Indications : התוויות

4.1        Therapeutic indications
For the treatment of conditions responsive to steroid injection therapy.

A.       For intramuscular administration

Methylprednisolone acetate (Depo-Medrol) is not suitable for the treatment of acute life threatening conditions. If a rapid hormonal effect of maximum intensity is required, the l.V administration of highly soluble methylprednisolone sodium succinate (Solu-Medrol) is indicated.
When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend this preparation to the treatment of the condition, the intramuscular use of Depo-Medrol is indicated as follows:

Anti-inflammatory treatment

1.    Rheumatic disorders
As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in:
Psoriatic arthritis
Ankylosing spondylitis.

For the following indications, preference should be given to in situ administration if possible:
Post-traumatic osteoarthritis
Synovitis of osteoarthritis
Rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low- dose maintenance therapy)
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        Acute and subacute bursitis
Epicondylitis
Acute nonspecific tenosynovitis
Acute gouty arthritis

2. Collagen diseases
During an exacerbation or as maintenance therapy in selected cases of: Systemic lupus erythematosus
Systemic dermatomyositis (polymyositis)
Acute rheumatic carditis

3. Dermatological diseases
Pemphigus
Bullous dermatitis herpetiformis (sulfone is the drug of first choice and systemic administration of glucocorticoids is an adjuvant)
Severe erythema multiforme (Stevens-Johnson syndrome)
Exfoliative dermatitis
Mycosis fungoides
Severe psoriasis

4. Allergic states
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in:
Bronchial asthma
Contact dermatitis
Atopic dermatitis
Serum sickness
Drug hypersensitivity reactions
Urticarial transfusion reactions
Acute noninfectious laryngeal edema (epinephrine is the drug of first choice).

5.   Gastro-intestinal diseases
To tide the patient over a critical period of the disease in:
Ulcerative colitis (systemic therapy)
Crohn disease (systemic therapy)

6. Respiratory diseases
Symptomatic pulmonary sarcoidosis
Berylliosis
Fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy
Loeffler's syndrome not manageable by other means
Aspiration pneumonitis

7. Hematologic disorders
Acquired (autoimmune) hemolytic anemia
Secondary thrombocytopenia in adults
Erythroblastopenia (RBC anemia)
Congenital (erythroid) hypoplastic anemia

8. Oncological diseases
For palliative management of:
Leukemias and lymphomas
Acute leukemia of childhood
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   9. Endocrine disorders
Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice. Synthetic analogues may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance) Acute adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice, mineralocorticoid supplementation may be necessary, particularly when synthetic analogs are used).In infancy mineralocorticoid supplementation is of particular importance.
Congenital adrenal hyperplasia
Hypercalcemia associated with cancer
Nonsuppurative thyroiditis

10. Opthalmic diseases dermatological diseases
Severe acute and chronic allergic and inflammatory processes involving the eye, such as: Herpes zoster ophthalmicus
Drug hypersensitivity reactions
Iritis, iridocyclitis
Anterior segment inflammation
Chorioretinitis
Allergic conjunctivitis
Diffuse posterior uveitis
Allergic corneal marginal ulcers
Optic neuritis
Keratitis

11. Edematous states
To induce diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.


12. Miscellaneous
Tuberculous meningitis with subarachnoid block or impending block when used\ concurrently with appropriate antituberculous chemotherapy.
Trichinosis with neurologic or myocardial involvement

B.      FOR INTRASYNOVIAL, PERIARTLCULAR, INTRABURSAL OR SOFT
TISSUE ADMINISTRATION (see Special warnings and precautions for use)

Depo-Medrol is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in:

Synovitis of osteoarthritis
Rheumatoid arthritis
Acute and subacute bursitis
Acute gouty arthritis
Epicondylitis
Acute nonspecific tenosynovitis
Post-traumatic osteoarthritis.

C.      FOR INTRALESIONAL ADMINISTRATION
Depo-Medrol is indicated for intralesional use in the following conditions: Keloids, Localized hypertropic, infiltrated, inflammatory lesions of: Lichen planus, psoriatic plaques
Necrobiosis lipodica diabeticorum
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      Granuloma annulare
Lichen Simplex chronicus (neurodermatitis)
Discoid lupus erythematosus
Alopecia areata

Depo-Medrol may also be useful in cystic tumors or an aponeurosis or tendon (ganglia).

D.      FOR INTRARECTAL INSTALLATION

Ulcerative colitis