Kenalog-40 Vial 5ml

Manufacturer B-M SQUIBB Active Ingredient Triamcinolone Injection(trye am SIN oh lone) Pronunciation Trye-am-SIN-oh-lone
It is used to treat arthritis of the knee.It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems. This is not a list of all health problems that this drug may be used for. Talk with the doctor.
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Drug Class
Glucocorticoid, Anti-inflammatory
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Pharmacologic Class
Corticosteroid
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Pregnancy Category
Category C
FDA Approved
Jun 1961
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

Triamcinolone is a type of medicine called a corticosteroid, similar to a natural hormone your body makes. It's given as an injection to reduce inflammation (swelling and pain) and suppress the immune system. It's used for conditions like arthritis, allergies, skin problems, and breathing disorders.
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How to Use This Medicine

Taking Your Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. It is essential to follow the instructions carefully.

Administration

This medication can be administered in two ways:
- Intra-articular Injection (Knee): The medication is injected directly into the knee joint.
- Other Administration: The medication is given as an injection.

Storage and Disposal

If you need to store this medication at home, consult with your doctor, nurse, or pharmacist for guidance on proper storage.

Missed Dose

If you miss a dose, contact your doctor to determine the best course of action.
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Lifestyle & Tips

  • Report any signs of infection (fever, chills, sore throat, unusual pain) immediately, as this medication can mask symptoms and increase infection risk.
  • Avoid close contact with people who are sick or have infections (e.g., chickenpox, measles).
  • Follow a balanced diet, potentially low in sodium and high in potassium, as advised by your doctor.
  • Monitor blood sugar if you have diabetes or are at risk, as this medication can raise blood sugar levels.
  • Do not stop this medication suddenly, especially after prolonged use, without consulting your doctor, as it can lead to withdrawal symptoms or adrenal insufficiency.
  • Carry a medical alert card or wear a bracelet if you are on long-term corticosteroid therapy, indicating your medication use.

Dosing & Administration

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Adult Dosing

Standard Dose: Highly variable, individualized based on condition and route of administration.
Dose Range: 2.5 - 100 mg

Condition-Specific Dosing:

Intramuscular (IM): 40-80 mg, deep into gluteal muscle, once every 1-4 weeks as needed.
Intra-articular/Intrabursal: 2.5-60 mg, depending on joint size and severity (e.g., small joint: 2.5-5 mg; large joint: 5-15 mg; bursae: 2.5-15 mg).
Intralesional: 1 mg/injection site, not exceeding 1 mg/cm² of skin area, total dose not exceeding 30 mg per week.
Soft Tissue Injection: 2.5-40 mg, depending on site and condition.
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Pediatric Dosing

Neonatal: Not established for routine use; use with extreme caution if necessary.
Infant: Not established for routine use; use with extreme caution if necessary.
Child: Dosing highly individualized, typically 0.11-1.6 mg/kg/day IM in divided doses for systemic effects, or 3.3-48 mg/m²/day IM in divided doses. Intra-articular/intralesional doses are scaled down from adult doses based on weight/surface area and joint size.
Adolescent: Dosing similar to adult recommendations, individualized based on condition and route.
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Dose Adjustments

Renal Impairment:

Mild: No specific dose adjustment generally required.
Moderate: No specific dose adjustment generally required.
Severe: No specific dose adjustment generally required; monitor for fluid retention and electrolyte imbalances.
Dialysis: Not significantly removed by dialysis; no specific dose adjustment required, but monitor for adverse effects.

Hepatic Impairment:

Mild: No specific dose adjustment generally required.
Moderate: No specific dose adjustment generally required; monitor for increased systemic effects.
Severe: No specific dose adjustment generally required; monitor for increased systemic effects due to altered metabolism.

