Zilretta
Zilretta (triamcinolone) is a steroid injection used to treat knee pain from osteoarthritis in adults. It works by reducing inflammation in the joint, helping to relieve pain and stiffness. The typical dose is 32 mg injected directly into the knee (intra-articular) by a healthcare professional. Some potential side effects include joint swelling, cough, and bruising where the medication is injected.
What is Zilretta (triamcinolone)?
What is Zilretta (triamcinolone) used for?
Pain from osteoarthritis of the knee
How Zilretta (triamcinolone) works
Zilretta (triamcinolone) is a corticosteroid. It works by reducing the release of chemicals in your body that cause swelling and inflammation.
Drug Facts
What are the side effects of Zilretta (triamcinolone)?
Common Side Effects
- Joint swelling (3%)
- Bruising at the injection site (2%)
- Sinus infection (2%)
- Cough (2%)
Other Side Effects
- Pain at the injection site
- Rash
- Itchiness
- Headache
- Muscle spasms
Serious Side Effects
- Serious allergic reaction: hives, difficulty breathing, difficulty swallowing, swelling of the face, lips, tongue, or throat
- Infection: fever, chills, muscle aches, constant cough, sore throat, skin redness or swelling, diarrhea, burning feeling during urination
- Extreme mood swings and severe depression
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Cushing syndrome—increased fat around the midsection, upper back, neck, or face, pink or purple stretch marks on the skin, thinning, fragile skin that easily bruises, unexpected hair growth
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- Increase in blood pressure
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Severe pain, redness, warmth, or swelling in joint where injected
- Stomach bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds
- Swelling of the ankles, hands, or feet
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Acne
- General discomfort and fatigue
- Headache
- Increase in appetite
- Nausea
- Trouble sleeping
- Weight gain
Pros and cons of Zilretta (triamcinolone)
Pros
Injected directly into the affected knee joint
Single injection per treatment
Lasts up to 3 months or longer
Cons
Must be given by a trained healthcare professional
Unknown if safe during pregnancy or breastfeeding
Side effects include joint swelling and bruising at the injection site
Pharmacist tips for Zilretta (triamcinolone)
Zilretta (triamcinolone) is typically given by a trained healthcare professional. Mark your appointment on your calendar so you don’t forget when it’s time for your injection.
Zilretta (triamcinolone) can raise your blood pressure and blood sugar levels. If you have diabetes, you might need a higher dose of your diabetes medication.
Zilretta (triamcinolone) can interact with many medications. Certain antibiotics, like clarithromycin, can lower how much Zilretta (triamcinolone) is cleared from your body, leading to more side effects. Zilretta (triamcinolone) can also affect how well blood thinners, like warfarin, work. Always ask your prescriber before starting a new medication.
Avoid live vaccines while receiving Zilretta (triamcinolone). These vaccines contain live viruses, and Zilretta (triamcinolone) weakens your immune system's ability to fight these viruses. If you’re unsure which vaccines are safe with this injection, ask your prescriber or pharmacist.
Zilretta (triamcinolone) raises your risk of infection. Call your prescriber right away if you have a fever, chills, flu-like symptoms, cough, pain with passing urine, or a wound that won't heal.
Zilretta (triamcinolone) can cause mood and behavior changes. Let your prescriber know right away if you or a loved one notice new or worsening mood swings, anxiety, depression, or unusual behavior.
Frequently asked questions about Zilretta (triamcinolone)
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What are the risks and warnings for Zilretta (triamcinolone)?
Zilretta (triamcinolone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious nervous system problems
Risk factors: Epidural injection
Serious nervous system problems have been reported with epidural (spinal) injections of corticosteroids like Zilretta (triamcinolone). These can include spinal cord damage, paralysis, blindness, and stroke. That's why Zilretta (triamcinolone) shouldn't be injected into the spine.
Severe allergic reactions
Corticosteroids like Zilretta (triamcinolone) can cause serious allergic reactions. If you experience trouble breathing, swelling of the face or throat, dizziness, or a severe rash after receiving this injection, get emergency medical help right away.
Greater risk of infections
Risk factors: History of infections | Weakened immune system | High doses | Using other medications that weaken your immune system
When Zilretta (triamcinolone) is injected into a joint, some of it gets absorbed into your body. Since corticosteroids like Zilretta (triamcinolone) can weaken your immune system, it becomes harder for your body to fight infections. Tell your prescriber right away if you develop fever, chills, or other signs of infection. If you haven’t had chickenpox or measles, avoid being around people who have these infections.
