Key takeaways:
Methylprednisolone (Medrol, Solu-Medrol) is a corticosteroid medication that treats many inflammatory health conditions. It’s available as a tablet and injection.
Methylprednisolone can interact with several medications. Oral blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), and Paxlovid (nirmatrelvir / ritonavir) are a few examples. It can also interact with live vaccines.
Keep an updated medication list handy for your pharmacist and prescriber. They can check if methylprednisolone interacts with any of your medications or supplements.
Save on related medications
If you or your child ever have ever had an overactive immune system, your healthcare professional may have prescribed methylprednisolone (Medrol, Solu-Medrol). It’s an FDA-approved prescription medication that’s commonly dispensed at retail pharmacies and used in hospitals.
Methylprednisolone belongs to a group of medications known as corticosteroids. It works by calming certain chemicals in your body to relieve inflammation (swelling). This helps treat many health conditions, including asthma, rheumatoid arthritis, and more. Methylprednisolone comes as an oral tablet and injection.
Alongside these benefits, a few risks are also possible. Methylprednisolone can interact with certain medications and vaccines you may need. This can raise the risk of experiencing certain side effects. Some interactions can also make medications less effective.
Methylprednisolone interactions at a glance
Methylprednisolone interacts with several medications, vaccines, and even certain foods. Top methylprednisolone interactions include:
Blood thinners, such as warfarin (Coumadin, Jantoven)
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
Alcohol
Diabetes medications, such as insulin
Antifungals, such as ketoconazole
Antiseizure medications, such as phenytoin (Dilantin, Phenytek)
Immunosuppressants, such as cyclosporine (Sandimmune)
Paxlovid (nirmatrelvir / ritonavir)
Mifepristone (Korlym, Mifeprex)
Aldesleukin (Proleukin)
Live vaccines, such as the measles, mumps, and rubella (MMR) vaccine
Grapefruit juice
Keep in mind this doesn’t include all possible interactions. It’s best to have your prescriber or pharmacist review all medications and supplements you take before starting methylprednisolone.
Here, we’ll provide more detail on 11 notable methylprednisolone interactions and how to manage them.
1. Blood thinners
Blood thinners are used to prevent and treat blood clots. Examples include warfarin (Coumadin, Jantoven), apixaban (Eliquis), and rivaroxaban (Xarelto). Methylprednisolone can change how blood thinners work in the body. It can make them more or less effective.
For instance, methylprednisolone has been reported to make some blood thinners less effective. Some studies report that corticosteroids like methylprednisolone could raise the risk of experiencing a blood clot. In other cases, methylprednisolone may enhance the effects of blood thinners — especially direct-acting oral anticoagulants (DOACs). This could raise the risk of bleeding.
Since these effects vary, your healthcare professional may recommend more frequent blood tests if you’re taking them together. This is especially true if you’re taking warfarin (Coumadin, Jantoven). It’s also a good idea to watch for signs or symptoms of unusual bleeding and bruising, such as unexplained nosebleeds, black or red stools, or bleeding gums.
2. Ibuprofen and other NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) treat pain and fever. They’re commonly found over the counter (OTC) and with a prescription. Examples include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). They’re go-to choices for a bothersome headache or a short spell of muscle pain, but combining them with methylprednisolone isn’t ideal.
NSAIDs and methylprednisolone can both be hard on the stomach. They can cause an upset stomach and nausea. In more severe cases, both medications raise the risk of stomach bleeding and ulcers. Taking them together can enhance these risks.
If possible, try to avoid taking NSAIDs and methylprednisolone at the same time. Your healthcare professional may recommend acetaminophen (Tylenol) instead if you need pain medication while taking methylprednisolone. It works differently than NSAIDs and is gentler on the stomach.
3. Alcohol
While there’s not a direct interaction between the two, you may want to use caution with alcohol while taking methylprednisolone.
Alcohol and methylprednisolone can both suppress the immune system. This makes it easier to get or harder to recover from an infection, especially if you drink in large quantities. Alcohol and methylprednisolone can also both lead to stomach bleeding. Using the two together could be a risky combination for your stomach.
It’s typically best to avoid alcohol while you’re taking methylprednisolone. But if you’re interested in drinking in moderation while taking a corticosteroid like methylprednisolone, ask your healthcare professional about the risks of doing so and how much may be acceptable.
4. Diabetes medications
Corticosteroids like methylprednisolone can raise your blood sugar levels. This can make it harder for diabetes medications like metformin to do their job. You’re more likely to experience hyperglycemia (high blood sugar) when diabetes medications don’t work as well.
If you’re taking these medications together, your healthcare professional may recommend checking your blood sugar more often at home. Make sure to watch for signs and symptoms of hyperglycemia, such as increased thirst and frequent urination.
5. Ketoconazole
Ketoconazole is an oral prescription medication that treats fungal infections. But it can also prevent the breakdown (metabolism) of methylprednisolone. This can cause methylprednisolone to stay in your body for longer, which raises the risk of side effects.
It’s best to avoid taking these medications together. This should help prevent methylprednisolone side effects, such as new or worsening:
Swelling (edema)
Stomach irritation
Mental health changes
Weaker bones
If you need to take these medications together, your healthcare professional may want to lower your methylprednisolone dose for safety purposes.
Ketoconazole also comes as a topical cream (Ketozole), but it’s unlikely that ketoconazole cream would cause an interaction.
6. Phenytoin and phenobarbital
Phenytoin (Dilantin, Phenytek) and phenobarbital are medications that treat certain types of seizures. They can lower the amount of methylprednisolone in the body by making it leave your system faster than normal. This can worsen its effectiveness.
