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Corticosteroid (Intra-articular / Soft Tissue) Pregnancy: Section 4.6 VERBATIM: 'Pregnancy: The ability of corticosteroids to cross the placenta varies between individual drugs, however triamcinolone does cross the placenta. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate, intra-uterine growth retardation and effects on brain growth and development. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate / lip in man. However, when administered for prolonged periods or repeatedly during pregnancy, corticosteroids may increase the risk of intra-uterine growth retardation. Hypoadrenalism may, in theory, occur in the neonate following prenatal exposure to corticosteroids but usually resolves spontaneously following birth and is rarely clinically important. As with all drugs, corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks. When corticosteroids are essential, however, patients with normal pregnancies may be treated as though they were in the non-gravid state.' BREAST-FEEDING, verbatim: 'Corticosteroids may pass into breast milk, although no data are available for triamcinolone. Infants of mothers taking high doses of systemic corticosteroids for prolonged periods may have a degree of adrenal suppression.' (The US provider's pregnancy text in this bundle is for a TOPICAL product and is not applied here.)

Triamcinolone Acetonide 10–40mg (Kenalog)

Brand names: Kenalog, Adcortyl (intra-articular)

Triamcinolone acetonide is a long-acting corticosteroid administered by intra-articular or soft-tissue injection to relieve inflammation in conditions such as osteoarthritis and inflammatory arthropathies.

Adult dose

Dose: Smaller joints: 5-10 mg (0.125-0.25 ml). Larger joints: up to 40 mg (1.0 ml). The same range applies to injection into tendon sheaths and bursae. Section 4.2 verbatim: 'For intra-articular administration or injection into tendon sheaths and bursae, the dose of Kenalog Injection may vary from 5 mg to 10 mg (0.125 - 0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints, depending on the specific disease entity being treated.'
Route: Intra-articular injection, and injection into tendon sheaths and bursae. Section 4.2 verbatim: 'Kenalog is for Intra-articular/Intramuscular injection ONLY. The safety and efficacy of administration by other routes has yet to be established.' 'Strict aseptic precautions should be observed.'
Frequency: Not at fixed intervals — section 4.2 verbatim: 'Since the duration of effect is variable, subsequent doses should be given when symptoms recur and not at set intervals.' The only interval figure the SPC gives is a withdrawal threshold, not a redosing schedule: more than one injection in a three-week period counts as 'more than physiological doses', and 'A single dose, which is not repeated within a three week period, is unlikely to lead to clinically relevant hpa-axis suppression in the majority of patients.'
Max: Up to 40 mg (1.0 ml) per larger joint per injection
SCOPE — what is published above is the page's PRIMARY route only: intra-articular and periarticular (tendon sheath / bursa) injection, which is exactly what this SPC doses. The same SPC also covers deep intramuscular (gluteal) administration for systemic corticosteroid therapy; that is a different route with a different purpose and its figures are deliberately NOT shown here. || CONCENTRATION: this product is 40 mg/ml — the SPC's own volume equivalents (40 mg = 1.0 ml, 10 mg = 0.25 ml) pin the strength. Adcortyl is the 10 mg/ml presentation and is a different product: 'It is recommended that, when injections are given into the sheaths of short tendons, Adcortyl Injection (triamcinolone acetonide 10 mg/ml) should be used'. Check the strength of the vial in your hand before drawing up. || MULTIPLE JOINTS IN ONE SESSION, section 4.2 verbatim: 'Single injections into several sites for multiple joint involvement, up to a total of 80 mg, have been given without undue reactions.' The SPC does not phrase this as a maximum and does not limit it to two sites, so it is recorded here rather than in maxDose. || REPEAT INJECTIONS, section 4.2 verbatim: 'In patients who have received more than physiological doses of Kenalog (more than one injection during a three week period), withdrawal should not be abrupt. The dose should be reduced and the dosage interval increased until a dose of not more than 40 mg and a dosage interval of at least three weeks have been achieved as the dose of systemic corticosteroid is reduced.' The only interval the SPC states is three weeks, and it is a withdrawal threshold. || The SPC covers 'tendon sheaths and bursae' generically and names no individual soft-tissue site. || INJECTION TECHNIQUE, section 4.4 verbatim: 'Care should be taken if injections are given into tendon sheaths to avoid injection into the tendon itself. Repeated injection into inflamed tendons should be avoided as it has been shown to cause tendon rupture.' 'Severe joint destruction with necrosis of bone may occur if repeated intra-articular injections are given over a long period of time.' || PAEDIATRIC: no intra-articular paediatric dose is stated anywhere in this bundle. The SPC's paediatric posology is for the INTRAMUSCULAR route only, and 'Kenalog is not recommended for children under six years.' paedDose is therefore null. || ELDERLY, section 4.2 verbatim: 'Treatment of elderly patients, particularly if long term, should be planned bearing in mind the more serious consequences of the common side effects of corticosteroids in old age, especially osteoporosis, diabetes, hypertension, susceptibility to infection and thinning of the skin. Close clinical supervision is required to avoid life-threatening reactions.' || SYSTEMIC ABSORPTION IS REAL: section 4.4 describes adrenal cortical atrophy, and section 4.8 lists Cushingoid appearance, adrenal suppression and hyperglycaemia after this product — do not treat an intra-articular depot steroid as having no systemic effect. || WARNING: sections 4.4 and 4.8 are truncated at the source-fetch limit; text beyond the precautions quoted here was not retrieved.