Hormone effects
Risk factors: High doses | Long-term use | Stress such as trauma, injury, or infection | History of thyroid problems
Long-term use of Zilretta (triamcinolone) can lead to adrenal insufficiency, where your adrenal glands stop making hormones naturally. If you stop this medication suddenly, you might experience steroid withdrawal, which can cause tiredness, joint or muscle pain, and low energy. This hormone imbalance can last for months after stopping treatment.
If you have thyroid problems, your body might process Zilretta (triamcinolone) differently. People with low thyroid hormone levels break down steroids more slowly, while those with high thyroid hormone levels break them down faster. If your thyroid function changes, your prescriber might need to adjust your dosage of Zilretta (triamcinolone).
Heart and kidney problems
Risk factors: High doses of Zilretta (triamcinolone) | History of high blood pressure | History of heart failure | History of kidney problems
Corticosteroids like Zilretta (triamcinolone), especially in high doses, can raise blood pressure, cause your body to hold onto excess salt and water, and lead to potassium loss. If you have a history of high blood pressure, heart failure, or kidney problems, your prescriber will monitor you for swelling, weight gain, and electrolyte imbalances. You might need to limit salt in your diet and take potassium supplements if necessary.
Eye problems
Risk factors: History of eye problems
Using Zilretta (triamcinolone) can raise eye pressure or make it worse if you already have high eye pressure. If you have glaucoma or other eye conditions, your prescriber will monitor your eye pressure and might adjust your treatment if needed.
Stomach problems
Risk factors: History of stomach problems
Corticosteroids, including Zilretta (triamcinolone), should be used carefully if you have stomach or digestive problems like peptic ulcers, diverticulitis, ulcerative colitis, or recent intestinal surgery. They can raise the risk of a tear or hole in your gut, which can be serious. Let your care team know if you have severe and sudden stomach pain, nausea, vomiting, fever, or poor appetite.
Bone problems
Risk factors: Women who've gone through menopause
Zilretta (triamcinolone) can weaken your bones and make them more brittle, raising the risk of osteoporosis. If you already have osteoporosis or are at risk (such as postmenopausal women), your prescriber might need to monitor your bone health before starting this medication.
Changes in mood and behavior
Risk factors: History of mental health conditions
Taking Zilretta (triamcinolone) can cause new or worsening mental health problems, such as mood swings, trouble sleeping, personality changes, or severe depression. If you have a history of mental health conditions, your prescriber might need to monitor you closely during treatment. Tell your care team right away if you or a loved one notice sudden mood changes, anxiety, depression, or unusual thoughts or behaviors.
Zilretta (triamcinolone) dosage forms
Typical dosing for Zilretta (triamcinolone)
The typical dose is 32 mg injected directly into the affected knee joint by a healthcare professional.
Zilretta (triamcinolone) contraindications
Allergy to corticosteroids
What are alternatives to Zilretta (triamcinolone)?
Allergies or allergic reactions
Conditions affecting certain hormones (e.g., low adrenal hormones)
Gut conditions (e.g., ulcerative colitis)
Conditions related to blood cells
Certain cancers (e.g., leukemia)
Nervous system conditions (e.g., multiple sclerosis)
Eye conditions
Kidney conditions
Lung conditions
Joint conditions (e.g., rheumatoid arthritis)
Zilretta (triamcinolone) images
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References
Best studies we foundConaghan, P. G., et al. (2018). Effects of a single intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain: A double-blinded, randomized, placebo-controlled, multinational study. The Journal of Bone and Joint Surgery.
Hodgens, A., et al. (2023). Corticosteroids. StatPearls.
Langworthy, M. J., et al. (2019). Efficacy of triamcinolone acetonide extended-release in participants with unilateral knee osteoarthritis: A post hoc analysis. Advances in Therapy.
McMorrow, K., et al. (2023). One to two days of rest is recommended before returning to sport after intra-articular corticosteroid injection in the high-level athlete. Arthroscopy, Sports Medicine, and Rehabilitation.
Pacira Pharmaceuticals, Inc. (2025). Zilretta- triamcinolone acetonide extended-release injectable suspension kit [package insert]. DailyMed.
Paik, J., et al. (2019). Triamcinolone acetonide extended-release: A review in osteoarthritis pain of the knee. Drugs.
Park, D. K. (2022). Spinal injections. OrthoInfo.
Peck. J., et al. (2021). A comprehensive review of viscosupplementation in osteoarthritis of the knee. Orthopedic Reviews.
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