Methylprednisolone (Medrol) alternatives: What can I take instead of methylprednisolone?

Compare methylprednisolone alternatives | Prednisone | Naprosyn | Trexall | Humira | Xeljanz XR | Natural alternatives | How to switch meds

Methylprednisolone and its fellow corticosteroids have a ton of therapeutic uses. As effective anti-inflammatories, methylprednisolone, and its drug classmates can be used for various autoimmune, allergic, and other inflammatory conditions. It can also replace deficient glucocorticoid levels in adrenal insufficiency. You may be more familiar with its brand name, oral tablet version, Medrol, or its intravenous version, Solu-Medrol. Whatever your use of it may be, methylprednisolone has a laundry list of adverse effects to give you pause when taking it. It is perfectly reasonable to ask your medical provider what alternatives exist for the drug. We will cover the options here to best prepare you for a conversion with your healthcare provider.

What can I take in place of methylprednisolone?

To start with, you should know that there are other corticosteroids. Corticosteroids, also known as glucocorticoids, differ from the anabolic steroids used and abused to pursue bigger muscles. Glucocorticoid names include prednisone, prednisolone, triamcinolone, and dexamethasone. These medications all tell immune system cells to produce more anti-inflammatory mediators and less inflammatory products. While they all substantially reduce inflammation, they also have similar side effects. 

Nonsteroidal anti-inflammatories (NSAIDs), such as meloxicam and Motrin, can be considered alternatives for some but not all uses of methylprednisolone. Through a different mechanism, they can reduce inflammation effectively, particularly for musculoskeletal conditions.

The Food and Drug Administration (FDA) has an extensive list of indications for methylprednisolone, including well-known conditions like rheumatoid arthritis, gout, lupus, multiple sclerosis (MS), psoriasis, contact dermatitis, allergic reactions, and inflammatory bowel disease. These are referred to as glucocorticoid-responsive conditions. Within specific disease treatment roles for methylprednisolone, there are medications that can serve as appropriate alternatives for some diseases but not others. For instance, biologic agents, such as Enbrel and Humira, may have FDA indications for only a few of the uses of methylprednisolone. It is best to dig into the details of the options to see which ones might apply to you.

Other alternatives to methylprednisolone

• Depo-Medrol (methylprednisolone)
• Prednisolone
• Kenalog (triamcinolone)
• Dexamethasone
• Plaquenil (hydroxychloroquine)
• Taltz (ixekizumab)
• Remicade (infliximab)
• Renflexis (infliximab)
• Inflectra (infliximab)
• Avsola (infliximab)
• Actemra (tocilizumab)
• Kevzara (sarilumab)
• Siliq (brodalumab)
• Kineret (anakinra)
• Ilumya (tildrakizumab)
• Entyvio (vedolizumab)
• Tysabri (natalizumab)
• Olumiant (baricitinib)
• Xeljanz (tofacitinib)
• Rinvoq (upadacitinib)
• Imuran (azathioprine)
• Mercaptopurine

Top 5 methylprednisolone alternatives

The following are some of the most common alternatives to methylprednisolone.

1. Prednisone

Prednisone shares many of the same beneficial and adverse effects as methylprednisolone. The list of indications is nearly identical, and their potency is fairly close, with 4 mg of methylprednisolone being equivalent to 5 mg of prednisone. They can be used acutely or chronically for autoimmune conditions, such as rheumatoid arthritis, Crohn’s disease, and inflammatory diseases like asthma and gout. 

Their side effects in the short-term, particularly with high doses, include mood changes, insomnia, hyperglycemia (elevated blood sugar levels), gastritis, and increased risk of infections from immunosuppression. If taken long-term, methylprednisolone and prednisone can cause adverse effects like cataracts, myopathy (muscle weakness), hypertension (high blood pressure), osteoporosis (fragile bones), weight gain, Cushing’s syndrome, adrenal insufficiency (inadequate cortisol production by the adrenal gland).