Pharmacology

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Mechanism of Action

Triamcinolone is a synthetic glucocorticoid. It exerts its effects by binding to specific cytoplasmic glucocorticoid receptors, forming a complex that translocates into the nucleus. This complex then modulates gene expression by binding to glucocorticoid response elements (GREs) in the DNA, leading to the synthesis of anti-inflammatory proteins (e.g., lipocortin-1) and inhibition of pro-inflammatory mediators (e.g., cytokines, chemokines, adhesion molecules, prostaglandins, leukotrienes). It also suppresses the immune system by inhibiting the function of lymphocytes and macrophages.
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Pharmacokinetics

Absorption:

Bioavailability: Varies significantly by route of administration (IM, intra-articular, intralesional). Systemic absorption occurs from all sites. IM injection provides sustained release.
Tmax: IM: Approximately 8-24 hours (for systemic effects from suspension). Intra-articular/intralesional: Variable, depends on local absorption.
FoodEffect: Not applicable for injectable formulation.

Distribution:

Vd: Approximately 0.2-1.5 L/kg (variable).
ProteinBinding: Approximately 60-70% (primarily to albumin and transcortin).
CnssPenetration: Limited, but can cross the blood-brain barrier to some extent.

Elimination:

HalfLife: Plasma half-life: Approximately 2-5 hours. Biological half-life (due to tissue binding and sustained release from suspension): 18-36 hours.
Clearance: Approximately 0.5-1.5 L/hr/kg (variable).
ExcretionRoute: Primarily renal (60-70% as metabolites, 10-20% unchanged), some biliary/fecal excretion.
Unchanged: Approximately 10-20% (renal).
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Pharmacodynamics

OnsetOfAction: IM: Within hours for systemic effects. Intra-articular/intralesional: Within hours to days for local effects.
PeakEffect: IM: 1-2 days for peak systemic anti-inflammatory effect. Intra-articular/intralesional: 2-7 days for peak local effect.
DurationOfAction: IM: 1-6 weeks (due to sustained release from suspension). Intra-articular/intralesional: 1-6 weeks (variable depending on dose and site).

Safety & Warnings

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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

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

Signs of an allergic reaction: 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, or swelling of the mouth, face, lips, tongue, or throat. In rare cases, allergic reactions can be fatal.
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or changed sputum production, painful urination, mouth sores, or a wound that won't heal.
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing.
Signs of adrenal insufficiency: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, fatigue, mood changes, decreased appetite, or weight loss.
Signs of high blood sugar: confusion, drowsiness, excessive thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath.
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision.
Signs of low potassium levels: muscle pain or weakness, muscle cramps, or an irregular heartbeat.
Signs of pancreatitis: severe abdominal pain, severe back pain, or severe nausea and vomiting.
Shortness of breath, sudden weight gain, or 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 vomit.
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.
Changes in menstrual periods.
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

Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you're concerned about any of the following side effects or if they persist, contact your doctor:

Trouble sleeping.
Nausea 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, 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.
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Seek Immediate Medical Attention If You Experience:

  • Severe stomach pain, black or tarry stools (signs of GI bleeding)
  • Unusual swelling in your hands, ankles, or feet (fluid retention)
  • Extreme fatigue, weakness, dizziness, nausea, vomiting, or loss of appetite (signs of adrenal insufficiency if stopped suddenly)
  • Blurred vision, eye pain, or seeing halos around lights (signs of glaucoma or cataracts)
  • Increased thirst or urination (signs of high blood sugar)
  • Any signs of new infection (fever, chills, body aches, flu symptoms, painful urination, skin sores)
  • Severe mood changes, depression, or unusual thoughts/behavior
  • Muscle weakness or joint pain that worsens
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Before Using This Medicine

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, including bacterial, viral, or fungal infections, as well as specific conditions like:
+ Amoeba infection (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 injections).
If you have idiopathic thrombocytopenic purpura (ITP), a condition affecting platelet count (specifically for intramuscular injections).

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 treatments and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor first.
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Precautions & Cautions

Important Information About Your Medication

It is crucial that you inform all of your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood tests, as directed by your doctor, are necessary to monitor your health. If you are taking this medication long-term, you may also need to have your eye pressure and bone density checked.

Special Considerations

This medication may 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 for guidance.
If you have diabetes, it is essential to closely monitor your blood sugar levels.
Before receiving any vaccines, 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.

