Medrol Dose Pak Therapy

The 21 pills are taken daily in a tapering regimen, starting with 6 on the first day.

Oral steroids can be used in cases of mild back pain, widespread inflammatory conditions or when insertion of a needle is contraindicated. The medicine, methylprednisolone is the same one that we commonly use for interlaminar epidural steroid injections, IL ESI’s, but in this case rather than being deposited directly at the site of spinal inflammation the medicine circulates throughout the body. Tissue levels in the back are lower leading to a decrease in efficacy and the blood levels in other parts of the body are higher leading to increased side effects.

The most common side effects with Medrol Dose Pak therapy are change mood, change in appetite or change in sleep pattern. Patients with diabetes will always see an elevation of their blood sugar levels, whereas non-diabetic patients generally do not. Mild weight gain is common, but also most often transient.

Therapy generally consists of 21 4mg tablets of methylprednisolone. Patients begin with 6 pills on day one, decreasing to 5 pills on day two, 4 pills on day three and so on. It is important to remember that with respect to the long-term complications of steroid therapy a Medrol Dose Pak counts as a steroid exposure the same as an ESI, so if one course of oral steroids is given then only two injections can be given in the same six month period and if two courses of oral steroids are given, only a single ESI will be available.

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