United States - English - NLM (National Library of Medicine)
SOLU-MEDROL- methylprednisolone sodium succinate injection, powder, for solution
Medical Purchasing Solutions, LLC
(methylprednisolone sodium succinate for injection, USP)
The formulations containing benzyl alcohol should not be used in neonates.
For Intravenous or Intramuscular Administration
SOLU-MEDROL Sterile Powder is an anti-inflammatory glucocorticoid, which contains
methylprednisolone sodium succinate as the active ingredient. Methylprednisolone sodium succinate,
USP, is the sodium succinate ester of methylprednisolone, and it occurs as a white, or nearly white,
odorless hygroscopic, amorphous solid. It is very soluble in water and in alcohol; it is insoluble in
chloroform and is very slightly soluble in acetone.
The chemical name for methylprednisolone sodium succinate is pregna-1,4-diene-3,20-dione,21-(3-
carboxy-1-oxopropoxy)-11,17-dihydroxy-6-methyl-monosodium salt, (6α, 11β), and the molecular
weight is 496.53. The structural formula is represented below:
Methylprednisolone sodium succinate is soluble in water; it may be administered in a small volume of
diluent and is well suited for intravenous use in situations where high blood levels of
methylprednisolone are required rapidly.
SOLU-MEDROL is available in preservative and preservative-free formulations:
40 mg Act-O-Vial System (Single-Dose Vial)—Each mL (when mixed) contains
methylprednisolone sodium succinate equivalent to 40 mg methylprednisolone; also 1.6 mg
monobasic sodium phosphate anhydrous; 17.46 mg dibasic sodium phosphate dried; and 25
mg lactose hydrous.
125 mg Act-O-Vial System (Single-Dose Vial)—Each 2 mL (when mixed) contains
methylprednisolone sodium succinate equivalent to 125 mg methylprednisolone; also 1.6 mg
monobasic sodium phosphate anhydrous; and 17.4 mg dibasic sodium phosphate dried.
Formulations preserved with Benzyl Alcohol
1 gram Vial—Each 16 mL (when mixed as directed) contains methylprednisolone sodium
succinate equivalent to 1 gram methylprednisolone; also 12.8 mg monobasic sodium
phosphate anhydrous; 139.2 mg dibasic sodium phosphate dried.
This package does not contain diluent. Recommended diluent (Bacteriostatic water) contains
benzyl alcohol as a preservative.
IMPORTANT — Use only the accompanying diluent or Bacteriostatic Water For Injection
with Benzyl Alcohol when reconstituting SOLU-MEDROL.
Use within 48 hours after mixing.
When necessary, the pH of each formula was adjusted with sodium hydroxide so that the pH of the
reconstituted solution is within the USP specified range of 7 to 8 and the tonicities are, for the 40 mg
per mL solution, 0.50 osmolar; for the 125 mg per 2 mL solution, 0.40 osmolar. (Isotonic saline = 0.28
Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that are readily absorbed
from the gastrointestinal tract.
Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining
properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs
are primarily used for their potent anti-inflammatory effects in disorders of many organ systems.
Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's
immune responses to diverse stimuli.
Methylprednisolone is a potent anti-inflammatory steroid with greater anti-inflammatory potency than
prednisolone and even less tendency than prednisolone to induce sodium and water retention.
Methylprednisolone sodium succinate has the same metabolic and anti-inflammatory actions as
methylprednisolone. When given parenterally and in equimolar quantities, the two compounds are
equivalent in biologic activity. Following the intravenous injection of methylprednisolone sodium
succinate, demonstrable effects are evident within one hour and persist for a variable period. Excretion
of the administered dose is nearly complete within 12 hours. Thus, if constantly high blood levels are
required, injections should be made every 4 to 6 hours. This preparation is also rapidly absorbed when
administered intramuscularly and is excreted in a pattern similar to that observed after intravenous
INDICATIONS AND USAGE
When oral therapy is not feasible, and the strength, dosage form, and route of administration of the drug
reasonably lend the preparation to the treatment of the condition, the intravenous or intramuscular use
of SOLU-MEDROL Sterile Powder is indicated as follows:
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional
treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or
seasonal allergic rhinitis, serum sickness, transfusion reactions.
Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe
erythema multiforme (Stevens-Johnson syndrome).
Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice;
synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy,
mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia,
hypercalcemia associated with cancer, nonsuppurative thyroiditis.
To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and
Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond-Blackfan
anemia), idiopathic thrombocytopenic purpura in adults (intravenous administration only; intramuscular
administration is contraindicated), pure red cell aplasia, selected cases of secondary thrombocytopenia.
Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid
block or impending block when used concurrently with appropriate antituberculous chemotherapy.
For the palliative management of leukemias and lymphomas.
Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain
tumor, or craniotomy.
Sympathetic ophthalmia, uveitis and ocular inflammatory conditions unresponsive to topical
To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus
Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with
appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic
As adjunctive therapy for short-term administration (to tide the patient over an acute episode or
exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic
arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-
dose maintenance therapy). For the treatment of dermatomyositis, temporal arteritis, polymyositis, and
systemic lupus erythematosus.
SOLU-MEDROL Sterile Powder is contraindicated:
in systemic fungal infections and patients with known hypersensitivity to the product and its
constituents. The SOLU-MEDROL 40 mg presentation includes lactose monohydrate produced
from cow's milk. This presentation is therefore contraindicated in patients with a known or suspected
hypersensitivity to cow's milk or its components or other dairy products because it may contain trace
amounts of milk ingredients.
for intrathecal administration. Reports of severe medical events have been associated with this route
Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura.
Additional contraindication for the use of SOLU-MEDROL Sterile Powder preserved with benzyl
Formulations preserved with benzyl alcohol are contraindicated for use in premature infants. (See
WARNINGS and PRECAUTIONS, Pediatric Use.)
Serious Neurologic Adverse Reactions with Epidural Administration
Serious neurologic events, some resulting in death, have been reported with epidural injection of
corticosteroids. Specific events reported include, but are not limited to, spinal cord infarction,
paraplegia, quadriplegia, cortical blindness, and stroke. These serious neurologic events have been
reported with and without use of fluoroscopy. The safety and effectiveness of epidural administration
of corticosteroids have not been established, and corticosteroids are not approved for this use.
Formulations with preservative (see DESCRIPTION) contain benzyl alcohol, which is potentially
toxic when administered locally to neural tissue. Exposure to excessive amounts of benzyl alcohol
has been associated with toxicity (hypotension, metabolic acidosis), particularly in neonates, and an
increased incidence of kernicterus, particularly in small preterm infants. There have been rare reports
of deaths, primarily in preterm infants, associated with exposure to excessive amounts of benzyl
alcohol. The amount of benzyl alcohol from medications is usually considered negligible compared to
that received in flush solutions containing benzyl alcohol. Administration of high dosages of
medications containing this preservative must take into account the total amount of benzyl alcohol
administered. The amount of benzyl alcohol at which toxicity may occur is not known. If the patient
requires more than the recommended dosages or other medications containing this preservative, the
practitioner must consider the daily metabolic load of benzyl alcohol from these combined sources (see
PRECAUTIONS, Pediatric Use).
Injection of SOLU-MEDROL may result in dermal and/or subdermal changes forming depressions in the
skin at the injection site. In order to minimize the incidence of dermal and subdermal atrophy, care must
be exercised not to exceed recommended doses in injections. Injection into the deltoid muscle should be
avoided because of a high incidence of subcutaneous atrophy.
Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy
(see ADVERSE REACTIONS).
