Usual Adult Dose for Ankylosing Spondylitis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Bursitis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Rheumatoid Arthritis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Gouty Arthritis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Psoriatic Arthritis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Synovitis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration:

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Periarticular Injection:

• Tenosynovitis: Use care to ensure injection into tendon sheath rather than tendon substance
• Epicondylitis: May treat by infiltrating into area of greatest tenderness

Comments:

• May use 10 mg/mL or 40 mg/mL injectable suspension.
• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.

Uses: Short-term, adjunctive therapy for acute episodes or exacerbations of acute gout arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, or synovitis

Usual Adult Dose for Alopecia

Doses should be individualized based on the disease and lesion being treated

• Use 10 mg/mL concentration only; multiple sites may be injected, separate by 1 cm or more
• May repeat at weekly or less frequent intervals as necessary

Comments:

• Inject directly into lesion, i.e. intradermally or subcutaneously.
• The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Uses: For the treatment of alopecia areata; discoid lupus erythematosus; keloids; localized inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; and necrobiosis lipoidica diabeticoruml; may be useful in cystic tumors of an aponeurosis or tendon (ganglia)

Usual Adult Dose for Lichen Simplex Chronicus

Doses should be individualized based on the disease and lesion being treated

• Use 10 mg/mL concentration only; multiple sites may be injected, separate by 1 cm or more
• May repeat at weekly or less frequent intervals as necessary

Comments:

• Inject directly into lesion, i.e. intradermally or subcutaneously.
• The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Uses: For the treatment of alopecia areata; discoid lupus erythematosus; keloids; localized inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; and necrobiosis lipoidica diabeticoruml; may be useful in cystic tumors of an aponeurosis or tendon (ganglia)

Usual Adult Dose for Psoriasis

Doses should be individualized based on the disease and lesion being treated

• Use 10 mg/mL concentration only; multiple sites may be injected, separate by 1 cm or more
• May repeat at weekly or less frequent intervals as necessary

Comments:

• Inject directly into lesion, i.e. intradermally or subcutaneously.
• The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Uses: For the treatment of alopecia areata; discoid lupus erythematosus; keloids; localized inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; and necrobiosis lipoidica diabeticoruml; may be useful in cystic tumors of an aponeurosis or tendon (ganglia)

Usual Adult Dose for Lichen Planus

Doses should be individualized based on the disease and lesion being treated

• Use 10 mg/mL concentration only; multiple sites may be injected, separate by 1 cm or more
• May repeat at weekly or less frequent intervals as necessary

Comments:

• Inject directly into lesion, i.e. intradermally or subcutaneously.
• The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Uses: For the treatment of alopecia areata; discoid lupus erythematosus; keloids; localized inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; and necrobiosis lipoidica diabeticoruml; may be useful in cystic tumors of an aponeurosis or tendon (ganglia)

Usual Adult Dose for Keloids

Doses should be individualized based on the disease and lesion being treated

• Use 10 mg/mL concentration only; multiple sites may be injected, separate by 1 cm or more
• May repeat at weekly or less frequent intervals as necessary

Comments:

• Inject directly into lesion, i.e. intradermally or subcutaneously.
• The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Uses: For the treatment of alopecia areata; discoid lupus erythematosus; keloids; localized inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; and necrobiosis lipoidica diabeticoruml; may be useful in cystic tumors of an aponeurosis or tendon (ganglia)

Usual Adult Dose for Osteoarthritis

Doses should be individualized based on the disease and lesion being treated

Intra-Articular (IA) Administration; may use 10 mg/mL or 40 mg/mL injectable suspension

• Smaller joints: 2.5 to 5 mg (up to 10 mg)
• Larger joints: 5 to 15 mg (up to 40 mg)

Maximum dose: For single injections into several joints, up to a total of 20 mg or more (using 10 mg/mL concentration) OR 80 mg (using 40 mg/mL concentration) have been used
Maximum frequency: Every 3 to 4 weeks; injection should be as infrequent as possible to avoid possible joint destruction

Extended-release: (Zilretta[R]) 32 mg/5 mL:

• For Osteoarthritic Knee Pain only: 32 mg as a single intra-articular injection
• The safety and efficacy of repeat administration has not been evaluated

Comments:

• If an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to provide pain relief and prevent undue dilution of the steroid.
• Zilretta(R) is not suitable for use in small joints, such as the hand, it is only indicated for osteoarthritis of the knee.

Use; Adjunctive therapy for acute episodes or exacerbations of osteoarthritis

Usual Adult Dose for Multiple Sclerosis

160 mg IM once a day for 1 week; then 64 mg IM every other day for 1 month

Comments:

• Controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, although they have not been shown to affect the natural history of the disease.
• Short-term high-dose corticosteroids are an accepted standard of care for treating relapses of multiple sclerosis; chronic daily corticosteroids are not recommended.
• IV methylprednisolone, oral prednisone and prednisolone are the corticosteroids most studied and cited in clinical guidelines; while this drug may be used, efficacy studies and comparative data are lacking.

Use: For the treatment of acute exacerbations of multiple sclerosis.

Usual Adult Dose for Allergic Rhinitis

40 to 100 mg IM once

Comments:

• Use 40 mg/mL concentration only
• Patients who have not responded to conventional therapy for hay fever or pollen asthma may obtain symptom relief with a single injection.

Use: For symptom relief of hay fever or pollen asthma.

