A 24 y/o patient is brought to your ED with a non-penetrating spinal cord injury. The injury occurred only 45 minutes ago. The patient has no other significant medical history. He is on no medications, has no allergies, and his last labs (during a routine physical 3 months ago) were all within normal limits.

The ED physician wants methylprednisolone [Solu Medrol®] according to the protocol which calls for a 30 mg/kg intravenous (IV) bolus (over 15 minutes) followed by a continuous IV infusion of methylprednisolone 5.4 mg/kg for the next 24 hours. The pharmacy calls back telling the physician methylprednisolone is on manufacturer backorder with no estimated release date.

Are there any options for this patient? If so, what?
 

SELECT  here for discussion

Yes. The option, although not studied as rigorously as methyprednisolone for this indication, is dexamethasone. The recommended dosage is 20mg IV (loading dose) followed by 10 mg intravenously every 6 hours for 24 hours.

The methylprednisolone regimen is recommended if the drug is started within 3 hours of the injury. If administered between 3 and 8 hours post injury, continue the infusion for 48 hours vice 24 hours. Higher rates of sepsis and pneumonia were observed in the 48 hour group versus the 24 hour group.

The methylprednisolone regimens showed NO benefit in patients with penetrating spinal cord injuries.

This Pearl is meant for academic and educational purposes only. This Pearl is meant to raise important points regarding the safe and cost-effective pharmacotherapy of patients. It is not meant to be the definitive reference for the treatment or prophylaxis of various diseases. Although every effort is taken to ensure this Pearl is correct and factual, errors may occur. The US Air Force, the 59th Medical Wing (MDW), and 59th MDW Pharmacy assume no liability for incorrect information or harm that may occur from the use of the information included in this Pearl.