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Methylprednisolone (Solu-Medrol) and hydrocortisone (Solu-Cortef) are used to treat infusion reactions to chemotherapy and other anticancer treatments. Some clinicians seem to favor one over the other. Is there a significant difference between the two or is it just a matter of clinician preference? 

—L. Jouthaan

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Methylprednisolone and hydrocortisone are both corticosteroids. Both of these products are available in intravenous formulations, making them very useful for treating infusion reactions. Currently, no clinical trial data compare the effectiveness of methylprednisolone to hydrocortisone for managing infusion reactions. Which agent a clinician selects is influenced by the different pharmacologic properties of the agents. 

Corticosteroids have both anti-inflammatory activity and mineralocorticoid activity. Agents with high mineralocorticoid activity can cause more salt and water retention than agents with lower activity. Methylprednisolone has less mineralocorticoid activity than hydrocortisone; therefore, methylprednisolone may be preferred over hydrocortisone in patients with cardiac issues. 

Methylprednisolone is also more potent than hydrocortisone; 4 mg of methylprednisolone is equivalent to 20 mg of hydrocortisone. This does not mean hydrocortisone is less effective, so long as an equivalent dose is given. Hydrocortisone has a longer half-life (8-12 hours) than methylprednisolone (approximately 3 hours), so it may last longer than methylprednisolone. The decision of whether to use hydrocortisone or methylprednisolone should be made after assessing all patient-specific factors. Nurses and other clinicians should be familiar with the dosing of both agents. ONA

Lisa Thompson is assistant professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.