Celecoxib
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Drug reference
Methylprednisolone
Systemic glucocorticoid (intermediate-acting) · Corticosteroid
Also known as Methylprednisolone acetate, Methylprednisolone succinate, Medrol, Solu-Medrol
START
Oral 4–48 mg/day or IV per severity; pulse 0.5–1 g if severe
TYPICAL MAX
~1 g/day IV pulse (short course)
STOP IF
Taper — do not stop abruptly after prolonged use (adrenal crisis)
WATCH
Glucose, BP, infection signs, bone health; taper plan
CDSCO approvedJan AushadhiNPPA price-controlledATC H02AB04
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 2h · Tmax
- t½
- 2.5h · plasma t½
- DURATION
- 1.3d · biological
EXCRETION
Hepatic metabolism; renal metabolites
route + CYP
INTERACTIONS
11 major
incl. contraindicated
PREGNANCY
Use lowest effective dose if needed; benefits often outweigh risk.
FDA category + note
Top interactionssee all 11 →
- CelecoxibContraindicatedTextbook-citedKDT 7e · p950
- IndomethacinContraindicatedTextbook-citedKDT 7e · p950
- KetorolacContraindicatedTextbook-citedKDT 7e · p950
- Mefenamic AcidContraindicatedTextbook-citedKDT 7e · p950
Mechanism
Glucocorticoid-receptor agonist that modulates gene transcription to produce broad anti-inflammatory and immunosuppressive effects (reduced cytokines, leukocyte trafficking, prostaglandin synthesis).
Indications
Acute inflammatory/allergic conditionsAutoimmune disease flaresAsthma/COPD exacerbationsTransplant rejection (pulse)CNS oedema / spinal cord injury (selected)Anti-emetic adjunct
Dosing
- Adult
- Oral 4–48 mg/day per condition. IV methylprednisolone sodium succinate 10–250 mg; pulse 0.5–1 g/day for 1–3 days (severe). Taper after prolonged courses.
- Pediatric
- 0.5–1.7 mg/kg/day in divided doses (condition-specific).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- No fixed adjustment; effect may be altered in severe disease.
- Geriatric
- Lowest effective dose; osteoporosis/skin/infection risk.
- Max dose
- Up to 1 g/day IV pulse (short course); oral per indication
Pharmacokinetics
Onset
Anti-inflammatory effect over hours
Peak effect
~1–2 h (oral Tmax); IV rapid
Duration
Biological 18–36 h (intermediate-acting)
Half-life
Plasma ~2–3 h (biological much longer)
Bioavailability
High (oral)
Protein binding
Moderate (transcortin/albumin)
Metabolism
Hepatic
Excretion
Renal (metabolites)
Contraindications
- Systemic fungal infection
- Live vaccine administration during immunosuppressive doses
- Hypersensitivity
- Caution: uncontrolled infection, diabetes, peptic ulcer, psychosis
Side effects
Common
HyperglycaemiaIncreased appetite/weight gainMood change/insomniaFluid retentionDyspepsia
Serious
- Adrenal suppression (abrupt withdrawal crisis)
- Immunosuppression/serious infection
- Osteoporosis/avascular necrosis
- GI bleeding/perforation
- Hyperglycaemic crisis
- Psychosis
Pregnancy & lactation
Pregnancy
Use lowest effective dose if needed; benefits often outweigh risk.
Lactation
Compatible at usual doses (delay feeding ~4 h after high IV dose).
Drug interactions
Indomethacin
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Ketorolac
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Mefenamic Acid
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Naproxen
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Piroxicam
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Aspirin
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Diclofenac
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Ibuprofen
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Azoles
Severe
Textbook
Increased plasma levels of methylprednisolone.
Source: Harrison 22e · p1742
Adalimumab
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
1 additional unreviewed or low-confidence interaction hidden because their provenance or source detail is insufficient.
Related guidelines
Ask House about Methylprednisolone
Continue into a citation-backed clinical answer with the drug context already attached.
Textbook-sourced·Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Updated: 2026-05-20·Cockpit curated: 2026-05-20