Methylprednisolone Aceponate

Registered South African indications:

• Eczema

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Pregnancy
• Tuberculous process in area to be treated
• Syphilitic process in area to be treated
• Viral diseases (herpes simplex, vaccinia, chickenpox, shingles)
• Presence of rosacea, perioral dermatitis, ulcers, acne vulgaris, atrophic skin diseases and postvaccination skin reactions in the area to be treated (scl, mlk)
• Skin diseases associated with bacterial or fungal infections (scl, mlk)

Cautions

• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Long-term continuous treatment
• Bacterial or fungal skin infections
• Facial dermatosis
• Infants and young children
• Psoriasis
• Skin crease areas
• Nappy area or use for flexural eruptions in infants and young children

Forms avail. in SA and covered in this monograph: cre, oin, mlk, scl

Atopic dermatitis
Neurodermatitis

• Topical (cre, oin, mlk): Apply small quantity to affected area, dly

Allergic contact dermatitis
Toxic degenerative eczema
Nummular eczema
Dyshydrotic eczema
Seborrhoeic eczema

• Topical (mlk): Apply small quantity to affected area, dly; Max duration: 2 weeks

Scalp inflammatory
Pruritic dermatoses

• Topical (scl): Apply small quantity to affected area, dly; Max duration: 4 weeks

See link: General prescribing points for steroids

Maximum duration of use (cream/ ointment/ fatty ointment): 12 weeks

Maximum duration of use (milk): 2 weeks

Paed. forms avail. in SA and covered in this monograph: cre, oin, mlk

Ideally should not be used in infants and young children

Atopic dermatitis
Neurodermatitis

• Topical (cre, oin, mlk): Apply small quantity to affected area, dly

Maximum duration of use: cream/ ointment/ fatty ointment 4 weeks

Maximum duration of use: milk 2 weeks

Allergic contact dermatitis
Toxic degenerative eczema
Nummular eczema
Dyshydrotic eczema
Seborrhoeic eczema

• Topical (mlk): Apply small quantity to affected area, dly; Max duration: 2 weeks

See link: General prescribing points for steroids

Pregnancy

• Contraindicated

Breastfeeding

• Caution
• The amount of methylprednisolone aceponate available systemically following topical application is unknown. Corticosteroids are excreted in small amounts in breast milk, however, systemic doses of up to 40 mg daily of methylprednisolone are unlikely to cause systemic effects in the infant, therefore, the risk from topical methylprednisolone is expected to be low. Infants of mothers taking higher doses than this may have a degree of adrenal suppression, but the benefits of breastfeeding are likely to outweigh any theoretical risk
• Corticosteroids distributed into breast milk may interfere with endogenous glucocorticoid production in nursing infants. Methylprednisolone should be used during breastfeeding only after a careful assessment of the benefit-risk ratio to the mother and infant. Topical methylprednisolone should not be applied to the breasts

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Caution; no information available

Elderly

• Caution; no information available

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Benign increased intracranial pressure

Endocrine and Metabolic Disorders

• Suppression of the hypothalamic-pituitary-adrenal axis
• Cushingoid state

Musculoskeletal Disorders

• Growth retardation

Skin and Subcutaneous Tissue Disorders

• Local skin irritation
• Erythema
• Pruritis
• Scaling
• Folliculitis
• Dry skin
• Atrophic changes
• Telangiectasia
• Ecchymosis
• Rosacea-like facies (facial use)
• Acneiform skin eruptions

No information available

None routine

Methylprednisolone acts at multiple levels in multiple systems in the body. The topical preparations act in the skin to cause an anti-inflammatory and immunosuppressive effect. The best understood mechanism is the pathway that leads to its anti-inflammatory effects. In this pathway, methylprednisolone binds to intracellular glucocorticoid receptors that result in changes to gene expression. This causes an increased production of macrocortin which in turn inhibits the release of arachidonic acid thus preventing the production of the pro-inflammatory prostaglandins and leukotrienes.

Cream (per g) 1mg

• Advantan cream (Adcock Ingram) originator

Ointment (per g) 1mg 

• Advantan Ointment (Adcock Ingram) originator

Fatty Ointment (per g) 1mg

• Advantan fatty ointment (Adcock Ingram) originator

Milk (per g) 1mg

• Advantan milk (Adcock Ingram) originator

Scalp Solution (per g) 1mg

• Advantan scalp sol (Adcock Ingram) originator