Adult Dosing
Intramuscular administration
- 60 mg IM q6wk, may give additional 20-100 mg IM PRN
- Intralesional injection: (use 10 mg/mL suspension) 1 mg/injection site 1 or more times/week; no more than 30 mg/day
Intra-articular/intrasynovial/soft-tissue injection
- Large joints: 15-40 mg
- Small joints/tendon sheath inflammation: 2.5-10 mg
Note:
- Dilute with local anesthetic before intra-articular/intralesional injection
- Care should be taken with this kind of injection, particularly in the deltoid region, to avoid injecting the suspension into the tissues surrounding the site, since this may lead to tissue atrophy
Intravitreally (Triesence)
- Visualization during vitrectomy: 1 to 4 mg (25 to 100 microliters of 40 mg/mL suspension)
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Intramuscular administration
- Allergic states
- Dermatologic diseases: Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome)
- Endocrine disorders: Primary or secondary adrenocortical insufficiency, congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis
- Hematologic disorders: Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia
- Neoplastic diseases: For the palliative management of leukemias and lymphomas
- Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy
- Ophthalmic: Sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids, visualization during vitrectomy
- Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus
- Respiratory diseases: Asthma, berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis
- Rheumatic disorders: As adjunctive therapy for short-term administration in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis
Intra-articular or soft tissue administration
- Adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis, or osteoarthritis
Intralesional administration
- Should not be administered intravenously, epidurally or intrathecally
- May cause adverse effects such as cataracts, infections, and glaucoma. During therapy, intraocular pressure (IOP) should be monitored
- Chronic use may cause Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, and hyperglycemia. Taper doses gradually if such conditions occur
- Therapy may cause increased susceptibility to new infection and increased risk of exacerbation, dissemination, or reactivation of latent infection
- Carefully monitor blood pressure and sodium, potassium serum levels as therapy may cause elevated blood pressure, salt and water retention, and hypokalemia
- Use with caution in patients with GI disorders as GI perforation has been reported
- Behavioral and mood disturbances such as euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis have been observed with the use of therapy
- Bone density should be measured in patients receiving long term corticosteroid therapy. Therapy may cause decrease in bone density
- Intra-articular injection may damage joint tissues
- Avoid administration of live or live attenuated vaccines in patients receiving immunosuppressive doses of corticosteroids
- Pediatric patients on long-term corticosteroids should be monitored carefully, as therapy may have negative effects on growth and development
- Fetal harm can occur with first trimester use
- Therapy may cause increased appetite and weight gain
- Risk of activation or exacerbation of latent disease
Cautions: Use cautiously in
Pregnancy Category:D
Breastfeeding: Safety unknown. An alternate drug may be preferred, especially while nursing a newborn. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 13 August 2013).
