Kenalog Spray 63gm
It is used to treat skin rashes and other skin irritation.
Drug Class
Topical Corticosteroid; Anti-inflammatory
Pharmacologic Class
Glucocorticoid
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Kenalog Spray contains a medicine called triamcinolone, which is a type of steroid. It works by reducing redness, swelling, and itching caused by skin conditions like eczema, psoriasis, or allergic reactions. It's applied directly to the skin as a spray.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Use this medication only as directed, and continue to use it even if your symptoms improve.
Application Instructions
Apply this medication only to your skin, avoiding the mouth, nose, and eyes, as it may cause burning.
Wash your hands before and after applying the medication, unless your hand is the treated area, in which case you should not wash it after application.
Clean the affected area before applying the medication, and make sure it is completely dry.
Apply a thin layer of the medication to the affected skin and gently rub it in.
Avoid applying the medication to the face, underarms, or groin area unless your doctor instructs you to do so.
Do not use bandages, dressings, or other coverings unless your doctor advises you to do so.
If the treated area is in the diaper region, avoid using tight-fitting diapers or plastic pants, as this may increase the amount of medication absorbed into the body.
Do not use this medication to treat diaper rash.
Avoid applying the medication to cuts, scrapes, or damaged skin.
Before each use, shake the medication well.
Storage and Disposal
Store the medication at room temperature, avoiding freezing temperatures.
Protect the medication from heat and open flames.
Do not puncture or burn the medication, even if it appears to be empty.
Keep all medications in a safe place, out of the reach of children and pets.
Missed Dose
If you miss a dose, apply it as soon as you remember.
If it is close to the time for your next dose, skip the missed dose and resume your regular schedule.
* Do not apply two doses at the same time or use extra doses.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Use this medication only as directed, and continue to use it even if your symptoms improve.
Application Instructions
Apply this medication only to your skin, avoiding the mouth, nose, and eyes, as it may cause burning.
Wash your hands before and after applying the medication, unless your hand is the treated area, in which case you should not wash it after application.
Clean the affected area before applying the medication, and make sure it is completely dry.
Apply a thin layer of the medication to the affected skin and gently rub it in.
Avoid applying the medication to the face, underarms, or groin area unless your doctor instructs you to do so.
Do not use bandages, dressings, or other coverings unless your doctor advises you to do so.
If the treated area is in the diaper region, avoid using tight-fitting diapers or plastic pants, as this may increase the amount of medication absorbed into the body.
Do not use this medication to treat diaper rash.
Avoid applying the medication to cuts, scrapes, or damaged skin.
Before each use, shake the medication well.
Storage and Disposal
Store the medication at room temperature, avoiding freezing temperatures.
Protect the medication from heat and open flames.
Do not puncture or burn the medication, even if it appears to be empty.
Keep all medications in a safe place, out of the reach of children and pets.
Missed Dose
If you miss a dose, apply it as soon as you remember.
If it is close to the time for your next dose, skip the missed dose and resume your regular schedule.
* Do not apply two doses at the same time or use extra doses.
Lifestyle & Tips
- Use exactly as directed by your doctor. Do not use more often or for longer than prescribed.
- Shake the can well before each use.
- Hold the can about 3-6 inches from the affected area and spray sparingly.
- Avoid spraying near your eyes, mouth, or nose. If it gets into your eyes, rinse thoroughly with water.
- Do not cover the treated area with bandages, plastic wrap, or other occlusive dressings unless specifically instructed by your doctor, as this can increase absorption and side effects.
- Wash your hands thoroughly after applying the spray, unless your hands are the treated area.
- Do not use on the face, groin, or armpits unless specifically directed by your doctor, as these areas are more sensitive to steroid side effects.
- Keep out of reach of children.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Apply to affected area 3 to 4 times daily
Condition-Specific Dosing:
generalUse:
Spray sparingly to the affected area. Do not use occlusive dressings unless directed by a physician.
Pediatric Dosing
Neonatal:
Not established
Infant:
Use with caution; increased risk of systemic absorption and HPA axis suppression. Use lowest effective dose for shortest duration.
Child:
Use with caution; increased risk of systemic absorption and HPA axis suppression. Use lowest effective dose for shortest duration.
Adolescent:
Similar to adult dosing, but caution with extensive use due to potential for systemic absorption.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed (minimal systemic absorption)
Moderate:
No adjustment needed (minimal systemic absorption)
Severe:
No adjustment needed (minimal systemic absorption)
Dialysis:
No specific considerations (minimal systemic absorption)
Hepatic Impairment:
Mild:
No adjustment needed (minimal systemic absorption)
Moderate:
No adjustment needed (minimal systemic absorption)
Severe:
No adjustment needed (minimal systemic absorption)
Pharmacology
Mechanism of Action
Triamcinolone acetonide is a synthetic corticosteroid that possesses anti-inflammatory, antipruritic, and vasoconstrictive properties. It acts by inducing phospholipase A2 inhibitory proteins, collectively called lipocortins. These proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.
