Typical doses of long-acting (depot) intraarticular glucocorticoids for adults with musculoskeletal conditions

Depot glucocorticoid suspension	Dose according to joint size or extraarticular site			Average duration of action (days)	Available strengths
Depot glucocorticoid suspension	Small*	Medium^¶	Large^Δ	Average duration of action (days)	Available strengths
Methylprednisolone acetate	10 to 20 mg	40 to 60 mg	40 to 80 mg	7 to 84	20 mg/mL 40 mg/mL 80 mg/mL
Triamcinolone acetonide^◊	8 to 10 mg	20 to 30 mg	20 to 40 mg	14	10 mg/mL 40 mg/mL 80 mg/mL

There is a lack of consensus on optimal dosing for joint injections. The dose ranges in this table are those often used by UpToDate contributors; a lower or higher dose may be used depending upon size of joint/body region, severity of inflammation, and amount of articular fluid present. UpToDate contributors usually dilute the glucocorticoid suspension with an equal volume of 1 or 2% lidocaine or other local anesthetic. Refer to topic on intraarticular and soft tissue injections.

* Including metacarpophalangeal and proximal interphalangeal joints, tendon sheaths.
¶ Including wrist, ankle, and elbow.
Δ Including knee, shoulder, and hip.
◊ An extended-release triamcinolone acetonide microsphere suspension (Zilretta) is also available for knee osteoarthritis pain as a 32 mg/mL preparation. It is not interchangeable with other triamcinolone acetonide suspensions and is costlier.

Courtesy of W Neal Roberts, Jr, MD and Derrick Todd, MD. Additional data from:

Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 2005; 13:37.
US Food & Drug Administration. Drugs@FDA: FDA Approved Drug Products. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/ (Accessed on September 4, 2019).

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Typical doses of long-acting (depot) intraarticular glucocorticoids for adults with musculoskeletal conditions