Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use.
Drug safety
Intrathecal injection
Methylprednisolone acetate
Off-label
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
13
04
2017
accepted:
05
11
2017
revised:
24
07
2017
pubmed:
21
11
2017
medline:
20
6
2020
entrez:
20
11
2017
Statut:
ppublish
Résumé
Complications of the intrathecal route may cause potential toxicity related to the medical device and properties of the administered drug and/or excipient. A description of clinical and histological effects of polyethylene glycol and miripirium after Depo-Medrol injection, and the adverse reactions of particulate methylprednisolone acetate was conducted. The safety of the intrathecal route with excipients, label and off-label drugs is discussed. A bibliographic search in Medline, Google, and Cochrane database from 1940 to June 2016 was performed. The keywords included 'intrathecal methylprednisolone acetate', 'miripirium', 'myristyl-gamma-picolinium', 'side effects', 'intrathecal Depo-Medrol', 'polyethylene glycol', and 'intrathecal devices' used individually or in combination. Adverse reactions have been reported with this intrathecal administration route such as arachnoiditis, bladder dysfunction, headache, meningitis. Some pharmaceutical excipients have been associated with specific toxicity issues and with allergic and anaphylaxis reactions. Additives of methylprednisolone acetate formulations such as polyethylene glycol and miripirium chloride can be neurotoxic when injected intrathecally. Polyethylene glycol-an antimicrobial agent widely used in pharmaceutical drugs-has been associated with cardiovascular, hepatic, respiratory, and CNS toxicity. Intrathecal methylprednisolone acetate (Depo-Medrol) therapy seems not fully safe due to reported adverse events. The use of other forms of corticosteroid therapy free from excipients should be emphasized such as soluble methylprednisolone sodium succinate.
Identifiants
pubmed: 29151132
doi: 10.1007/s00586-017-5387-x
pii: 10.1007/s00586-017-5387-x
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Methylprednisolone Acetate
43502P7F0P
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
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