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Long-acting corticosteroid Pregnancy: Section 4.6: 'Triamcinolone crosses the placenta. Corticosteroids are teratogenic in animal experiments. The significance of this fact for humans is not exactly known, but so far the use of corticosteroids has not been shown to increase the incidence of malformations. Long-term use of corticosteroids in humans and animals has led to a decrease in weight of the placenta and the newborn. Long-term corticosteroid therapy is also associated with a risk of adrenocortical suppression in the newborn. The product should be used during pregnancy only if the benefit to the mother is clearly greater than the risk to the fetus.' Breast-feeding: 'Triamcinolone hexacetonide is excreted in human milk, but is not likely to have any effect on the child at therapeutic doses. Caution must be observed in the long-term use of large doses.' Fertility: corticosteroid therapy may cause menstrual disorders and amenorrhea; long-term treatment in men may prevent spermatogenesis.

Triamcinolone hexacetonide

Brand names: Lederspan

Triamcinolone hexacetonide is a long-acting corticosteroid given by intra-articular injection to reduce inflammation in conditions such as inflammatory arthritis and juvenile idiopathic arthritis.

Adult dose

Dose: Adults and adolescents, intra-articular injection for subacute and chronic inflammatory joint diseases (rheumatoid arthritis, juvenile idiopathic arthritis, osteoarthritis and post-traumatic arthritis, synovitis, tendinitis, bursitis and epicondylitis): 2-20 mg per injection, determined individually according to the size of the joint and the amount of articular fluid. Large joints (e.g. hip, knee, shoulder) generally 10-20 mg (0.5-1 ml); medium-sized joints 5-10 mg (0.25-0.5 ml); smaller joints 2-6 mg (0.1-0.3 ml). Product strength 20 mg/ml.
Route: Intra-articular
Frequency: The next dose and the number of injections depend on the progress of the clinical condition; injections into an individual joint more frequently than at 3-4 week intervals are not recommended; an injection may be given into two joints at the most at each treatment session.
Strength: 20 mg/ml suspension for injection (SPC section 2). The SPC covers intra-articular, intrasynovial and periarticular use; this page is dosed for the INTRA-ARTICULAR route (the SPC states the 2-20 mg individually determined dose 'for all indications' under intra-articular injection). Periarticular injection (adults and adolescents only): bursitis/epicondylitis generally 10-20 mg (0.5-1 ml) depending on the size of the bursa and the severity of the disease, a single treatment being sufficient in the majority of cases; synovitis/tendinitis generally 10-20 mg (0.5-1 ml), with the need for additional injections determined on response. If there is a lot of articular fluid it can be aspirated before administration. Accumulation of the drug at the injection site must be avoided because it may cause atrophy. Do not administer in unstable joints. Shake the vial carefully before use; observe asepsis; sterilise the injection site using the same technique as with lumbar puncture. Must not be used intravenously, intraocularly, epidurally or intrathecally. Contains benzyl alcohol 9 mg/ml and sorbitol 455 mg/ml (hereditary fructose intolerance: do not give). SPC section 4.2 refers to section 6.6 for dilution instructions (not retrieved in the bundle). Doses for any route other than intra-articular and periarticular are not covered by this SPC and none is written here.

Paediatric dose

Dose: Intra-articular use in children aged 3-12 years with juvenile idiopathic arthritis (JIA) only: 1 mg/kg for large joints (knees, hips and shoulders); 0.5 mg/kg for smaller joints (ankles, wrists and elbows). For the hands and feet, 1-2 mg/joint for metacarpophalangeal/metatarsophalangeal (MCP/MTP) joints and 0.6-1 mg/joint for proximal interphalangeal (PIP) joints may be used.
Route: Intra-articular
Frequency: Not stated separately for children in the SPC.
These are the SPC's own printed figures (section 4.2 'Dosage for intraarticular use in children aged 3 - 12 years with Juvenile Idiopathic Arthritis'), not scaled doses. The SPC gives adults-and-adolescents dosing as the adult regimen above. The SPC states the product must not be given to infants born recently or prematurely, nor to infants and children up to 3 years of age (benzyl alcohol, section 4.3); not to be given to newborn babies up to 4 weeks old and not used for more than a week in young children under 3 years (section 4.4). Monitor growth and development of children on prolonged corticosteroid therapy (section 4.4).

Dose adjustments

Renal

No renal dose adjustment is printed in SPC section 4.2. Section 4.4 lists renal insufficiency, acute glomerulonephritis and chronic nephritis among the conditions in which this potent glucocorticoid should be used with caution, and states that high volumes of benzyl alcohol should be used with caution in kidney impairment because of the risk of accumulation and toxicity (metabolic acidosis).