Infection Risks

Steroid medications like this one can increase the risk of infection, which can be severe or even life-threatening. Avoid close contact with individuals who have infections, colds, or flu, and wash your hands frequently.
If you have been exposed to chickenpox or measles, inform your doctor immediately, as these infections can be severe or even deadly in people taking steroid medications.
Some infections, such as tuberculosis and hepatitis B, may reactivate in patients taking this medication; notify your doctor if you have a history of these infections.

Additional Warnings

This medication may lower your body's natural steroid production. If you experience a fever, infection, surgery, or injury, consult with your doctor, as you may require additional oral steroid doses. Carry a warning card indicating that you may need extra steroids in certain situations.
The use of this medication in the spine (epidural) has been associated with serious health problems, including paralysis, loss of vision, stroke, and death. Discuss the risks and benefits with your doctor.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.

Stopping the Medication

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, inform your doctor promptly.

Long-term Use

Prolonged use of this medication may increase the risk of osteoporosis (weak bones); discuss your risk factors with your doctor.
Long-term use may also increase the risk of cataracts or glaucoma; consult with your doctor for guidance.
Some products containing this medication may include benzyl alcohol, which can be harmful to newborns and infants; discuss alternative options with your doctor.

Rare but Serious Side Effects

Long-term use of this medication has been associated with an increased risk of Kaposi's sarcoma, a type of cancer; discuss the risks and benefits with your doctor.
This medication may affect growth in children and adolescents; regular growth checks may be necessary.

Pregnancy and Breastfeeding

If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the potential risks and benefits of this medication with your doctor.
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Overdose Information

Overdose Symptoms:

  • Acute overdose is rare but may include: severe fluid retention, hypertension, hyperglycemia, electrolyte imbalances (e.g., hypokalemia), and exacerbation of known side effects.

What to Do:

There is no specific antidote. Treatment is supportive and symptomatic. Contact a poison control center or emergency medical services immediately. Call 1-800-222-1222.

Drug Interactions

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Contraindicated Interactions

  • Live or live attenuated vaccines (during immunosuppressive doses of corticosteroids)
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Major Interactions

  • Barbiturates, Phenytoin, Rifampin (decreased corticosteroid effect)
  • Ketoconazole, Itraconazole, Ritonavir, Cobicistat (increased corticosteroid effect)
  • Warfarin (altered anticoagulant effect, usually increased)
  • NSAIDs (increased risk of GI ulceration/bleeding)
  • Diuretics (thiazide and loop) (increased risk of hypokalemia)
  • Antidiabetics (insulin, oral hypoglycemics) (decreased glycemic control)
  • Cholestyramine, Colestipol (decreased corticosteroid absorption)
  • Cyclosporine (increased levels of both drugs, increased risk of seizures)
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Moderate Interactions

  • Cardiac glycosides (increased toxicity with hypokalemia)
  • Neuromuscular blockers (prolonged blockade)
  • Oral contraceptives/Estrogens (increased corticosteroid effect)
  • Aspirin (reduced salicylate levels, increased GI risk)
  • Vaccines (reduced antibody response to inactivated vaccines)
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Minor Interactions

  • Antacids (may reduce absorption of oral corticosteroids, less relevant for injectable)

Monitoring

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Baseline Monitoring

Blood Pressure

Rationale: Corticosteroids can cause fluid retention and hypertension.

Timing: Prior to initiation of therapy.

Blood Glucose

Rationale: Corticosteroids can induce hyperglycemia, especially in predisposed individuals.

Timing: Prior to initiation of therapy.

Serum Electrolytes (Na, K)

Rationale: Risk of fluid retention, hypokalemia.

Timing: Prior to initiation of therapy.

Bone Mineral Density (BMD)

Rationale: For patients anticipated to receive long-term therapy, to assess osteoporosis risk.

Timing: Prior to initiation of therapy (if long-term use is expected).

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Routine Monitoring

Blood Pressure

Frequency: Regularly, especially during initial therapy and dose adjustments.

Target: Individualized, aim for normotensive.

Action Threshold: Sustained elevation requiring intervention.

Blood Glucose

Frequency: Periodically, more frequently in diabetics or those at risk.

Target: Individualized, aim for euglycemia.

Action Threshold: Persistent hyperglycemia requiring intervention (e.g., antidiabetic medication adjustment).

