Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use.

Abstract

Complications of the intrathecal route may cause potential toxicity related to the medicaldevice and properties of theadministered drugand/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 theintrathecal route with excipients,label and off-label drugs is discussed. A bibliographicsearch inMedline, 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 suchas 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 excipientsshould be emphasized such as soluble methylprednisolone sodium succinate.