Kenalog-40 Vial 1ml

Triamcinolone acetonide is a synthetic corticosteroid that binds to specific glucocorticoid receptors in the cytoplasm of target cells. This complex then translocates to the nucleus, where it modulates gene expression, leading to the synthesis of anti-inflammatory proteins (e.g., lipocortins) and inhibition of pro-inflammatory mediators (e.g., prostaglandins, leukotrienes, cytokines). It exerts potent anti-inflammatory, immunosuppressive, and anti-allergic actions.

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of infection, including:
+ Fever
+ Chills
+ Severe sore throat
+ Ear or sinus pain
+ Cough
+ Increased or changed sputum production
+ Painful urination
+ Mouth sores
+ Wounds that won't heal
Signs of Cushing's syndrome, such as:
+ Weight gain in the upper back or belly
+ Moon face
+ Severe headache
+ Slow wound healing
Signs of a weak adrenal gland, including:
+ Severe stomach upset or vomiting
+ Severe dizziness or fainting
+ Muscle weakness
+ Fatigue
+ Mood changes
+ Decreased appetite
+ Weight loss
Signs of high blood sugar, such as:
+ Confusion
+ Drowsiness
+ Increased thirst or hunger
+ Frequent urination
+ Flushing
+ Rapid breathing
+ Fruity-smelling breath
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Fainting
+ Changes in vision
Signs of low potassium levels, such as:
+ Muscle pain or weakness
+ Muscle cramps
+ Abnormal heartbeat
Signs of pancreatitis, including:
+ Severe stomach pain
+ Severe back pain
+ Severe stomach upset or vomiting
Shortness of breath
Sudden weight gain
Swelling in the arms or legs
Abnormal heartbeat (fast, slow, or irregular)
Chest pain
Stomach pain
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Unexplained bruising or bleeding
Bone pain
Joint pain or swelling
Muscle pain or weakness
Fatigue or weakness
Redness or white patches in the mouth or throat
Changes in vision
New or worsening mental, mood, or behavioral changes
Menstrual changes
Seizures
Skin changes (acne, stretch marks, slow healing, hair growth)
Purple, red, blue, brown, or black bumps or patches on the skin or in the mouth
Burning, numbness, or tingling sensations
Redness or swelling at the injection site

Other Possible Side Effects

Most people experience no side effects or only mild side effects when taking this medication. However, if you notice any of the following side effects, contact your doctor or seek medical attention if they bother you or persist:

Trouble sleeping
Upset stomach or vomiting
Weight gain
Restlessness
Excessive sweating
Hair thinning

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

To ensure safe treatment, inform your doctor about the following:

Any allergies you have to this medication, its components, or other substances, including foods and drugs. Describe the allergic reaction you experienced, such as symptoms and signs.
Stomach or bowel problems, including diverticulitis, diverticulosis, ulcerative colitis, or ulcers.
Any current infections, such as bacterial, viral, or fungal infections, including:
+ Amoeba infections (e.g., traveler's diarrhea)
+ Herpes infection of the eye
+ Malaria infection in the brain
+ Threadworm infestation
+ Other infections
If you have an infection at the site where the injection will be administered (for intramuscular injection).
If you have idiopathic thrombocytopenic purpura (ITP), a bleeding disorder (for intramuscular injection).

Additionally, provide your doctor and pharmacist with a comprehensive list of:

All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
Any health problems you have

This information is crucial to determine the safety of taking this medication with your other drugs and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor first.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor will likely recommend regular blood tests to monitor your condition. If you are taking this medication long-term, you may also need to undergo eye pressure and bone density checks.

This medication can interfere with allergy skin tests, so be sure to notify your doctor and laboratory personnel that you are taking it. You may need to reduce your salt intake and increase your potassium consumption; consult with your doctor to determine the best approach for your specific situation.

If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication. Before receiving any vaccinations, discuss the potential risks and benefits with your doctor, as some vaccines may not be effective or may increase the risk of infection when taken with this medication.

Be aware that steroid medications like this one can increase the risk of infection, and in some cases, may cause active infections to worsen or make symptoms of infection more difficult to detect. The risk of infection is typically higher with higher doses of steroids. To minimize the risk of infection, wash your hands frequently, avoid close contact with people who have infections, colds, or flu, and notify your doctor if you experience any signs of infection.

Some infections, such as tuberculosis and hepatitis B, may reactivate in patients taking medications like this one. If you have a history of these infections, inform your doctor. Additionally, this medication may lower your body's natural steroid production, so if you experience a fever, infection, surgery, or injury, consult with your doctor, as you may require additional oral steroids to help your body cope with stress. It is recommended that you carry a warning card indicating that you may need extra steroids in certain situations.

It is essential to note that administering medications like this one into the spine (epidural) has been associated with severe health problems, including paralysis, loss of vision, stroke, and death. The safety and efficacy of this medication for spinal administration have not been established, and it is not approved for this use. Discuss the potential risks with your doctor.

If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. If you have been taking this medication for an extended period, consult with your doctor before stopping, as you may need to gradually taper off the medication. If you have missed a dose or recently stopped taking this medication and experience symptoms such as fatigue, weakness, shakiness, rapid heartbeat, confusion, sweating, or dizziness, notify your doctor.

