Intramuscular Injection: Provides an extended duration of therapeutic effect and fewer side effects of the kind associated with oral corticosteroid therapy, particularly gastro-intestinal reactions such as peptic ulceration. Studies indicate that, following a single intramuscular dose of 80 mg triamcinolone acetonide, adrenal suppression occurs within 24 - 48 hours and then gradually returns to normal, usually in approximately three weeks. This finding correlates closely with the extended duration of therapeutic action of triamcinolone acetonide.
In common with other corticosteroids, triamcinolone is metabolised largely hepatically but also by the kidney and is excreted in urine. The main metabolic route is 6-beta-hydroxylation; no significant hydrolytic cleavage of the acetonide occurs. In view of the hepatic metabolism and renal excretion of triamcinolone acetonide, functional impairments of the liver or kidney may affect the pharmacokinetics of the drug. This may become clinically significant if large or frequent doses of intradermal or intra-articular triamcinolone acetonide are given.
The procedure for injection therapy is uncomplicated and well established. The object is to inject the corticosteroid preparation with as little pain and as few complications as possible. The technique is similar for muscle, periarticular, or articular injections. Selection of the site and careful attention to surface and deep anatomy are of paramount importance. [ 20 ] Injections in the vicinity of known nerve or arterial landmarks should not be attempted. For example, a lateral epicondyle injection is relatively easy. An injection into at the medial epicondyle (near the ulnar nerve) carries greater risk, and extra care must be taken to identify the nerve, outline its course, and avoid it.