Preservative vs. Preservative-Free: Steroid Choice for Epidural Steroid Injections FactFinder

Committed to providing helpful information to International Spine Intervention Society members about key patient safety issues, the Patient Safety Committee has developed a FactFinder series. FactFinders will explore and debunk myths surrounding patient safety issues. The intent of this FactFinder is to address issues surrounding use of preservatives in epidural steroid injections.

Myth: Steroid formulations containing preservatives, when administered in the epidural space, have resulted in significant neurological injury.

Fact: There are no documented adverse events from the placement of preservative-containing steroids in the epidural space. Neurological injuries have been documented when the preservatives have been injected intrathecally.

Due to concerns about inadvertent intrathecal injection, some physicians prefer to use preservative-free steroids. Physicians who wish to use preservative-free steroid formulations have limited options. The vast majority of preservative-free formulations, including betamethasone and triamcinolone, are currently unavailable from major pharmaceutical manufacturers. The Patient Safety Task Force believes dexamethasone is the only preservative-free steroid currently available from a major manufacturer. Practitioners who elect to use preservative-free steroids must carefully weigh the risks and benefits of obtaining preservative-free steroids from compounding pharmacies, which have recently come under scrutiny regarding sterility assurance concerns.

Additional guidance on selecting compounding pharmacies can be found HERE.

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