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Triamcinolone Acetonide

Kenalog

Kenalog (Triamcinolone Acetonide) is an FDA-approved corticosteroid used to treat a variety of inflammatory conditions, including skin disorders, arthritis, and digestive system diseases like Crohn’s disease and ulcerative colitis. Available in different strengths for injection, Kenalog helps reduce inflammation by suppressing the immune system’s activity. It is administered by a healthcare professional and dosage varies based on the condition, patient age, and other medications. Key considerations include potential side effects like skin thinning and joint damage, and it’s contraindicated in certain conditions like fungal infections and specific blood disorders. Have a discussion with your primary health caregiver if you have any doubts regarding the usage of the medication to get the best possible results. 

Product Overview

Kenalog, or Triamcinolone Acetonide, is a potent corticosteroid medication primarily used to manage and treat various inflammatory and autoimmune conditions. Its applications span across different medical fields, addressing issues such as severe skin conditions (e.g., eczema, psoriasis), joint pain from arthritis, and systemic diseases like multiple sclerosis and lupus. Kenalog works by mimicking the effects of cortisol, a natural hormone, reducing the immune system’s inflammatory response.

This medication comes in multiple forms, including Kenalog-10, Kenalog-40, and Kenalog-80, indicating the milligrams per milliliter of the drug. Depending on the severity and location of the condition, it may be injected directly into the skin, muscle, or joint. The specific dosage and frequency of administration are determined by the healthcare provider based on the patient’s age, the severity of the condition, and response to previous treatments.

Side effects of Kenalog can vary; mild reactions include skin irritation and fluid retention, while more severe reactions might involve joint damage, high blood pressure, and increased risk of infections. Long-term use can lead to complications such as osteoporosis and adrenal insufficiency. It is essential for patients to disclose their full medical history to their healthcare provider, as Kenalog is contraindicated in certain conditions like idiopathic thrombocytopenic purpura (ITP) for intramuscular injections and in cases of known fungal infections. Monitoring during treatment is crucial to adjust doses and manage any arising side effects, ensuring the safe and effective use of Kenalog.

Uses of Kenalog

  • It is used to treat certain skin conditions in adults, including:
    • Neurodermatitis
    • Discoid lupus
    • Keloids
    • Alopecia areata
    • Lichen planus
    • Necrobiosis lipoidica
  • It is used to treat many other inflammatory conditions in adults, including:
    • Blood conditions: like autoimmune hemolytic anemia
    • Eye conditions: like uveitis
    • Nervous system conditions: like multiple sclerosis
    • Allergic conditions: like seasonal allergies
    • Kidney conditions: like protein in the urine
    • Lung conditions: like sarcoidosis
    • Endocrine conditions: like congenital adrenal hyperplasia
  • It is also used to treat certain digestive system conditions in adults, including:
    • Enteritis: Inflammation of parts of the digestive system
    • Crohn’s disease
    • Ulcerative colitis
  • It is also used to treat certain joint conditions in adults, including:
    • Rheumatoid arthritis
    • Bursitis
    • Tennis elbow
    • Tenosynovitis
    • Gout

How to Use Kenalog?

Dosage

Kenalog is available as a liquid suspension in a multiple-dose vial. The strengths are as follows:

  • Kenalog-10: 10 mg/mL (milligrams per milliliter) of liquid suspension
  • Kenalog-40: 40 mg/mL
  • Kenalog-80: 80 mg/mL

Usage:

  • Kenalog-10: This dosage is prescribed for injections into affected areas of skin (skin wounds or lesions) and joints.
  • Kenalog-40 and Kenalog-80: Prescribed for joint and intramuscular injections.

A healthcare professional will administer your Kenalog injections in a doctor’s office or clinic.

Recommended Dosage for Different Patients

Dosage for Certain Skin Conditions

  • Purpose: Kenalog is prescribed to treat certain skin conditions in adults. Examples include: Discoid lupus, Alopecia areata, Lichen planus
  • Administration: Kenalog may be injected into the affected area of your skin.
  • Dosage: The typical dosage of Kenalog for skin conditions varies.
    • Note: Your doctor will recommend the exact dosage needed to treat your specific condition.

