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European Spine Journal

, Volume 28, Issue 1, pp 21–30 | Cite as

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

  • Joël SchlatterEmail author
  • David Nguyen
  • Michèle Zamy
  • Sofiane Kabiche
  • Jean-Eudes Fontan
  • Salvatore Cisternino
Review Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Drug safety Intrathecal injection Methylprednisolone acetate Off-label 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.PharmacieHôpital Universitaire Necker - Enfants Malades, APHPParisFrance
  2. 2.Pharmacie, Hôpital Jean Verdier, APHPHôpitaux Universitaires de Paris-Seine-Saint-Denis (HUPSSD)BondyFrance
  3. 3.Pharmacovigilance, Hôpital Saint-Antoine, APHPHôpitaux Universitaires Est ParisienParisFrance
  4. 4.INSERM UMR-S 1144Université Paris Descartes, Faculté de pharmacieParisFrance

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