Long-term use of this medication may increase the risk of osteoporosis (weak bones); discuss your individual risk with your doctor. Prolonged use may also raise the risk of cataracts or glaucoma; consult with your doctor to determine the best course of action.

Some formulations of this medication contain benzyl alcohol, which can cause serious side effects in newborns and infants. If possible, avoid products containing benzyl alcohol in these age groups, and consult with your doctor to determine if this product contains benzyl alcohol.

There is a potential increased risk of a type of cancer called Kaposi's sarcoma associated with long-term use of medications like this one. Discuss this risk with your doctor.

This medication may affect growth in children and adolescents; regular growth checks may be necessary. Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding, as you will need to discuss the benefits and risks of this medication for both you and your baby.

• Live or live attenuated vaccines (if immunosuppressed doses of corticosteroids are used)
• Systemic fungal infections

• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, clarithromycin): May increase triamcinolone levels and systemic effects.
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs): Increased risk of gastrointestinal ulceration and bleeding.
• Anticoagulants (e.g., warfarin): May alter anticoagulant effect (either increase or decrease). Monitor INR.
• Antidiabetics (e.g., insulin, oral hypoglycemics): Corticosteroids can increase blood glucose, requiring dose adjustments of antidiabetics.
• Diuretics (especially thiazide and loop diuretics): Increased risk of hypokalemia.
• Cardiac glycosides (e.g., digoxin): Increased risk of digitalis toxicity due to hypokalemia.

• Cholestyramine, colestipol: May decrease absorption of corticosteroids.
• Phenytoin, phenobarbital, rifampin, ephedrine: May increase corticosteroid metabolism, decreasing efficacy.
• Neuromuscular blocking agents: May prolong or antagonize neuromuscular blockade.
• Anticholinesterases (e.g., neostigmine, pyridostigmine): May cause severe weakness in patients with myasthenia gravis.
• Growth hormone (somatropin): May inhibit growth-promoting effects.

• Oral contraceptives/estrogens: May decrease corticosteroid clearance, increasing effects.
• Aspirin (high dose): Increased risk of GI side effects; corticosteroids may decrease salicylate levels.

• Signs of infection (fever, chills, sore throat, unusual pain)
• Increased thirst or urination (hyperglycemia)
• Swelling of ankles/feet, weight gain (fluid retention)
• Mood changes (irritability, depression, euphoria)
• Difficulty sleeping
• Stomach pain, black/tarry stools (GI ulceration)
• Muscle weakness or cramps (hypokalemia)
• Vision changes, eye pain
• Unusual bruising or skin thinning
• Joint pain (if intra-articular injection, monitor for post-injection flare or infection)

Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Corticosteroids have been shown to be teratogenic in animals. Human data are limited but suggest a possible association with cleft palate and intrauterine growth restriction. Monitor neonates for signs of hypoadrenalism if exposed in utero.

L3 (Moderately safe). Corticosteroids are excreted in breast milk in small amounts. While generally considered compatible with breastfeeding, monitor the infant for potential adverse effects such as growth suppression or adrenal suppression, especially with high doses or prolonged maternal use. Use the lowest effective dose.

Corticosteroids can cause growth retardation in children. Monitor growth and development carefully. Adrenal suppression can occur. Use the lowest effective dose for the shortest possible duration. Intra-articular injections should be used cautiously in children due to potential effects on growth plates.

Elderly patients may be at increased risk for common corticosteroid adverse effects, including osteoporosis, hypertension, diabetes, fluid retention, and skin thinning. Use the lowest effective dose and monitor closely for adverse reactions.

• Kenalog-40 is a suspension; shake the vial well before drawing up the dose to ensure uniform distribution of the active ingredient.
• This formulation is NOT for intravenous (IV) administration. Accidental IV administration can lead to serious adverse events, including anaphylaxis, collapse, and death.
• Aseptic technique is crucial during administration to prevent infection, especially for intra-articular or intralesional injections.
• Patients receiving prolonged systemic corticosteroid therapy should not abruptly discontinue the drug due to the risk of adrenal insufficiency. Doses must be tapered gradually.
• Local injections (intra-articular, intralesional) can cause a 'post-injection flare' of pain and swelling for 24-48 hours, which usually resolves spontaneously.
• Repeated intra-articular injections into the same joint should be avoided due to potential damage to joint structures (e.g., cartilage atrophy, osteonecrosis).

• Other injectable corticosteroids (e.g., methylprednisolone acetate, dexamethasone sodium phosphate, betamethasone acetate/phosphate)
• Oral corticosteroids (e.g., prednisone, methylprednisolone, dexamethasone)
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) for inflammatory conditions
• Disease-modifying antirheumatic drugs (DMARDs) or biologics for chronic inflammatory conditions (e.g., rheumatoid arthritis)
• Topical corticosteroids for localized skin conditions
• Physical therapy, rest, ice/heat for musculoskeletal conditions

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed otherwise, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities offer drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the quantity, and the time of the incident.