Pharmacokinetics
Absorption:
Bioavailability:
Low (<1-5% typically, but variable depending on skin integrity, site, and use of occlusive dressings)
Tmax:
Not well-quantified for topical application due to minimal systemic absorption.
FoodEffect:
Not applicable for topical administration.
Distribution:
Vd:
Not well-quantified for topical application.
ProteinBinding:
Not well-quantified for topical application; systemically, corticosteroids are bound to plasma proteins to varying degrees.
CnssPenetration:
Limited (minimal systemic absorption)
Elimination:
HalfLife:
Not well-quantified for topical application due to minimal systemic absorption.
Clearance:
Not well-quantified for topical application.
ExcretionRoute:
Renal (for systemically absorbed drug)
Unchanged:
Not significant for topical application
Pharmacodynamics
OnsetOfAction:
Hours to days (for symptomatic relief)
PeakEffect:
Days (with consistent application)
DurationOfAction:
Varies with application frequency and severity of condition; effects persist as long as applied.
Safety & Warnings
Side Effects
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: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar: confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of a weak adrenal gland: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, extreme fatigue, mood changes, decreased appetite, or weight loss
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Irritation at the application site
Skin changes: acne, stretch marks, slow healing, or excessive hair growth
Changes in skin color
Thinning of the skin
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Burning sensation
Itching
* Dry skin
This is not an exhaustive list of possible side effects. If you have 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.
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: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar: confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of a weak adrenal gland: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, extreme fatigue, mood changes, decreased appetite, or weight loss
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Irritation at the application site
Skin changes: acne, stretch marks, slow healing, or excessive hair growth
Changes in skin color
Thinning of the skin
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
Burning sensation
Itching
* Dry skin
This is not an exhaustive list of possible side effects. If you have 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.
Seek Immediate Medical Attention If You Experience:
- Worsening of your skin condition or no improvement after a few days/weeks of use.
- Signs of a skin infection (e.g., increased redness, swelling, pain, pus, fever).
- Severe burning, itching, or irritation at the application site.
- Development of new skin problems like thinning skin, stretch marks, or acne.
- Unusual fatigue, weakness, nausea, or weight gain (rare signs of systemic absorption).
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor assess potential interactions between this medication and other substances you are taking.
* Any health problems you have, as they may affect the safety and efficacy of this medication.
To ensure your safety, do not start, stop, or change the dose of any medication without first consulting your doctor. It is crucial to verify that it is safe to take this medication with all your other medications and health conditions. Your doctor and pharmacist will work together to determine the best course of treatment for you.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor assess potential interactions between this medication and other substances you are taking.
* Any health problems you have, as they may affect the safety and efficacy of this medication.
To ensure your safety, do not start, stop, or change the dose of any medication without first consulting your doctor. It is crucial to verify that it is safe to take this medication with all your other medications and health conditions. Your doctor and pharmacist will work together to determine the best course of treatment for you.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Adhere to the prescribed duration of use and do not exceed the recommended treatment period.
Before using any other medications or products on your skin, including soaps, consult with your doctor to ensure safe and effective treatment. Exercise caution when applying this medication to a large area of skin, and discuss any concerns with your doctor.
Using this medication too frequently can exacerbate your skin condition. Therefore, it is crucial to follow the recommended dosage and treatment schedule.
This medication is flammable, so it is imperative to avoid using it near open flames or while smoking. Additionally, avoid inhaling the vapors to prevent potential respiratory complications.
When using this medication in children, exercise caution, as the risk of certain side effects may be higher in this population. In some cases, this medication may affect growth in children and teenagers, necessitating regular growth checks. Consult with your doctor to discuss the potential risks and benefits.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor to discuss the benefits and risks of using this medication, both for you and your baby. This will enable your doctor to weigh the potential advantages against the potential risks and make an informed decision about your treatment.
Before using any other medications or products on your skin, including soaps, consult with your doctor to ensure safe and effective treatment. Exercise caution when applying this medication to a large area of skin, and discuss any concerns with your doctor.
Using this medication too frequently can exacerbate your skin condition. Therefore, it is crucial to follow the recommended dosage and treatment schedule.
This medication is flammable, so it is imperative to avoid using it near open flames or while smoking. Additionally, avoid inhaling the vapors to prevent potential respiratory complications.