Hepatic

No hepatic dose adjustment is printed in SPC section 4.2. Section 4.4 lists cirrhosis among the conditions for caution, and states that high volumes of benzyl alcohol should be used with caution in liver impairment because of the risk of accumulation and toxicity (metabolic acidosis).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients (section 4.3)
  • Infants born recently or prematurely, and infants and children up to 3 years of age, because of benzyl alcohol (toxic and anaphylactoid reactions) (section 4.3)
  • Active tuberculosis (section 4.3)
  • Herpes simplex keratitis (section 4.3)
  • Acute psychoses (section 4.3)
  • Systemic mycoses and parasitoses (strongyloid infections) (section 4.3)
  • Not to be given intravenously, intraocularly, epidurally or intrathecally (section 4.4)
  • Intra-articular injection should not be carried out in the presence of active infection in or near joints; not to be used to alleviate joint pain arising from infectious states such as gonococcal or tubercular arthritis (section 4.4)
  • Hereditary fructose intolerance (contains sorbitol) (section 4.4)

Side effects

  • Systemic adverse effects are rare but may occur as a result of repeated periarticular injection; transient adrenocortical suppression has been observed during the first week after injection (section 4.8)
  • Repeated injections may damage the joint; severe joint destruction with necrosis of bone may occur if repeated intra-articular injections are given over a long period (section 4.4)
  • Skin: impaired wound healing, thin and fragile skin, atrophy, petechiae and ecchymoses; very rare hyperpigmentation or hypopigmentation (section 4.8)
  • Musculoskeletal: very rare calcinosis and tendon rupture; loss of muscle mass, osteoporosis, aseptic necrosis of the heads of the humerus and femur, spontaneous fractures, Charcot-like arthropathy (section 4.8)
  • Endocrine: menstrual irregularities, amenorrhoea, postmenopausal vaginal bleeding, cushingoid state, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, hyperglycaemia (section 4.8)
  • Infections: latent infection, reactivation of an infection, increased susceptibility to infections (section 4.8)
  • Eye: posterior subcapsular cataracts, increased intraocular pressure, glaucoma, blurred vision, central serous chorioretinopathy (section 4.8)
  • Metabolic: hypokalaemia, sodium accumulation, fluid retention (section 4.8)
  • Psychiatric: insomnia, depression (sometimes severe), euphoria, mood swings, psychotic symptoms (section 4.8)
  • Very rare anaphylaxis-type reactions and thromboembolism (section 4.8)

Interactions

  • Amphotericin B injection and potassium-depleting agents - monitor for additive hypokalaemia (section 4.5)
  • Oral anticoagulants - corticosteroids may potentiate or decrease the anticoagulant effect; monitor closely (section 4.5)
  • Antidiabetics and insulin - corticosteroids may increase blood glucose; monitor diabetic patients on starting, stopping or dose change (section 4.5)
  • Hepatic enzyme inducers (barbiturates, phenytoin, carbamazepine, rifampicin, primidone, aminoglutethimide) - increased metabolic clearance; possible reduced effect, adjust dose (section 4.5)
  • CYP3A4 inhibitors (protease inhibitors including ritonavir, ketoconazole, cobicistat-containing products) - decreased corticosteroid clearance with Cushing's syndrome and adrenal suppression; co-administration not recommended unless benefit outweighs risk (sections 4.4, 4.5)
  • NSAIDs - corticosteroids may increase the incidence/severity of gastrointestinal bleeding and ulceration; may reduce serum salicylate levels (section 4.5)
  • Cyclosporin - increase in both cyclosporin and corticosteroid activity (section 4.5)
  • Digitalis glycosides - increased likelihood of digitalis toxicity (section 4.5)
  • Antihypertensives including diuretics - reduction in arterial blood pressure may be diminished (section 4.5)
  • Somatropin - growth-promoting effect may be inhibited during long-term therapy (section 4.5)
  • Live vaccines - not to be given with moderate or high dose corticosteroids for longer than 2 weeks; intraarticular and periarticular use, or steroids for less than 2 weeks, are not considered a contraindication (section 4.4)

Monitoring

  • Frequent patient review to titrate the dose against disease activity (section 4.4)
  • Growth and development of children on prolonged corticosteroid therapy (section 4.4)
  • Closely monitor patients taking oral anticoagulants with corticosteroids (section 4.5)
  • Monitor diabetic patients, especially on starting or stopping corticosteroids and with dose changes (section 4.5)
  • Monitor for additive hypokalaemia with amphotericin B or potassium-depleting agents (section 4.5)
  • Monitor for systemic corticosteroid effects if co-administered with CYP3A inhibitors (sections 4.4, 4.5)
  • Ophthalmology referral if blurred vision or other visual disturbances occur (section 4.4)

Clinical monograph

How it works

As a glucocorticoid it binds intracellular receptors to suppress inflammatory mediator production and immune cell activity within the joint, providing prolonged local anti-inflammatory effect.

Prescribing in practice

  • Septic arthritis must be excluded before injection, and a clearly infected joint is a contraindication.
  • It is intended for intra-articular use only and is not given intravenously.
  • Repeated injections into the same joint should be limited to reduce cartilage and soft-tissue damage; consult current prescribing references for paediatric use via a children's formulary.

Monitoring

Monitor the injected joint for response and signs of infection, and observe for systemic glucocorticoid effects with repeated or large injections.

Counselling the patient

  • A short-lived flare of joint pain can occur after injection before benefit is felt.
  • Report increasing pain, swelling, redness or fever in the joint, which could indicate infection.
  • Skin thinning or colour change at the injection site can occur.

Evidence & guidelines

Intra-articular corticosteroid use is supported by the SPC and NICE/specialist rheumatology guidance.

Reference: BSR; 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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