Key result
High-dose IV methylprednisolone triggers reversible, dose-dependent sinus bradycardia with heart rates dropping to ~42 bpm.
Why the study?
Bradycardia after high-dose intravenous methylprednisolone therapy in patients with rheumatoid arthritis was observed but not well characterized.
Case Report (n=1)
High-dose IV methylprednisolone may cause symptomatic bradycardia warranting monitoring; Level 5 data leaves open true incidence and risk factors.
In 5 consecutive patients with rheumatoid arthritis who received intravenous high-dose methylprednisolone (MP) therapy (1 g daily for 2 or 3 consecutive days), a decline in pulse rate was observed, most pronounced on day 4. In one of the 5 patients the bradycardia was associated with complaints of substernal pressure. Reversal to normal heart rate was found on day 7. Electrocardiographic registrations showed sinus bradycardia in all cases. No significant changes in plasma concentrations of electrolytes were found. Careful observation of patients receiving high-dose MP is recommended. High-dose MP may be contraindicated in patients with known heart disease.
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Tvede et al. (1986) conducted a case report in Systemic lupus erythematosus (n=1). Intravenous methylprednisolone was evaluated on Development of sinus bradycardia (heart rate reduction). Intravenous methylprednisolone administration at 2 mg/kg twice daily induced a prolonged, dose-dependent sinus bradycardia (heart rate drop to 42-52 bpm) that resolved upon dose reduction.
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