Your healthcare professional will likely monitor you closely if you take either of these medications with methylprednisolone. Your dose may also need to be raised to get the full benefits of the medication.
7. Cyclosporine and tacrolimus
Cyclosporine (Sandimmune) and tacrolimus (Prograf) are immunosuppressant medications. They help protect new organs after transplant surgeries. Methylprednisolone is sometimes used with these medications to prevent organ rejection, but they can also interact.
The interaction between cyclosporine and methylprednisolone is a two-way street. Taking them together can raise the risk of side effects of both medications, including possible seizures. Methylprednisolone may also alter cyclosporine levels in your body.
Methylprednisolone’s interaction with tacrolimus is more one-sided. It can lower the amount of tacrolimus in the body, making it less effective. What’s more, the severity of this interaction depends on the dose of methylprednisolone. Higher methylprednisolone doses lead to lower amounts of tacrolimus in the body. Your healthcare professional may need to raise your tacrolimus dose if it’s paired with methylprednisolone.
8. Paxlovid
You’ve likely heard of the antiviral medication Paxlovid (nirmatrelvir / ritonavir) in the media. It can help lower the risk of hospitalization and death from COVID-19. But, it has many interactions to be aware of. One possible interaction is with corticosteroids like methylprednisolone.
Paxlovid can increase the amount of methylprednisolone in the body. This raises the risk of methylprednisolone side effects. To help with this, your healthcare professional may lower your dose. Or they may recommend a different medication other than methylprednisolone. Prednisone is another option that has a milder interaction with Paxlovid.
9. Certain live vaccines
For live vaccines to work their best, your immune system needs to be at the top of its game. But corticosteroids lower the strength of your immune system. This can make live vaccines less effective at preventing disease.
On top of this, live vaccines contain a weakened form of the germ it’s looking to teach your body about. If your immune system isn’t in tip-top shape, the vaccine could end up causing an infection by mistake.
Because of this, your healthcare professional may want to delay giving you a live vaccine while you’re taking methylprednisolone. Examples of live vaccines include:
BCG for tuberculosis
Oral typhoid (Vivotif)
Oral cholera (Vaxchora)
Rotavirus (Rotarix)
These risks are highest for high-dose methylprednisolone. Taking high-dose methylprednisolone for 14 days (2 weeks) or more can weaken your immune system to a meaningful degree. In this case, it’s best to wait 1 month to get a live vaccine after stopping methylprednisolone.
10. Aldesleukin
Methylprednisolone can interfere with the effectiveness of aldesleukin (Proleukin), a medication used to treat kidney and skin cancer.
Aldesleukin works by stimulating your immune system to attack cancer cells, while methylprednisolone suppresses the immune system. By suppressing the immune system, methylprednisolone can prevent aldesleukin from working as intended.
Healthcare professionals usually recommend avoiding steroids like methylprednisolone while you’re receiving aldesleukin, if possible.
11. Mifepristone
Mifepristone (Korlym, Mifeprex) can make methylprednisolone less effective. It does so by blocking specific receptors that methylprednisolone needs to bind to in order to work. These receptors are known as glucocorticoid receptors.
It’s usually not recommended to take these medications together. If you need to take both medications, your healthcare professional should monitor you closely and determine if your methylprednisolone dosage needs to be changed.
Frequently asked questions
Yes, you can take Tylenol (acetaminophen) with methylprednisolone. Tylenol isn’t a NSAID. So it doesn’t raise your risk of stomach ulcers or bleeding the way NSAIDs can when combined with a steroid like methylprednisolone. In fact, if you need pain relief while taking methylprednisolone, your prescriber will likely suggest Tylenol.
You should avoid grapefruit and grapefruit juice while taking methylprednisolone (especially in large quantities). This is because grapefruit blocks the enzymes that break down methylprednisolone in your body. If methylprednisolone builds up in your body, it increases your risk of side effects.
The best way to manage interactions is to prevent them from happening in the first place. Try to keep a current list of all your OTC and prescription medications. Your pharmacist and prescriber can check this list for methylprednisolone interactions before you start taking it.
In rare cases, interactions can happen even if you have someone check your medication list. If you’re concerned about a medication interaction at any point, make sure to reach out to your healthcare professional or pharmacist as soon as you can. Medication interactions can raise the risk of side effects, and these can sometimes be dangerous. Contact a healthcare professional right away if you notice any side effects that are concerning or don’t go away.
Yes, you can take Tylenol (acetaminophen) with methylprednisolone. Tylenol isn’t a NSAID. So it doesn’t raise your risk of stomach ulcers or bleeding the way NSAIDs can when combined with a steroid like methylprednisolone. In fact, if you need pain relief while taking methylprednisolone, your prescriber will likely suggest Tylenol.
You should avoid grapefruit and grapefruit juice while taking methylprednisolone (especially in large quantities). This is because grapefruit blocks the enzymes that break down methylprednisolone in your body. If methylprednisolone builds up in your body, it increases your risk of side effects.
The best way to manage interactions is to prevent them from happening in the first place. Try to keep a current list of all your OTC and prescription medications. Your pharmacist and prescriber can check this list for methylprednisolone interactions before you start taking it.
In rare cases, interactions can happen even if you have someone check your medication list. If you’re concerned about a medication interaction at any point, make sure to reach out to your healthcare professional or pharmacist as soon as you can. Medication interactions can raise the risk of side effects, and these can sometimes be dangerous. Contact a healthcare professional right away if you notice any side effects that are concerning or don’t go away.
The bottom line
Methylprednisolone (Medrol, Solu-Medrol) is a corticosteroid that lowers inflammation. It interacts with several medications and vaccines, including blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), and diabetes medications. To help prevent interactions, make sure your pharmacist and healthcare professional have an updated list of medications you take.
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