What are the commonly used injectable corticosteroids (Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)) and their typical doses?

Common Injectable Corticosteroids and Their Typical Doses

Injectable corticosteroids are commonly used for various inflammatory conditions, with specific preparations and dosages that vary based on the clinical indication and administration route.

Major Injectable Corticosteroid Preparations

• Triamcinolone acetonide: Most widely used in dermatology and musculoskeletal injections 1, 2

  • Intramuscular: 40-80 mg for systemic effects (range 20-100 mg) 1
  • Intra-articular: 2.5-5 mg for smaller joints, 5-15 mg for larger joints 1
  • For larger joints (e.g., knee): 10-40 mg (recent evidence suggests 10 mg may be as effective as 40 mg) 3
  • For shoulder conditions: 20 mg is as effective as 40 mg 4

• Betamethasone: Used for systemic and local effects 5

  • Systemic dosing: 0.75-9 mg daily depending on condition 5
  • Pediatric dosing: 0.02-0.3 mg/kg/day divided into 3-4 doses 5
  • Bursitis/tenosynovitis: 1 mL of injectable suspension 5
  • Rheumatoid/osteoarthritis: 0.5-2 mL intra-articularly 5

• Methylprednisolone: Used for various inflammatory conditions 6, 4

  • Systemic use: 40-60 mg/day for 3-10 days for acute conditions 6
  • Repository injection: 40-80 mg/mL intramuscularly 6
  • Similar efficacy to triamcinolone for joint injections 4

• Hydrocortisone: Used primarily for adrenal insufficiency 6

  • Perioperative dosing: 100 mg IV at induction, followed by 200 mg/24h continuous infusion 6
  • For patients on chronic steroids undergoing surgery: 100 mg IV at induction 6

• Dexamethasone: Used for various conditions including severe asthma 6

  • Typical dose: 6-8 mg intravenously 6
  • For asthma exacerbations: 10 mg IV (range: 4-10 mg) 6

Dosing Considerations

• Relative potency (compared to hydrocortisone at 20 mg) 1, 5:

  • Cortisone: 25 mg
  • Prednisolone/Prednisone: 5 mg
  • Methylprednisolone: 4 mg
  • Triamcinolone: 4 mg
  • Paramethasone: 2 mg
  • Betamethasone: 0.75 mg
  • Dexamethasone: 0.75 mg

• Intra-articular dosing principles:

  • Lower doses (10-20 mg triamcinolone) may be as effective as higher doses (40 mg) for knee and shoulder injections 4, 3, 7
  • Dose should be adjusted based on joint size and severity of inflammation 1
  • For small joints: 2.5-5 mg triamcinolone 1
  • For large joints: 5-40 mg triamcinolone 1, 4

Administration Considerations

• Technique is critical for efficacy and minimizing complications 2
• Ultrasound guidance increases accuracy and reduces procedural pain 4
• Local anesthetics can be mixed with corticosteroids (avoid preparations containing parabens) 5
• Strict aseptic technique is mandatory for all injections 1

Potential Adverse Effects

• Local effects: Skin atrophy, telangiectasia, pigmentary changes, infection risk 8, 2
• Systemic effects: Adrenal suppression, increased blood glucose, reduced bone mineral density 4
• Joint-specific concerns: Potential detrimental effects on cartilage with repeated high-dose injections 4, 3

Special Considerations

• Frequency: Limit injections to 3-4 times yearly in the same location to minimize adverse effects 4
• Pregnancy: Most injectable corticosteroids should be used with caution during pregnancy 6
• Children: Dosing is weight-based and generally lower than adult doses 6, 1

Injectable corticosteroids remain a valuable treatment option for various inflammatory conditions when used at appropriate doses and with proper technique.