The pharmacological basis of treatment with high dose corticosteroids in circulatory shock.

It is evident that the majority of studies concerning the use of high dose corticosteroids (HDC) in circulatory shock hitherto published, in a pharmacological sense, are mainly descriptive. However, some of the studies have none the less provided valuable information about the mechanisms of action and a few investigations have primarily been designed to study the pharmacodynamics of HDC in different shock settings. The research has shown that HDC interferes with various pathophysiological mechanisms including cell membrane stability, granulocyte aggregability, oxygen delivery, peripheral circulation and metabolism. Less is known about the pharmacokinetics of HDC, a subject which has been more or less neglected until very recently. However, some basic facts are known. Hence, the mean elimination half life of methylprednisolone (MP) administered i.v. ranges from 2.4 to 3.5 hours in normal healthy adults. The drug is distributed widely throughout the body including the central nervous system and is metabolized mainly in the liver to inactive metabolites.