Monday, June 10, 2013

Steroid injection - what's in the bottle? "Can't you just give me a cortisone injection, doc?"

In Vitro Cytotoxic Effects of Benzalkonium Chloride in Corticosteroid Injection Suspension

Patients often ask for an injection of their shoulder to relieve pain or to get them ready for some special event. We've never been a big fan of the use of intraarticular steroids because of a concern of the potential risk of tendon and cartilage degeneration.

The authors of this article point to another possible risk: that due to preservatives in the bottle.

They treated human and bovine articular chondrocytes, bovine synovial cells, mouse C3H10T1/2 cells, and human osteosarcoma MG-63 cells were treated for thirty minutes in monolayer or suspension culture with an injectable corticosteroid suspension or its chemical components, including betamethasone sodium phosphate, betamethasone acetate, and benzalkonium chloride (as preservative). 

They found that the injectable corticosteroid suspension caused death in in vitro culture of human and bovine articular chondrocytes as well as bovine synovial cells because of its preservative benzalkonium chloride. The betamethasone corticosteroids per se did not cause significant chondrocyte death under the conditions tested.

We need to read the bottle and be sure we're comfortable with what we're injecting.

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