Dose adjustments

Renal

Not stated. No renal-impairment section was retrieved from the UK SPC in this bundle (section 4.2 covers adults and children over 12, the elderly, and children 6-12 only), and the second provider is a US topical label with no renal section. Do not infer an adjustment, and do not infer from the intra-articular route that none is needed — the SPC is explicit that this depot corticosteroid is systemically absorbed (adrenal suppression, Cushingoid appearance and hyperglycaemia are listed undesirable effects).

Hepatic

Not stated. No hepatic-impairment section was retrieved from the UK SPC in this bundle, and the second provider is a US topical label with no hepatic section. Do not infer an adjustment.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Section 4.3 verbatim: 'Hypersensitivity to any of the ingredients.'
  • Section 4.3 verbatim: 'Systemic infections unless specific anti-infective therapy is employed.'
  • Section 4.3 verbatim: 'Administration by intravenous, intrathecal, epidural, or intraocular injection.' (This product is for intra-articular / intramuscular injection ONLY.)
  • Not a section 4.3 contraindication but a section 4.4 precaution: 'Intra-articular injection should not be carried out in the presence of active infection in or near joints.'
  • Section 4.4 precaution: 'The preparation should not be used to alleviate joint pain arising from infectious states such as gonococcal or tubercular arthritis.'
  • Section 4.4 warning: 'Corticosteroids should not be injected into unstable joints.'
  • Section 4.4 warning: 'Due to the absence of a true tendon sheath, the Achilles tendon should not be injected with depot corticosteroids.'
  • Section 4.4 warning (route safety): adequate studies to demonstrate safety by intra-turbinal, subconjunctival, sub-tenons, retrobulbar and intraocular (intravitreal) injection have not been performed; 'Several instances of blindness have been reported following injection of corticosteroid suspensions into the nasal turbinates and intralesional injection about the head.'
  • Section 4.2 (paediatric): 'Kenalog is not recommended for children under six years.' The SPC states this for its intramuscular paediatric posology; no intra-articular paediatric dose is given at all.
  • WARNING: section 4.3 is short and section 4.4 is truncated at the source-fetch limit — this list is not necessarily complete.

Side effects

  • Common (>=1/100 to <1/10), section 4.8: infection; headache; arthralgia; injection site reaction.
  • Uncommon (>=1/1000 to <1/100), section 4.8 — infections: sterile injection site abscess, masked infection, tuberculosis, candida infection, viral and fungal eye infection, rhinitis, conjunctivitis.
  • Uncommon, section 4.8 — immune: anaphylactoid reaction, anaphylactic reaction, anaphylactoid shock. Section 4.4 verbatim: 'Cases of serious anaphylactic reactions and anaphylactic shock, including death, have been reported in individuals receiving triamcinolone acetonide injection, regardless of the route of administration.'
  • Uncommon, section 4.8 — endocrine: Cushingoid appearance, adrenal suppression, secondary adrenocortical insufficiency, hypopituitarism.
  • Uncommon, section 4.8 — metabolic: sodium retention, fluid retention, hypokalaemic alkalosis, hyperglycaemia, inadequate control of diabetes mellitus, calcium deficiency, increased appetite.
  • Uncommon, section 4.8 — musculoskeletal (most relevant to repeated joint injection): osteoporosis, osteonecrosis, pathological fracture, delayed fracture union, musculoskeletal discomfort, muscular weakness, myopathy, muscle atrophy, growth retardation, neuropathic arthropathy, myalgia.
  • Uncommon, section 4.8 — general and administration site: synovitis, pain, injection site irritation, injection site discomfort, fatigue, impaired healing, hyperthermia.
  • Uncommon, section 4.8 — skin: urticaria, rash, skin hyper- and hypopigmentation, skin atrophy, skin fragility, petechiae, ecchymosis, erythema, hyperhidrosis, purpura, striae, hirsutism, acneiform dermatitis, cutaneous lupus erythematosus, angioedema, pruritus.
  • Uncommon, section 4.8 — eye: blindness, cataract, glaucoma, exophthalmos, corneal perforation, papilloedema. Not known: blurred vision and central serous chorioretinopathy.
  • Uncommon, section 4.8 — psychiatric: psychiatric symptoms, depression, euphoric mood, mood swings, psychotic disorder, personality change, insomnia, drug dependence, irritability, suicidal ideation, anxiety, cognitive disorder.
  • Uncommon, section 4.8 — nervous system: convulsion, epilepsy, syncope, benign intracranial hypertension, neuritis, paraesthesia, raised intracranial pressure, dizziness; ear: vertigo.
  • Uncommon, section 4.8 — cardiovascular: congestive cardiac failure, arrhythmia, hypertension, embolism, thrombophlebitis, necrotising vasculitis, hypotension, flushing.
  • Uncommon, section 4.8 — gastrointestinal: peptic ulcer with perforation or haemorrhage, pancreatitis, abdominal distension, ulcerative oesophagitis, dyspepsia.
  • Uncommon, section 4.8 — renal/reproductive: glycosuria; menstrual irregularities, amenorrhoea, postmenopausal vaginal bleeding.
  • Section 4.4 warning specific to this route: 'Severe joint destruction with necrosis of bone may occur if repeated intra-articular injections are given over a long period of time.' 'Repeated injection into inflamed tendons should be avoided as it has been shown to cause tendon rupture.'
  • WARNING: section 4.8 is truncated at the source-fetch limit (it cuts off mid-'Investigations') — this list is not complete.