Dosage for Certain Joint Conditions

  • Purpose: Kenalog is prescribed to treat certain joint conditions in adults. Examples include Rheumatoid arthritis, Gout, and Bursitis.
  • Administration: Kenalog may be injected into the affected joint.
  • Dosage: The typical dosage of Kenalog for joint conditions varies based on the joint size and specific condition.
    • Smaller Joints: The typical starting dose is 2.5–5 mg per injection.
    • Larger Joints: The typical starting dose is 5–15 mg per injection.
    • Note: Your doctor will recommend the exact dose and the number of Kenalog injections needed to treat your specific condition.

Dosage for Certain Digestive System Conditions

  • Purpose: Kenalog is prescribed to treat certain digestive system conditions in adults. Examples include Enteritis and ulcerative colitis.
  • Administration: Kenalog may be injected into a muscle in your buttocks.
  • Dosage: The typical starting dose for digestive system conditions is 60 mg per injection.
    • Note: Your doctor will decide the exact dose of Kenalog and how often you’ll receive it.

Dosage for Other Inflammatory Conditions

  • Purpose: Kenalog is prescribed to treat various other inflammatory conditions in adults. Examples include: Sarcoidosis, Multiple sclerosis, Uveitis.
  • Administration: Kenalog may be injected into a muscle in your buttocks.
  • Dosage: The typical starting dose for these inflammatory conditions is 60 mg per injection.
    • Note: Your doctor will recommend the exact dose of Kenalog and how often you’ll receive it.

Children’s Dosage

To treat various inflammatory conditions in children ages 1 month and older.

  • Administration: Kenalog may be injected into a child’s muscle, joint, or affected area of skin.
  • Dosage: The typical dosage may vary based on the specific condition and the child’s body weight in kilograms (kg).
    • The typical starting dose for children is 0.11–1.6 mg per kg of body weight.
    • Example: A child weighing 45 kg (about 99 lb) would receive a total dose ranging from 5–64 mg. This dose would likely be divided into three or four injections given in one day.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

The appropriate dosage of Kenalog that your doctor prescribes will depend on several key factors, including:

  • The specific type and severity of the condition being treated with Kenalog.
  • The form of Kenalog injection administered.
  • Your age.
  • Any other medications you are currently taking.
  • For children, the body weight is kilograms (kg).

The information provided here outlines commonly prescribed or recommended dosages. However, it’s crucial to follow the specific dosage tailored to your needs as determined by your doctor. Always talk to your healthcare provider to ensure the dosage is optimized for your health condition and personal circumstances.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Kenalog Work?

Kenalog is a corticosteroid prescribed to treat many inflammatory conditions. Inflammation is the body’s response to infection, injury, or other harmful processes, signaling the immune system to act. However, sometimes inflammation occurs when the immune system mistakenly attacks healthy tissues. Kenalog works by reducing the activity of the immune system, which helps alleviate the symptoms of inflammatory conditions. If you have additional questions about how Kenalog works, consult your doctor.

Important Safety Information

Side Effects

Mild side effects of Kenalog may include:

  • Skin rash
  • Mild allergic reaction
  • Fluid retention
  • Pain or swelling at the injection site
  • Weight gain

Serious side effects Kenalog may include:

  • Severe allergic reaction.
  • Joint damage signs may consist of the following:
    • limited range of motion in the affected joint
    • joint swelling
    • joint pain
  • High blood pressure
  • Osteoporosis signs may consist of:
    • bone fractures
    • changes in posture or height
  • Changes in mood or personality, signs may include:
    • euphoria (feeling extremely happy or excited)
    • depression
    • insomnia
  • Eye problems, including glaucoma & cataracts, signs may include:
    • eye pain
    • sensitivity to light
    • vision loss or blurred vision
  • Low adrenal gland function also called adrenal insufficiency, signs may include:
    • abdominal pain
    • loss of appetite
    • Fatigue
  • Increased risk of infection, signs may include:
    • cough
    • fever or chills
    • sore throat
  • Low blood potassium level, signs may include:
    • fatigue
    • muscle cramps or weakness
    • excessive thirst

