Triamcinolone Acetonide (Intra-articular)

SCOPE — this is the page's PRIMARY route: intra-articular injection, which is exactly what the fetched UK SPC doses. ⚠️ THE INTRAMUSCULAR ROUTE THIS PAGE ALSO NAMES IS NOT COVERED. The fetched product is licensed for injection into joints and skin only — §4.2 verbatim: 'Adcortyl is for intra-articular or intra-dermal injection ONLY. The safety and efficacy of administration by other routes has yet to be established (see sections 4.3 and 4.4).' No intramuscular dose, and no PMR or RA bridging regimen, appears anywhere in this bundle; do not read the intra-articular figures below as an IM dose. The only UK SPC in this bundle is the 10 mg/ml presentation, whose intra-articular doses are 2.5–5 mg for smaller joints and 5–15 mg for larger joints. The SPC's own instruction is that subsequent doses are given when symptoms recur and not at set intervals. || §4.2 VERBATIM, the published figures: 'Adults: The dose of Adcortyl injection for intra-articular administration, and injection into tendon sheaths and bursae, is dependent on the size of the joint to be treated and on the severity of the condition. Doses of 2.5-5 mg (0.25-0.5 ml) for smaller joints and 5-15 mg (0.5-1.5 ml) for larger joints usually alleviate the symptoms. Triamcinolone acetonide 40 mg/ml (Kenalog) is available to facilitate administration of larger doses (see section 4.4 re Achilles tendon).' || ⚠️ STRENGTH GAP — THE 40 mg/ml PRODUCT IS NAMED BUT NOT DOSED. The sentence above is the only mention of Kenalog 40 mg/ml in the whole bundle; it states that the stronger product exists to allow larger doses but gives no figure for it, and the Kenalog SPC was not fetched. Every milligram figure published here therefore belongs to the 10 mg/ml presentation, and no number in this bundle supports a 40 mg intra-articular dose. Check the strength of the vial in your hand before drawing up. || MAX DOSE DELIBERATELY LEFT EMPTY. §4.2 states no maximum for the intra-articular route. The two caps that do appear — 'No more than 5 mg (0.5 ml) should be injected at any one site' and 'If several sites are injected the total dosage administered should not exceed 30 mg (3 ml)' — sit inside the INTRADERMAL paragraph ('Intradermal dosage is usually 2-3 mg (0.2-0.3 ml), depending on the size of the lesion. No more than 5 mg (0.5 ml) should be injected at any one site. If several sites are injected the total dosage administered should not exceed 30 mg (3 ml). The injection may be repeated if necessary, at one or two week intervals.'). They are a different route's ceiling, and a 5 mg per-site cap would directly contradict the 5–15 mg intra-articular dose for larger joints, so they are NOT carried into maxDose. || §4.4 INJECTION-SPECIFIC WARNINGS, verbatim: 'Corticosteroids should not be injected into unstable joints. Patients should be specifically warned to avoid over-use of joints in which symptomatic benefit has been obtained. Severe joint destruction with necrosis of bone may occur if repeated intra-articular injections are given over a long period of time. 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. Due to the absence of a true tendon sheath, the Achilles tendon should not be injected with depot corticosteroids.' And: 'Intra-articular injection should not be carried out in the presence of active infection in or near joints. The preparation should not be used to alleviate joint pain arising from infectious states such as gonococcal or tubercular arthritis.' || §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.' 'Several instances of blindness have been reported following injection of corticosteroid suspensions into the nasal turbinates and intralesional injection about the head.' || §4.4 verbatim, minimising systemic effect: 'Undesirable effects may be minimised using the lowest effective dose for the minimum period... Frequent patient review is required to titrate the dose appropriately against disease activity.' '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... During prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage.' || ELDERLY, §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, hypokalaemia, susceptibility to infection and thinning of the skin. Close supervision is required to avoid life-threatening reactions.' || THE SECOND PROVIDER IN THIS BUNDLE IS THE WRONG ROUTE: the US 'Trilona' record is a topical corticosteroid label whose entire posology is 'Topical corticosteroids are generally applied to the affected area as a thin film two to four times daily for the 0.025% strength and two or three times daily for the 0.1% and 0.5% strength'. It contributes no injection dose and its skin-reaction profile is not the profile of an injected depot steroid. || ⚠️ §4.4 and §4.8 are truncated at the source-fetch limit — treat neither as complete.

NO PER-KILOGRAM OR PER-SQUARE-METRE PAEDIATRIC FIGURE EXISTS IN THIS BUNDLE, so dosePerKg is null and the weight calculator is deliberately left unset. §4.2 VERBATIM, in full: 'Children: Adcortyl is not recommended in children under 6 years. Adcortyl intra-articular/intradermal may be used in older children in suitably adjusted dosages. 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 (see section 4.4).' The SPC gives no figure for what a 'suitably adjusted' dose is. || concentration is null because the bundle offers two different strengths and only one is sourced: the fetched SPC product is 10 mg/ml, while the 40 mg/ml (Kenalog) product it names was not fetched. Pinning a single number here would be a real mg-vs-ml hazard on a paediatric card. || Specialist paediatric rheumatology advice, and a children's formulary, should be used for any paediatric joint injection. || The SPC's own paediatric content is the under-6 restriction quoted above.