In patients receiving the 40 mg presentation of SOLU-MEDROL during the treatment for acute allergic
conditions and where these symptoms worsen or any new allergic symptoms occur, consideration
should be given to the potential for hypersensitivity reactions to cow's milk ingredients (see
CONTRAINDICATIONS). If appropriate, administration of SOLU-MEDROL should be stopped, and
the patient's condition should be treated accordingly. Alternative treatments, including the use of
corticosteroid formulations that do not contain ingredients produced from cow's milk, should be
considered for acute allergy management, where appropriate.
Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy
who are subjected to any unusual stress before, during, and after the stressful situation.
Results from one multicenter, randomized, placebo-controlled study with methylprednisolone
hemisuccinate, an intravenous corticosteroid, showed an increase in early (at 2 weeks) and late (at 6
months) mortality in patients with cranial trauma who were determined not to have other clear indications
for corticosteroid treatment. High doses of systemic corticosteroids, including SOLU-MEDROL,
should not be used for the treatment of traumatic brain injury.
Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water
retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic
derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may
be necessary. All corticosteroids increase calcium excretion.
Literature reports suggest an apparent association between the use of corticosteroids and left
ventricular free wall rupture after a recent myocardial infarction; therefore, therapy with
corticosteroids should be used with great caution in these patients.
Hypothalamic-pituitary adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia.
Monitor patients for these conditions with chronic use.
Corticosteroids can produce reversible HPA axis suppression with the potential for
glucocorticosteroid insufficiency after withdrawal of treatment. Drug induced secondary
adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative
insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of
stress occurring during that period, hormone therapy should be reinstituted.
Drug-Induced Liver Injury
Rarely, high doses of cyclically pulsed intravenous methylprednisolone (usually for the treatment of
exacerbations of multiple sclerosis at doses of 1 gram/day) can induce a toxic form of acute hepatitis.
The time to onset of this form of steroid-induced liver injury can be several weeks or longer.
Resolution has been observed after discontinuation of treatment. However, serious liver injury can
occur, sometimes resulting in acute liver failure and death. Discontinue intravenous methylprednisolone
if toxic hepatitis occurs. Since recurrence has occurred after re-challenge, avoid use of high dose
intravenous methylprednisolone in patients with a history of toxic hepatitis caused by
Patients who are on corticosteroids are more susceptible to infections than are healthy individuals.
There may be decreased resistance and inability to localize infection when corticosteroids are used.
Infections with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the
body may be associated with the use of corticosteroids alone or in combination with other
These infections may be mild, but can be severe and at times fatal. With increasing doses of
corticosteroids, the rate of occurrence of infectious complications increases. Corticosteroids may also
mask some signs of current infection. Do not use intra-articularly, intrabursally or for intratendinous
administration for local effect in the presence of acute local infection.
A study has failed to establish the efficacy of methylprednisolone sodium succinate in the treatment of
sepsis syndrome and septic shock. The study also suggests that treatment of these conditions with
methylprednisolone sodium succinate may increase the risk of mortality in certain patients (i.e., patients
with elevated serum creatinine levels or patients who develop secondary infections after
methylprednisolone sodium succinate).
Corticosteroids may exacerbate systemic fungal infections and therefore should not be used in the
presence of such infections unless they are needed to control drug reactions. There have been cases
reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac
enlargement and congestive heart failure (see CONTRAINDICATIONS and PRECAUTIONS, Drug
Interactions, Amphotericin B injection and potassium-depleting agents).
Latent disease may be activated or there may be an exacerbation of intercurrent infections due to
pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia,
It is recommended that latent amebiasis or active amebiasis be ruled out before initiating corticosteroid
therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea.
Similarly, corticosteroids should be used with great care in patients with known or suspected
Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may
lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often
accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.
Corticosteroids should not be used in cerebral malaria. There is currently no evidence of benefit from
steroids in this condition.
The use of corticosteroids in active tuberculosis should be restricted to those cases of fulminating or
disseminated tuberculosis in which the corticosteroid is used for the management of the disease in
conjunction with appropriate antituberculous regimen.