Usual Adult Dose for Anti-inflammatory

Doses should be individualized based on disease and response of patient:

Initial dose: 60 mg IM deep into gluteal muscle

• Dose adjustments within the range of 40 to 80 mg are generally adequate
• Dose ranges of 2.5 to 100 mg have been used; in certain overwhelming, acute, life-threatening situations, much higher doses may be used

Comments:

• Use 40 mg/mL concentration only
• Improper IM administration may result in atrophy of subcutaneous fat; therefore, IM injection should be made deeply into the gluteal muscle; alternative sites should be used for subsequent injections.

Uses: As an anti-inflammatory when systemic corticosteroid therapy is appropriate, such as treatment of certain allergic states; dermatologic diseases, endocrine disorders, gastrointestinal diseases, hematologic disorders, neoplastic, nervous system, ophthalmic, renal, or respiratory diseases.

Usual Pediatric Dose for Anti-inflammatory

Doses should be individualized based on disease and response of patient:

Initial dose: 0.11 to 1.6 mg/kg/day OR 3.2 to 48 mg/m2/day IM in 3 or 4 divided doses

• Doses should be adjusted to response with goal of titrating to lowest effective dose

Comments:

• Use 40 mg/mL concentration only
• Improper administration may result in atrophy of subcutaneous fat; injection should be made deeply into the gluteal muscle and alternative sites used for subsequent injections.
• In order to minimize the potential growth effects of this drug, titrate to the lowest effective dose.

Uses: As an anti-inflammatory when systemic corticosteroid therapy is appropriate, such as treatment of certain allergic states; dermatologic diseases, endocrine disorders, gastrointestinal diseases, hematologic disorders, neoplastic, nervous system, ophthalmic, renal, or respiratory diseases.

Renal Dose Adjustments

Use with caution

Liver Dose Adjustments

Use with caution

Dose Adjustments

Drug Discontinuation:

• Abrupt discontinuation after high-dose or long-term therapy should be avoided.
• Drug-induced adrenocortical insufficiency may persist for up to 12 months after drug discontinuation.

Recommendations:

• Gradual dose reduction is recommended.
• In situations of stress, restarting or increasing corticosteroid dose may be needed to account for drug-induced adrenocortical insufficiency.
• Long-acting preparations such as triamcinolone are not suitable for use in acute stress situations.

Precautions

Some parenteral formulations contain benzyl alcohol and should therefore not be used in premature or low birthweight infants.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Shake well before use to ensure a uniform suspension
• Once syringe is prepared, inject promptly to prevent settling in syringe

CONCENTRATION:

• Use 40 mg/mL for IM, Intra-Articular (IA), and Soft-Tissue Administration only
• Use 10 mg/mL for IA and Intralesional administration only
• Use extended-release suspension for IA administration into knee only

ADMINISTRATION:

• For IM administration: Inject deeply into gluteal muscle using a minimum needle length of 1.5 inches (adults); a longer needle may be needed for obese patients
• For IA administration: Follow IA injection technique; if an excessive amount of synovial fluid is present in the joint, aspirate some (not all) to aid in the relief of pain; prior use of a local anesthetic may be desirable
• For Soft Tissue administration: For non-specific tenosynovitis, injection should be made into the tendon sheath rather than the tendon substance; epicondylitis should be treated by infiltrating into the area of greatest tenderness

For Intralesional administration: Inject directly into lesion (i.e. intradermally or subcutaneously); a tuberculin syringe and small-bore needle (23 to 25 gauge) are preferred to improve accuracy of dosing; ethyl chloride spray may be used as anesthetic

Storage requirements:
Injectable suspensions:

• Store at 20C to 25C (68F to 77F); do not refrigerate; avoid freezing; protect from light

Extended-release suspension:

• Prior to use; Store in refrigerator 2C to 8C (36F to 46F); if refrigeration is not possible, may store at room temperature for up to 6 weeks at temperatures not exceeding 25C (77F); do not freeze
• In use extended-release suspension: Stable at ambient conditions for up to 4 hours; gently swirl to resuspend

Reconstitution/preparation techniques:

• Corticosteroids are sensitive to heat and therefore should not be autoclaved to sterilize the exterior of the vial
• Extended-release injectable suspension is supplied as a single-dose kit: must use supplied diluent to reconstitute; See Manufacturer's Instructions for complete instructions.

General:

• Extended-release suspension is not interchangeable with other formulations of injectable triamcinolone acetonide.
• Extended-release suspension is not intended for repeat administrations.
• Corticosteroids confer palliative, symptomatic treatment by their anti-inflammatory effects; they are not curative. Patients should be warned about over use of treated joints.
• Long acting preparations such as triamcinolone acetonide are not suitable for use in acute stress situations which require systemic steroids.
• Patients on immunosuppressive doses should not receive live vaccines.

Monitoring:

• Monitor intraocular pressure for patients on steroid therapy for more than 6 weeks
• Monitor linear growth of pediatric patients treated with corticosteroids

Patient advice:

• Patients should be warned to avoid over use of treated joints.
• Patients should understand that this drug is a corticosteroid and counseled on what that specifically means for them.
• Patients on long term steroid therapy should understand that during times of stress, such as surgery or infection, additional supplementation may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card identifying their corticosteroid use.
• Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists and that they should avoid exposure to chickenpox or measles; if exposed, they should consult their healthcare professional promptly.
• Patients should be advised of possible adverse reactions including fluid retention, changes in glucose tolerance, high blood pressure, behavioral/mood changes, increased appetite, and weight gain.

Frequently asked questions

• Where should you not use triamcinolone acetonide cream?
• Is triamcinolone good for poison ivy?
• Is triamcinolone acetonide an antifungal cream?
• Clobetasol vs. triamcinolone - how do they compare?
• What causes Plaque Psoriasis?
• Can triamcinolone acetonide B be used to treat severe diaper rash on a little girl?
• Halobetasol vs triamcinolone: which is better?