Monitoring

  • Section 4.4 verbatim: 'Frequent patient review is required to titrate the dose appropriately against disease activity.' 'Undesirable effects may be minimised using the lowest effective dose for the minimum period.'
  • Exclude infection before injecting: section 4.4 requires that intra-articular injection 'not be carried out in the presence of active infection in or near joints', and infection plus sterile injection site abscess are listed undesirable effects after injection.
  • Warn the patient about joint use afterwards — section 4.4 verbatim: 'Patients should be specifically warned to avoid over-use of joints in which symptomatic benefit has been obtained.'
  • Elderly, especially on long-term treatment — section 4.2 verbatim: 'Close clinical supervision is required to avoid life-threatening reactions', bearing in mind osteoporosis, diabetes, hypertension, susceptibility to infection and thinning of the skin.
  • Children on prolonged corticosteroid therapy — section 4.2 verbatim: 'Growth and development of children on prolonged corticosteroid therapy should be carefully observed.' 'Caution should be used in the event of exposure to chickenpox, measles or other communicable diseases.'
  • Adrenal function after repeated or prolonged dosing — section 4.4 verbatim: 'Adrenal cortical atrophy develops during prolonged therapy and may persist for years after stopping treatment. Withdrawal of corticosteroids after prolonged therapy must, therefore, always be gradual to avoid acute adrenal insufficiency.'
  • Section 4.4 verbatim: 'During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage. If corticosteroids have been stopped following prolonged therapy they may need to be reintroduced temporarily.'
  • Section 4.4 verbatim: 'Patients should carry steroid treatment cards which give clear guidance on the precautions to' [sentence truncated at the source-fetch limit].
  • Glycaemic control — the SPC states no monitoring schedule, but hyperglycaemia and 'diabetes mellitus inadequate control' are listed undesirable effects in section 4.8 of this injectable label.

Clinical monograph

How it works

As a glucocorticoid it suppresses local inflammation by inhibiting inflammatory mediators and reducing immune cell activity within the joint.

Prescribing in practice

  • Septic arthritis and infection in or around the injection site must be excluded before injection, as intra-articular steroid into an infected joint can be catastrophic.
  • Repeated injections into the same joint should be limited because of the risk of cartilage damage and joint deterioration.
  • Injection may cause a transient post-injection flare, local skin and subcutaneous fat atrophy, and systemic effects including a rise in blood glucose.

Monitoring

Observe the injected joint for signs of infection or flare afterwards, and monitor blood glucose in people with diabetes.

Counselling the patient

  • Some increase in pain can occur in the first day or two after the injection before it settles.
  • Seek advice if the joint becomes hot, red, very painful or swollen, or you develop a fever.
  • Your blood sugar may rise temporarily if you have diabetes.

Evidence & guidelines

Intra-articular corticosteroid injection provides short-term symptom relief in osteoarthritis according to NICE guidance.

Reference: NICE NG226 (Osteoarthritis); BSMS and BSRA Joint Injection Guidelines; BMJ Best Practice; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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