Serum Electrolytes (Na, K)

Frequency: Periodically, especially with higher doses or concomitant diuretics.

Target: Within normal limits.

Action Threshold: Significant hypokalemia or hypernatremia.

Signs of Infection

Frequency: Continuously (patient education).

Target: Absence of fever, localized redness, swelling, pain.

Action Threshold: Any signs of infection, requiring prompt evaluation.

Growth (Pediatric Patients)

Frequency: Regularly (e.g., every 3-6 months) for long-term therapy.

Target: Normal growth velocity for age.

Action Threshold: Growth retardation.

Adrenal Function (ACTH stimulation test)

Frequency: Considered after prolonged therapy, especially before discontinuation.

Target: Normal adrenal response.

Action Threshold: Adrenal suppression.

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Symptom Monitoring

  • Signs of infection (fever, sore throat, malaise, localized pain/redness)
  • Hyperglycemia (increased thirst, urination, fatigue)
  • Fluid retention (swelling in ankles/feet, weight gain, shortness of breath)
  • Mood changes (irritability, anxiety, depression, euphoria)
  • Gastrointestinal upset (stomach pain, heartburn, black/tarry stools)
  • Muscle weakness or pain
  • Vision changes (blurred vision, eye pain)
  • Skin changes (thinning, bruising, acne)
  • Sleep disturbances

Special Patient Groups

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Pregnancy

Category C. Animal studies have shown teratogenic effects. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Monitor neonates for signs of hypoadrenalism if exposed in utero.

Trimester-Specific Risks:

First Trimester: Potential for increased risk of cleft palate in animal studies; human data are inconclusive but suggest a possible small increased risk.
Second Trimester: Risk of fetal growth restriction and adrenal suppression.
Third Trimester: Risk of fetal growth restriction and adrenal suppression; monitor neonates for hypoadrenalism.
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Lactation

Triamcinolone is excreted in breast milk. The amount is generally small, but potential for adverse effects on the infant (e.g., growth suppression, interference with endogenous corticosteroid production) exists. Use with caution; consider the risk-benefit for mother and infant. Monitor infant for adverse effects.

Infant Risk: Risk level: L3 (Moderate risk). Potential for growth suppression, adrenal suppression, and other systemic effects in the infant. Consider using the lowest effective dose and monitoring the infant.
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Pediatric Use

Corticosteroids can cause growth retardation in children. Monitor growth velocity carefully. Long-term use can lead to adrenal suppression. Use the lowest effective dose for the shortest possible duration. Increased susceptibility to infections.

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Geriatric Use

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

Clinical Information

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Clinical Pearls

  • Kenalog-40 is a suspension and MUST NOT be administered intravenously (IV). Accidental IV administration can lead to severe adverse events, including death.
  • Dosing is highly individualized. Always use the lowest effective dose for the shortest duration possible.
  • For intra-articular injections, ensure proper aseptic technique to prevent septic arthritis.
  • Patients on long-term corticosteroid therapy should carry a steroid emergency card.
  • Withdrawal of corticosteroids after prolonged therapy should be gradual to prevent adrenal insufficiency.
  • Local injections (intra-articular, intralesional) can still lead to systemic absorption and systemic side effects.
  • Avoid injecting into infected areas or unstable joints.
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Alternative Therapies

  • Other injectable corticosteroids (e.g., methylprednisolone acetate, betamethasone acetate/phosphate)
  • Oral corticosteroids (e.g., prednisone, methylprednisolone)
  • NSAIDs (for inflammatory conditions)
  • Disease-modifying antirheumatic drugs (DMARDs) or biologics (for chronic inflammatory conditions like rheumatoid arthritis)
  • Local anesthetics (for pain relief)
  • Physical therapy
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Cost & Coverage

Average Cost: $50 - $200 per 5ml vial (40mg/ml)
Generic Available: Yes
Insurance Coverage: Tier 1 or Tier 2 (for generic triamcinolone acetonide injectable suspension); Tier 3 (for brand Kenalog-40)
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe use, do not share your medication with others, and never take someone else's medication. 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; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the proper disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may have additional patient information leaflets, so it is a good idea to check with your pharmacist. 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 call your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure prompt and effective treatment.