When Is Solu-Medrol Used in Multiple Sclerosis?

How Doctors Make the Decision to Use Solu-Medrol

Healing from Your MS
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Many of us with multiple sclerosis, especially relapsing-remitting MS (RRMS), have experienced a course of Solu-Medrol, the high-dose intravenous corticosteroid used to lessen the symptoms of relapses by decreasing inflammation in the central nervous system.

For many people, the effects of Solu-Medrol are just short of miraculous. MS symptoms that were debilitating before the needle was even placed in the vein may be manageable or even gone by the time the first infusion is complete—and two or three days into the course, the majority of people can report that those symptoms are much better.

However, losing the MS symptoms (and the panic that often accompanies them) allows people to shift their attention to the side effects of Solu-Medrol, which can be uncomfortable (to say the least), although not life-threatening.

My Experience with Solu-Medrol

For me, a Solu-Medrol treatment is like someone offering to remove a bear trap from my leg, while knowing that they are going to punch me in the face as soon as it is removed. Yes, the effects have been miraculous—I was blind, then I could see; I could not walk, then I got up and marched out of the room.

However, I was then a seeing, walking person who was experiencing anxiety, night sweats, insomnia, headaches and nausea. Sure, the trade-off is worth it in most cases, but I have wondered about how the decision is made by physicians to send patients on a Solu-Medrol “journey.”

Am I Going to Be Prescribed Solu-Medrol?

If you are having a relapse, you may be prescribed Solu-Medrol if your symptoms make it difficult for you to function, like vision, strength, or balance problems.

OK, you say, how do I know if I am having a relapse? While this is up to the doctor to determine definitively, you can suspect a relapse if you answer “yes” to the following questions:

  • Am I experiencing new symptoms or worsening of existing symptoms?
  • Has this worsening happened over the course of 24 hours to a couple of days?
  • Have these symptoms lasted more than 24 hours?
  • Has it been at least a month since my last relapse? (In other words, had these symptoms been non-existent or stable for at least 30 days before they appeared or got worse?)
  • Am I free of fever or infection?

What If My MS Symptoms Are Getting Worse, But Gradually?

Solu-Medrol is typically reserved to treat relapses, rather than symptoms that are worsening slowly over time. However, it could be that you have pain or some other symptom that you have been dealing with for some time that just crossed a line of being intolerable. The doctor may be ready to try some Solu-Medrol, in this case, to bring you some relief. This decision will probably involve looking at other available options for treating this symptom and how you have responded to these, combined with clues that he may glean from an MRI scan.

What If an MRI Shows Active Lesions, But I Don’t Have New Symptoms?

This is also not an indication for Solu-Medrol. It turns out that many people with MS, especially relapsing-remitting multiple sclerosis in the early years, have little active lesions happening all the time.

These are the lesions that “light up” in the presence of gadolinium (a contrast agent used for MRI scans) for about six weeks, then fade as the inflammation recedes.

But, very few of lesions are causing symptoms, and certainly not causing symptoms dramatic enough to apply the word “relapse” to the situation or to prescribe Solu-Medrol. This is a situation of pretty normal RRMS activity, and the recommendations are to have people on one of the disease-modifying therapies.

A Word from Verywell

The bottom line here is that your MS symptoms have to be pretty bad to receive a course of Solu-Medrol, in most cases. However (and this is a big “HOWEVER”), there are some doctors out there who use Solu-Medrol differently—meaning some tend to use it more frequently and others not. Still, other doctors prefer oral prednisone (a steroid you can take by mouth) to Solu-Medrol when treating relapses (other than optic neuritis).

Keep in mind, also, that if the potential side effects of Solu-Medrol are more unpleasant to you than the symptoms the drug is aiming to treat, you should discuss this with your doctor. While there is clear evidence that Solu-Medrol helps lessen symptom duration and severity during a relapse, there is no evidence that there is long-term benefit.

This means that if you can stand having the symptom (or trying to treat it some other way) and waiting out the relapse instead of taking Solu-Medrol, it does not mean that you are more likely to have permanent damage or residual effects from the relapse (than you would be if you did take the course of Solu-Medrol).


Olek MJ. Treatment of acute exacerbations of multiple sclerosis in adults. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2016.

Ontaneda D & Rae-Grant AD. Management of acute exacerbations in multiple sclerosis. Ann Indian Acad Neurol. 2009 Oct;12(4):264-72.

Edited by Dr. Colleen Doherty, August 2nd 2016.

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