If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close
observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid
therapy, these patients should receive chemoprophylaxis.
Administration of live or live, attenuated vaccines is contraindicated in patients receiving
immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered.
However, the response to such vaccines can not be predicted. Immunization procedures may be
undertaken in patients receiving corticosteroids as replacement therapy, e.g., for Addison's disease.
Chicken pox and measles can have a more serious or even fatal course in pediatric and adult patients on
corticosteroids. In pediatric and adult patients who have not had these diseases, particular care should
be taken to avoid exposure. The contribution of the underlying disease and/or prior corticosteroid
treatment to the risk is also not known. If exposed to chicken pox, prophylaxis with varicella zoster
immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with immunoglobulin (IG)
may be indicated. (See the respective package inserts for complete VZIG and IG prescribing
information.) If chicken pox develops, treatment with antiviral agents should be considered.
Reports of severe medical events have been associated with the intrathecal route of administration (see
ADVERSE REACTIONS, Gastrointestinal and Neurologic/Psychiatric).
Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to
the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria,
fungi, or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis
and may lead to an increase in the risk of new episodes. Corticosteroids should be used cautiously in
patients with ocular herpes simplex because of corneal perforation. Corticosteroids should not be used
in active ocular herpes simplex.
This product, like many other steroid formulations, is sensitive to heat. Therefore, it should not be
autoclaved when it is desirable to sterilize the exterior of the vial.
The lowest possible dose of corticosteroid should be used to control the condition under treatment.
When reduction in dosage is possible, the reduction should be gradual.
Since complications of treatment with glucocorticoids are dependent on the size of the dose and the
duration of treatment, a risk/benefit decision must be made in each individual case as to dose and
duration of treatment and as to whether daily or intermittent therapy should be used.
Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy, most often for
chronic conditions. Discontinuation of corticosteroids may result in clinical improvement.
Caution is required in patients with systemic sclerosis because an increased incidence of scleroderma
renal crisis has been observed with corticosteroids, including methylprednisolone.
As sodium retention with resultant edema and potassium loss may occur in patients receiving
corticosteroids, these agents should be used with caution in patients with congestive heart failure,
hypertension, or renal insufficiency.
Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of
dosage. This type of relative insufficiency may persist for months after discontinuation of therapy;
therefore, in any situation of stress occurring during that period, hormone therapy should be
Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in
hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustment in dosage.
Gas trointes tinal
Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal
anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation. Signs
of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may
be minimal or absent.
There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis.
Mus culos keletal
Corticosteroids decrease bone formation and increase bone resorption both through their effect on
calcium regulation (i.e., decreasing absorption and increasing excretion) and inhibition of osteoblast
function. This, together with a decrease in the protein matrix of the bone secondary to an increase in
protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in
pediatric patients and the development of osteoporosis at any age. Special consideration should be
given to patients at increased risk of osteoporosis (i.e., postmenopausal women) before initiating
Local injection of a steroid into a previously infected site is not usually recommended.
Although controlled clinical trials have shown corticosteroids to be effective in speeding the
resolution of acute exacerbations of multiple sclerosis, they do not show that corticosteroids affect the
ultimate outcome or natural history of the disease. The studies do show that relatively high doses of
corticosteroids are necessary to demonstrate a significant effect. (See DOSAGE AND
An acute myopathy has been observed with the use of high doses of corticosteroids, most often
occurring in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in
patients receiving concomitant therapy with neuromuscular blocking drugs (e.g., pancuronium). This
acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in
quadriparesis. Elevations of creatine kinase may occur. Clinical improvement or recovery after
stopping corticosteroids may require weeks to years.
Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia,
mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also,
existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
Intraocular pressure may become elevated in some individuals. If steroid therapy is continued for more
than 6 weeks, intraocular pressure should be monitored.
Information for Patients
Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical
supervision, to advise any medical attendants that they are taking corticosteroids, and to seek medical
advice at once should they develop fever or other signs of infection.
