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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 technique, indications, and complications that can occur with intraarticular and periarticular injections of glucocorticoids, as well as the use of intraarticular hyaluronic acid derivatives, are discussed separately. (See "Joint aspiration or injection in adults: Technique and indications" and "Joint aspiration or injection in adults: Complications" and "Management of knee osteoarthritis", section on 'Hyaluronans' and "Management of moderate to severe knee osteoarthritis", section on 'Intraarticular glucocorticoid injection' .)