | 80 (rectal: 14) | % |
| Peso Molecular | 375 | daltons |
| Unión proteínas | 77 | % |
| Vd | 1,2 - 1,5 | l/Kg |
| pKa | 12,59 | - |
| Tmax | 2 | horas |
| T½ | 3,5 | horas |
| Dosis Teórica | 0,07 - 0,2 | mg/Kg/d |
| Dosis Relativa | 0,5 - 1,45 | % |
Rastreabilidade
Bibliografia
- Zengin Karahan S, Boz C, Terzi M, Aktoz G, Sen S, Ozbudun B, Caglar A, Şener M. Methylprednisolone Concentrations in Breast Milk and Serum of Patients with Multiple Sclerosis Treated with IV Pulse Methylprednisolone. Clin Neurol Neurosurg. 2020 Oct;197:106118. Resumen
- Costanzo G, Firinu D, Losa F, Deidda M, Barca MP, Del Giacco S. Baricitinib exposure during pregnancy in rheumatoid arthritis. Ther Adv Musculoskelet Dis. 2020 Feb 3;12:1759720X19899296. Resumen Texto completo (enlace a fuente original)
- Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, Brex PA. UK consensus on pregnancy in multiple sclerosis: 'Association of British Neurologists' guidelines. Pract Neurol. 2019 Apr;19(2):106-114. Resumen Texto completo (enlace a fuente original)
- Boz C, Terzi M, Zengin Karahan S, Sen S, Sarac Y, Emrah Mavis M. Safety of IV pulse methylprednisolone therapy during breastfeeding in patients with multiple sclerosis. Mult Scler. 2018 Aug;24(9):1205-1211. Resumen
- Almas S, Vance J, Baker T, Hale T. Management of Multiple Sclerosis in the Breastfeeding Mother. Mult Scler Int. 2016;2016:6527458. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Gunduz S, Gencler OS, Celik HT. Four hours is enough for lactation interruption after high-dose methylprednisolone treatment in multiple sclerosis mothers by measuring milk cortisol levels. J Matern Fetal Neonatal Med. 2016 Resumen
- Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016 Sep;55(9):1693-7. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Cooper SD, Felkins K, Baker TE, Hale TW. Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. J Hum Lact. 2015 Resumen
- Strijbos E, Coenradie S, Touw DJ, Aerden L. High-dose methylprednisolone for multiple sclerosis during lactation: Concentrations in breast milk. Mult Scler. 2015 Resumen
- Bodiguel E, Bensa C, Brassat D, Laplaud D, Le Page E, Ouallet JC, Zephir H, De Seze J; Groupe de Réflexion sur la Sclérose en Plaques. Multiple sclerosis and pregnancy. Rev Neurol (Paris). 2014 Resumen
- Babwah TJ, Nunes P, Maharaj RG. An unexpected temporary suppression of lactation after a local corticosteroid injection for tenosynovitis. Eur J Gen Pract. 2013 Dec;19(4):248-50. Resumen
- Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012 Resumen
- Jain V, Gordon C. Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther. 2011 Resumen Texto completo (enlace a fuente original)
- van der Woude CJ, Kolacek S, Dotan I, Oresland T, Vermeire S, Munkholm P, Mahadevan U, Mackillop L, Dignass A; European Crohn's Colitis Organisation (ECCO). European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis. 2010 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Mottet C, Vader JP, Felley C, Froehlich F, Gonvers JJ, Juillerat P, Stockbrügger R, Angelucci E, Seibold F, Michetti P, Pittet V; EPACT II Study Group. Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel-EPACT II. J Crohns Colitis. 2009 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009 Resumen
- Henderson JJ, Hartmann PE, Newnham JP, Simmer K. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics. 2008 Resumen
- Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 Resumen
- Mottet C, Juillerat P, Pittet V, Gonvers JJ, Froehlich F, Vader JP, Michetti P, Felley C. Pregnancy and breastfeeding in patients with Crohn's disease. Digestion. 2007 Resumen
- Heetun ZS, Byrnes C, Neary P, O'Morain C. Review article: Reproduction in the patient with inflammatory bowel disease. Aliment Pharmacol Ther. 2007 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. None 2004 Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Nyberg G, Haljamäe U, Frisenette-Fich C, Wennergren M, Kjellmer I. Breast-feeding during treatment with cyclosporine. Transplantation. 1998 Resumen
- Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985 Resumen
- Grekas DM, Vasiliou SS, Lazarides AN. Immunosuppressive therapy and breast-feeding after renal transplantation. Nephron. 1984 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)