Persons who are on corticosteroids should be warned to avoid exposure to chicken pox or measles.
Patients should also be advised that if they are exposed, medical advice should be sought without delay.
Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression.
Amphotericin B injection and potassium-depleting agents
When corticosteroids are administered concomitantly with potassium-depleting agents (i.e.,
amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. There
have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed
by cardiac enlargement and congestive heart failure.
Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance
(see Drug Interactions, Hepatic Enzyme Inhibitors).
Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in
patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24
hours before initiating corticosteroid therapy.
Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin,
although there have been some conflicting reports. Therefore, coagulation indices should be monitored
frequently to maintain the desired anticoagulant effect.
Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic
agents may be required.
Serum concentrations of isoniazid may be decreased.
Cholestyramine may increase the clearance of corticosteroids.
Increased activity of both cyclosporine and corticosteroids may occur when the two are used
concurrently. Convulsions have been reported with this concurrent use.
Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia.
Estrogens, including oral contraceptives
Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their
Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin)
Drugs which induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of
corticosteroids and require that the dosage of the corticosteroid be increased.
Hepatic Enzyme Inhibitors (e.g., ketoconazole, macrolide antibiotics such as erythromycin and
Drugs which inhibit cytochrome P450 3A4 have the potential to result in increased plasma
concentrations of corticosteroids.
Ketoconazole has been reported to significantly decrease the metabolism of certain corticosteroids by
up to 60%, leading to an increased risk of corticosteroid side effects.
Nonsteroidal anti-inflammatory agents (NSAIDs):
Concomitant use of aspirin (or other nonsteroidal anti-inflammatory agents) and corticosteroids
increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with
corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent
use of corticosteroids.
Corticosteroids may suppress reactions to skin tests.
Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or
inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the
replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines
or toxoids should be deferred until corticosteroid therapy is discontinued if possible (see
WARNINGS, Infections, Vaccination).
Carcinogenesis, Mutagenesis, Impairment of Fertility
No adequate studies have been conducted in animals to determine whether corticosteroids have a
potential for carcinogenesis or mutagenesis.
Steroids may increase or decrease motility and number of spermatozoa in some patients.
Corticosteroids have been shown to impair fertility in male rats.
Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to
the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and
rabbits have yielded an increased incidence of cleft palate in the offspring. There are no adequate and
well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if
the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received
corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
This product contains benzyl alcohol as a preservative.
Benzyl alcohol can cross the placenta. See PRECAUTIONS: Pediatric use.
Systemically administered corticosteroids appear in human milk and could suppress growth, interfere
with endogenous corticosteroid production, or cause other untoward effects. Because of the potential
for serious adverse reactions in nursing infants from corticosteroids, a decision should be made
whether to continue nursing, or discontinue the drug, taking into account the importance of the drug to
Some formulations of this product contain benzyl alcohol as a preservative (see DESCRIPTION).
Carefully examine vials to determine formulation that is being used.
Benzyl alcohol, a component of this product, has been associated with serious adverse events and death,
particularly in pediatric patients. The "gasping syndrome" (characterized by central nervous system
depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its
metabolites found in the blood and urine) has been associated with benzyl alcohol dosages >99
mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may include gradual
neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin
breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse. Although
normal therapeutic doses of this product ordinarily delivers amounts of benzyl alcohol that are
substantially lower than those reported in association with the "gasping syndrome", the minimum amount
of benzyl alcohol at which toxicity may occur is not known. The risk of benzyl alcohol toxicity depends
on the quantity administered and the hepatic capacity to detoxify the chemical. Premature and low-birth-
weight infants, as well as patients receiving high dosages, may be more likely to develop toxicity.
Practitioners administering this and other medications containing benzyl alcohol should consider the
combined daily metabolic load of benzyl alcohol from all sources.
The efficacy and safety of corticosteroids in the pediatric population are based on the well-established