When using this medication in children, exercise caution, as the risk of certain side effects may be higher in this population. In some cases, this medication may affect growth in children and teenagers, necessitating regular growth checks. Consult with your doctor to discuss the potential risks and benefits.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor to discuss the benefits and risks of using this medication, both for you and your baby. This will enable your doctor to weigh the potential advantages against the potential risks and make an informed decision about your treatment.
Overdose Information
Overdose Symptoms:
- Prolonged or excessive use, especially over large areas or under occlusive dressings, can lead to systemic absorption and symptoms of hypercorticism (Cushing's syndrome) or adrenal suppression.
- Symptoms may include: moon face, buffalo hump, central obesity, thinning skin, easy bruising, muscle weakness, fatigue, high blood pressure, high blood sugar.
What to Do:
If you suspect an overdose or significant systemic effects, contact your doctor or poison control center immediately. Call 1-800-222-1222. Treatment is supportive and may involve gradual withdrawal of the medication.
Drug Interactions
Monitoring
Baseline Monitoring
Skin condition assessment
Rationale: To establish baseline severity of dermatosis and identify any signs of infection or contraindications.
Timing: Prior to initiation of therapy
Routine Monitoring
Efficacy of treatment (reduction in inflammation, pruritus)
Frequency: Regularly during treatment (e.g., weekly or bi-weekly)
Target: Improvement in symptoms and skin appearance
Action Threshold: Lack of improvement or worsening symptoms warrants re-evaluation.
Local adverse effects (e.g., skin atrophy, striae, telangiectasias, folliculitis, burning, itching)
Frequency: Regularly during treatment
Target: Absence or minimal local irritation
Action Threshold: Development of significant local adverse effects warrants discontinuation or change in therapy.
Signs of secondary infection
Frequency: Regularly during treatment
Target: Absence of redness, pus, increased pain, fever
Action Threshold: Presence of infection requires appropriate antimicrobial treatment and re-evaluation of corticosteroid use.
HPA axis suppression (for extensive/prolonged use, especially in children or with occlusive dressings)
Frequency: Periodically, if risk factors present (e.g., morning plasma cortisol, ACTH stimulation test)
Target: Normal cortisol levels
Action Threshold: Evidence of suppression requires gradual withdrawal or reduction in potency/frequency.
Symptom Monitoring
- Worsening of skin condition
- Increased redness, swelling, or pain at application site
- Pus or signs of infection
- Unusual fatigue or weakness (rare, systemic effects)
- Weight gain or swelling in ankles/feet (rare, systemic effects)
- Blurred vision (rare, systemic effects)
Special Patient Groups
Pregnancy
Triamcinolone acetonide is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown teratogenic effects with corticosteroids.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenic effects, though systemic absorption from topical use is minimal.
Second Trimester:
Generally considered safer than first trimester, but still Category C.
Third Trimester:
No specific risks identified beyond general corticosteroid risks; potential for HPA axis suppression in neonate if significant systemic absorption occurs.
Lactation
It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Use with caution. If used, avoid applying to the breast area to prevent infant ingestion.
Infant Risk:
Low risk with appropriate use due to minimal systemic absorption, but theoretical risk of growth suppression or other adverse effects if significant amounts are absorbed by the infant.
Pediatric Use
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio. Use the lowest effective dose for the shortest duration possible. Monitor for signs of systemic effects (e.g., growth retardation, delayed weight gain).
Geriatric Use
No specific dosage adjustments are generally needed. However, elderly patients may have thinner skin, which could increase susceptibility to local adverse effects such as skin atrophy, purpura, and striae. Use with caution and monitor skin integrity.
Clinical Information
Clinical Pearls
- Kenalog Spray is a medium-potency topical corticosteroid, useful for inflammatory and pruritic dermatoses.
- The spray formulation is particularly useful for treating hairy areas (e.g., scalp) or large, difficult-to-reach body surfaces where creams or ointments are impractical.
- Patients should be advised to spray sparingly and not to overuse, as excessive application can lead to systemic absorption and local skin atrophy.
- Avoid prolonged use on sensitive areas like the face, groin, or axillae due to increased risk of side effects such as skin thinning, telangiectasias, and perioral dermatitis.
- If no improvement is seen after 2-4 weeks, the diagnosis and treatment plan should be re-evaluated.
Alternative Therapies
- Other topical corticosteroids (e.g., hydrocortisone, fluocinolone, clobetasol, betamethasone)
- Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) for non-steroidal anti-inflammatory effects
- Emollients and moisturizers for barrier repair and symptomatic relief
- Oral antihistamines for severe pruritus
- Phototherapy for extensive psoriasis or eczema
Cost & Coverage
Average Cost:
Varies widely by pharmacy and formulation per 63gm can
Generic Available:
Yes
Insurance Coverage:
Tier 2-3 (often covered by most prescription plans)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.