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

  • There have been rare cases of severe allergic reactions, known as anaphylaxis, in patients receiving corticosteroid treatments like triamcinolone acetonide injections.
  • Kenalog, which is a suspension, should never be given through an intravenous (IV) route.
  • You may be ineligible for Kenalog if you have or have had a fungal infection or a specific blood condition known as ITP (idiopathic thrombocytopenic purpura).
  • The Kenalog injection includes benzyl alcohol, which in high amounts can be toxic, causing conditions like low blood pressure (hypotension) and metabolic acidosis, particularly in newborns. 
  • This toxicity can also increase the risk of kernicterus, a type of brain damage in infants caused by high bilirubin levels. It’s important to consider the total daily intake of benzyl alcohol from all sources.
  • When administered as an intramuscular injection, Kenalog should be injected deeply into a large muscle, such as the buttock, rather than smaller muscles, like the shoulder, to minimize the risk of tissue shrinkage at the injection site.
  • Kenalog is a long-acting drug and is not suitable for managing acute stress situations. 
  • Additional corticosteroid treatment may be needed during stressful times such as trauma, surgery, or severe illness during the use of Kenalog and for a year following treatment.
  • High doses of Kenalog should not be used to treat traumatic brain injuries.

Precautions

This medication requires careful consideration before use. Before starting Kenalog, it’s important to discuss your medical history with your doctor to determine if this drug is suitable for you, especially if you have any of the following health issues:

  • Conditions that increase the risk of osteoporosis, such as post-menopause
  • Recent contact with chickenpox or measles
  • Digestive issues, like stomach ulcers
  • Eye conditions such as glaucoma
  • Thyroid disorders, whether overactive or underactive
  • Infections, including tuberculosis (TB)
  • Kidney issues, such as kidney failure
  • Previous allergic reactions to this or similar medications
  • Mental health issues, such as depression
  • Liver conditions like cirrhosis
  • Heart conditions, including heart failure or a recent heart attack
  • Pregnancy
  • High blood pressure
  • Breastfeeding
  • Neurological disorders, such as myasthenia gravis
  • Diabetes

Always consult your doctor about these factors to ensure that Kenalog is a safe choice for your treatment.

Other Important Precautions

  • Pregnancy: It is not known whether Kenalog is safe to use during pregnancy. If you are planning a pregnancy or could become pregnant, discuss this with your doctor before receiving Kenalog injections. Kenalog injections will be administered by a healthcare professional in a doctor’s office or clinic.
  • Birth Control: It is not known whether Kenalog treatment is safe during pregnancy. If you are sexually active and you or your partner could become pregnant, discuss your birth control needs with your doctor while receiving Kenalog. Keep in mind that Kenalog may interact with birth control pills containing estrogen. Your doctor can recommend a birth control option that does not interact with Kenalog.
  • Breastfeeding: It is not known whether Kenalog is safe to use while breastfeeding. If you are currently breastfeeding or planning to breastfeed, consult your doctor before starting Kenalog injections.

Contraindications

Contraindications refer to specific health conditions or scenarios where a medication should not be used due to safety concerns. If you have certain conditions, taking Triamcinolone (Kenalog) may not be safe. It’s essential to inform your healthcare provider if you have any of the following:

  • A blood condition known as idiopathic thrombocytopenic purpura (ITP), which reduces platelet counts (this is specifically a contraindication for intramuscular (IM) injections of Triamcinolone). 

Missed Dose

  • If you miss an appointment for a scheduled Kenalog injection, contact your doctor for further instructions.
  • When Kenalog is used as a single dose, there is no regular dosing schedule to follow.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Since Kenalog is administered by a healthcare professional in a medical setting, the likelihood of an overdose is low. Excessive use of Kenalog generally does not result in severe problems. However, prolonged use at high doses may lead to some side effects, including skin thinning, easy bruising, redistribution of body fat (notably in the face, neck, back, and waist), more acne or facial hair, menstrual irregularities, impotence, or a decreased sexual drive.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Kenalog Interactions

Kenalog Injections may interact with several other medications but are not known to interact with supplements or foods. Before starting Kenalog, discuss your medication use with your doctor and pharmacist. Inform them about all prescription, over-the-counter, and other drugs you take, as well as any vitamins, herbs, and supplements you use. Sharing this information helps avoid potential interactions and ensures safe and effective use of Kenalog.

