Maximum Volume for Gluteal Intramuscular Injection
The maximum volume that can be safely injected into the gluteal muscle of a standard adult is 3 mL per injection site. 1
Standard Volume Recommendations
The gluteal muscle can accommodate up to 3 mL per injection, as demonstrated by long-acting cabotegravir PrEP which is administered at 600 mg in 3 mL volume via gluteal intramuscular injection. 1
Testosterone undecanoate is administered as 750 mg in 3 mL (250 mg/mL concentration) via gluteal intramuscular injection only, providing additional evidence that 3 mL is a safe and effective volume for this site. 1, 2
For testosterone enanthate and cypionate, typical volumes range from 0.5-1 mL when dosed at 100-200 mg every 2 weeks or 50-100 mg weekly, though the muscle can accommodate larger volumes if needed. 1, 2
Site Selection Considerations
The ventrogluteal site is generally preferred over the dorsogluteal site due to greater muscle thickness (40.13 ± 5.59 mm vs 25.61 ± 4.30 mm) and lower subcutaneous tissue thickness (20.07 ± 6.64 mm vs 22.97 ± 7.40 mm) in older adults. 3
Both dorsogluteal and ventrogluteal sites are acceptable for intramuscular injections when proper technique is used, though the ventrogluteal site may be safer due to lower risk of bone contact and subcutaneous injection. 3, 4
The dorsogluteal site should be used when directed by drug package insert, clinical need, nursing judgment, or patient preference, particularly for medications that specifically require this site. 4
Needle Length Requirements
For adults, a 1-1.5 inch, 22-25 gauge needle is recommended for gluteal intramuscular injections. 1
In obese patients (BMI >30), needles longer than 1.5 inches may be required, as subcutaneous tissue thickness can exceed 51 mm at the dorsogluteal site and 54 mm at the ventrogluteal site. 5
Standard 1.5-inch needles fail to reach muscle in 98% of obese women and 37% of obese men at the dorsogluteal site, emphasizing the importance of adequate needle length selection based on body habitus. 5
Important Caveats
Multiple injections in the same limb should be separated by at least 1 inch to allow differentiation of any local reactions. 1
Aspiration before injection is recommended - if blood appears in the needle hub, withdraw and select a new site. 1
Patients with gluteal implants or fillers should use caution with gluteal injections, as these may interfere with proper medication delivery. 1
The deltoid muscle is NOT appropriate for volumes of 3 mL - it should be reserved for smaller volumes (typically ≤1 mL), with the gluteal sites used for larger volume injections. 1