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
12 major
incl. contraindicated
PREGNANCY
Use lowest effective dose if needed; benefits often outweigh risk.
FDA category + note
Top interactionssee all 12 →
- 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
Live Attenuated Vaccines
Contraindicated
Database
Reduced immune response to the vaccine, leading to vaccine failure, and potential for disseminated infection with the vaccine strain.
Avoid administration of live attenuated vaccines during and for a period after high-dose or prolonged corticosteroid therapy. Consult immunization guidelines.
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
Related guidelines
Ask House about Methylprednisolone
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20