Interactions with Medications

Below is a list of medications that can interact with Kenalog. This list is not exhaustive, and there may be other drugs that interact with Kenalog. If you have questions about drug interactions that may affect you, consult your doctor or pharmacist.

Medications that can interact with Kenalog

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen (Advil, Motrin)
  • Birth control pills containing estrogen: such as ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)
  • Certain antibiotics: such as clarithromycin
  • Certain antifungals: such as ketoconazole
  • Certain seizure drugs: such as phenytoin (Dilantin, Phenytek)
  • Diabetes drugs: such as insulin or glipizide (Glucotrol XL)
  • Blood thinners: such as warfarin (Jantoven)
  • Immunosuppressants: such as cyclosporine (Gengraf, others)
  • Heart medications: such as digoxin (Lanoxin)

Lab Tests or Vaccines That Can Interact with Kenalog

  • Skin Tests: Certain allergy tests.
  • Live Vaccines: These include the chickenpox vaccine (Varivax) or the measles, mumps, and rubella (MMR) vaccine.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Consuming Alcohol During Kenalog Treatment

While there is no known interaction between alcohol and Kenalog injections, it is generally considered safe to consume alcohol in moderation during your treatment. However, if you have concerns or questions about the appropriate amount of alcohol that can be consumed safely while receiving Kenalog injections, it is recommended to consult with your healthcare provider or pharmacist. They can provide personalized guidance based on your specific medical condition, dosage, and overall health status. It is always advisable to exercise caution and follow your healthcare professional’s recommendations regarding alcohol consumption during any medical treatment.

[Note: This isn’t a complete list, and there could be other drugs that interact with Kenalog. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Kenalog Alternatives

  • Omnipred (prednisolone)
  • Rayos (prednisone)
  • Hemady (dexamethasone)
  • Medrol (methylprednisolone)
  • Solu-Medrol (methylprednisolone)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Frequently Asked Questions

What to avoid while receiving Kenalog-40?

After receiving a Kenalog-40 injection into a joint:

  1. Limit strenuous activities or high-impact sports to prevent joint damage.
  2. Stay away from people who are sick or have infections.
  3. If you are exposed to chickenpox or measles, contact your doctor for preventive treatment immediately, as these illnesses can be particularly severe or even deadly for those on Kenalog-40.

Avoid receiving any “live” or toxoid vaccines while using Kenalog-40, as there is a risk of developing a serious infection. Live vaccines include mumps, measles, zoster (shingles), polio, rubella (MMR),  rotavirus, yellow fever,  typhoid, varicella (chickenpox), and the nasal spray flu vaccine. Toxoid vaccines include the diphtheria-tetanus toxoid (DT or Td).

Who should not take Kenalog?

You should be cautious about using Kenalog if you have had any issues with your kidney, liver, or thyroid gland, as the dosage may need to be adjusted. Additionally, if you have recently had any form of cancer, suffer from osteoporosis (thin or brittle bones), or have myasthenia gravis (a condition that causes muscle weakness), you should discuss these conditions with your doctor to determine if Kenalog is safe for you.

Is it safe for children to use Kenalog?

It’s important to note that Kenalog contains a preservative known as benzyl alcohol, which can be harmful. In some cases, benzyl alcohol can cause serious side effects, including brain damage and death, particularly in infants and young children. While the concentration of benzyl alcohol in standard doses of Kenalog is generally not linked to these severe effects, the risk cannot be entirely ruled out. If your child shows signs of severe distress, such as gasping for air, extreme drowsiness, seizures, a slowed response, or a slow heartbeat, seek emergency medical attention immediately.

What’s the difference between Kenalog and other steroids?

These medications reduce swelling and inflammation throughout the body, and they share similar side effects. However, these corticosteroids differ in potency, meaning their strength and effectiveness per milligram can vary. For instance, 4 mg of triamcinolone (Kenalog) is roughly equivalent to 5 mg of prednisone or 25 mg of cortisone. This difference in potency means that doses are not interchangeable directly and require adjustment.

Moreover, these steroids are available in various forms, including liquids, tablets, and injections. When switching from one corticosteroid to another, such as from prednisone to triamcinolone, it is crucial that your healthcare provider adjusts your dosage correctly to ensure safety and maintain the effectiveness of the treatment.

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