Prednisone comes as 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, or 50 mg tablets, allowing a flexible range of dosing options. This may be one of the reasons why it is probably the most commonly used glucocorticoid. Before you jump at changing to prednisone, you should know that methylprednisolone has some advantages over it. Methylprednisolone is available in oral (Medrol tablets), intravenous (Solu-Medrol), and intramuscular injection (Depo-Medrol) formulations, whereas prednisone is only available as a tablet. Methylprednisolone is also available in the convenient prepackaged tapered dose Medrol DosePak. Besides that convenience, methylprednisolone may have less likelihood to cause fluid retention and elevations in blood pressure, since it has less mineralocorticoid effects compared to prednisone.

2. Naprosyn

The hazards of glucocorticoids steer many individuals toward non-steroid options, and this is where NSAIDs can step in. Naprosyn and other NSAIDs, like Celebrex and Motrin, avoid some methylprednisolone side effects, like hyperglycemia and osteoporosis. No wonder much of the class is available over-the-counter. For this reason, they are preferable for many inflammatory conditions such as arthritis. They are not an option for many autoimmune diseases, and unfortunately, NSAIDs have their own drawbacks. They are linked to stomach ulcers, kidney damage, and fluid retention.

3. Trexall

Trexall may actually be better known by its generic name, methotrexate. The pill form is used for inflammatory arthritis conditions, often as a steroid-sparing strategy to limit the amount of methylprednisolone needed. Injectable formulations of methotrexate are utilized as chemotherapy against various cancers. While it has many uses, Trexall also has its share of adverse effects. Immunosuppression, liver failure, kidney failure, and reduced blood cell counts are all reasons for concerns and require monitoring.

4. Humira

Biologic agents have revolutionized medicine; some of their first uses were for autoimmune conditions. Remicade was one of the earliest biologic drugs. In an intravenous infusion, the drug blocks the inflammatory mediator called tumor necrosis factor (TNF). Humira is another TNF inhibitor, but it can be given by subcutaneous injection at home rather than requiring an intravenous infusion at an office or hospital like Remicade. 

The biologics have great potency as disease-modifying antirheumatic drugs (DMARDs). These meds truly limit the damaging effects of diseases like rheumatoid arthritis as well as spare patients the long-term consequences of methylprednisolone and its fellow steroids. The strength of Humira and other TNF inhibitors can be their downfall, though. Immune suppression from biologics can be considerable and requires careful testing before initiation and diligent monitoring during therapy.

5. Xeljanz XR

If you are looking for an alternative to methylprednisolone and are averse to an injectable biologic, oral Xeljanz XR might work. It uses Janus kinase inhibition to suppress inflammation. Xeljanz XR may not be the first line, but it could be a viable option for battling inflammatory bowel disease or arthritis.

Natural alternatives to methylprednisolone

Steroids are a double-edged sword. They do a marvelous job of reducing inflammation and relieving the ravaging effects of various diseases, from lupus to Crohn’s to multiple sclerosis. Their side effects, however, cut deeply. The mental, fluid retention, and glucose effects in the short-term and long-term detriment to weight, bones, and adrenal function are enough to send anyone looking for any other way.

Natural alternatives are a commonly considered option. They are typically thought of as safe, whether that is true or not. Unfortunately, they often have not been studied or proven effective. Fish oil, antioxidants, and Ashwagandha are prime examples of over-the-counter supplements that people try for inflammation but have not demonstrated efficacy. When you consider the damage that an autoimmune inflammatory illness can do, you may not want to trust these options.

How to switch to a methylprednisolone alternative

If you are considering a prescription or over-the-counter alternative to methylprednisolone, you now know that there are no perfect options. Each drug has some advantages and disadvantages when compared to Medrol. Before you change anything, you should call your healthcare provider for medical advice. Have a conversation about why you are concerned about methylprednisolone and what alternatives interest you. By reviewing your health history and other medications, and looking for drug interactions, you two can develop a plan of action that makes the most sense, with or without Medrol.