Kenalog Injection
Kenalog Injection
Triamcinolone Acetonide
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KENALOG-40 INJECTION

What is KENALOG-40?

Kenalog-40 is a prescription-only injectable form of triamcinolone which is a synthetic glucocorticoid. It imitates the naturally produced steroid hormones in the body and works by toning down the body’s overreactive immune response, thereby also reducing inflammation.

This medication helps to normalize the immune system when it overreacts. Kenalog-40’s generic name is Triamcinolone acetonide. Triamcinolone acetonide is also sold under the brand names Hexatrione and Zilretta.

Kenalog-40 is sold in 1 mL vials containing 40 mg of triamcinolone acetonide in a sterile aqueous suspension. The vial also contains sodium chloride, and benzyl alcohol as a preservative. This particular formulation is only suitable for intraarticular or intramuscular injection. It should not be used for intradermal injection.

Indications

Kenalog-40 is used for a wide variety of inflammatory conditions, for example, allergies, arthritis, some types of cancer, gout, skin conditions created by autoimmune issues such as lupus or psoriasis. It is also used in the treatment of severe colitis, joint and tendon inflammation, and issues caused by adrenal gland hormone deficiencies.

How Does it Work?

Kenalog-40 works by calming the body’s excessive inflammatory response due to an overactive immune system.

Kenalog-40 Injection has an extended duration of effect. This may be seen over several weeks.  After a single intramuscular dose of 60 mg to 100 mg, adrenal suppression takes place within 24 to 48 hours and then slowly returns to normal, over about 30 days.

Dosage

Because Kenalog-40 is used for such a vast number of conditions, there is a variety of dosages. It is not even injected into the same areas of the body. Sometimes the injection is given as a once-off dose, while at other times it is given at regular intervals. The physician’s dosing instructions must be carefully adhered to. Dosage requirements are highly variable and are decided on a case-by-case basis.

After the initial injection, if a favorable response is seen, the doctor will decide on a maintenance dose. This will usually be the smallest possible dose to still achieve symptom relief. After long-term administration, the medication must be tapered off gradually rather than stopped abruptly to prevent withdrawal symptoms.

This injectable form of triamcinolone is always given in a doctor’s rooms.

Adults: For intramuscular injection intended to treat severe allergies, arthritis, or skin issues such as psoriasis or eczema that haven’t responded to topical treatment, a dose of 40-80 mg is usually given to begin with. Depending on the patient’s response to the treatment, the injection continuation and dose will be decided by the doctor. The usual recommended dose is 60 mg which should be injected deeply into the gluteal muscle.

Particularly in cases of seasonal hay fever or asthma caused by pollen, a single dose of between 40 and 100 mg given at the beginning of the season may tide the patient over the whole season.

In treating acute flare-ups of multiple sclerosis, a daily dose of 160 mg for 7 days and thereafter 64 mg every second day for a month is suggested.

For injection into a joint (intra-articular), Kenalog-40 is given to help the patient through an acute episode of gout, arthritis, bursitis, tenosynovitis, osteoarthritis, and similar conditions. The initial dose varies from 2.5 mg to 5 mg for smaller joints while 5 mg to 15 mg is given for larger joints. Sometimes injections into several joints at once are indicated. This may be done, up to a maximum of 80 mg at one time.

Children: Dosage is carefully decided depending on the child’s age, weight, and the condition being treated.

How Kenalog-40 is administered

Kenalog-40 should be administered by a medical practitioner. The vial is shaken to disperse the contents evenly throughout the suspension. Before withdrawing, the liquid is checked for any lumps – these can result from freezing and if found, the vial should be discarded.

SYSTEMIC: (Given intramuscularly) The liquid is drawn up into a syringe with a needle using a strict aseptic technique. Once drawn up, the medication should be administered immediately. The practitioner must ensure they do not inject the medication into a blood vessel. Kenalog-40 is injected directly into a muscle (preferably gluteal), A minimum needle length of 1 ½ inches (3.8 cm) is suggested for adults but if obese, a longer needle may be necessary to reach the muscle. Sites should be alternated for subsequent injections.

LOCAL (Given intra-articularly into the joint): The injection may be given into the gap between a joint and tendon, or into a skin lesion. Excessive synovial fluid should be aspirated prior to giving the injection. This will assist with pain relief and will prevent the medication from being diluted. A local anesthetic is usually given first to keep the patient comfortable. When treating tenosynovitis, the doctor should take care that the injection is made into the tendon sheath, not into the tendon itself.

Storage

Kenalog-40 vials should be stored upright in their cartons between 20-25?C (68-77?F) in a cool, dark place. Refrigeration is unnecessary. Do not freeze.

Side Effects

Emergency medical help should be administered in the case of an allergic reaction. Signs include hives, difficulty breathing, and swelling of the face, tongue, lips, or throat.

Reported common side effects include:

  • Skin issues such as acne, dryness, redness, or bruising
  • Increased or decreased hair growth
  • Gastrointestinal symptoms such as nausea, bloating, stomach pain
  • Respiratory symptoms such as cough, runny or blocked nose, shortness of breath
  • Headaches or dizziness
  • Insomnia
  • Slow healing of wounds
  • Excessive sweating
  • Changes in the menstrual cycle
  • Weight gain
  • Fluid retention
  • Mood fluctuations, depression, anxiety, or restlessness

Reported serious side effects include:

  • After an intra-articular injection, there may be increased inflammation or stiffness at the site
  • Fever
  • Eye symptoms – blurred or tunnel vision, halos around lights
  • Mood or behavioral changes
  • Swelling or rapid weight increase
  • Shortness of breath
  • Gastrointestinal symptoms like cramps, vomiting, blood in the stools, diarrhea
  • Stroke or seizures
  • Severe headache
  • Increased intracranial pressure causing severe headache, tinnitus, dizziness, nausea, pain behind the eyes, visual disturbance
  • Low adrenal hormones – signs include flu-type symptoms, depression, tiredness, dizziness, salt cravings
  • Corticosteroids may cause hypernatremia, hypokalemia, fluid retention, and raised blood pressure.
  • Rapid heart rate
  • Pancreatitis – pain in the upper stomach region, vomiting
  • In children, steroid use may stunt growth

This list of side effects may not be complete. Consult a doctor for advice and treatment and report side effects to the FDA at 1-800-FDA-1088.

Warnings and Special Precautions

  • Kenalog-40’s safety and efficacy are unknown for children younger than 6 years of age.
  • Triamcinolone may weaken the immune system making patients more prone to infection. Medical help should be sought if there are signs of infection such as fever or body aches.
  • Live vaccines should not be used concurrently with
  • Some patients may have a severe allergic reaction to the medication. The doctor should be informed of previous reactions to corticosteroids.
  • Contains benzyl alcohol
  • The doctor should be informed if the patient is pregnant or breastfeeding
  • Salt intake may need to be limited during treatment with Kenalog-40 to prevent hypertension
  • Potassium supplements may be necessary
  • The medication should not be stopped suddenly after long-term use
  • Corticosteroids may elevate cholesterol levels, therefore, patients with high cholesterol levels should be closely monitored if the therapy is going to be prolonged. Adjustments to their lipid-lowering regime may be necessary.

Contraindications

  • This medication should not be used if there is an existing infection such as tuberculosis.
  • Kenalog-40 is contraindicated in cases of fungal infections, or idiopathic thrombocytopenic purpura (ITP).
  • Severe hypertension or heart disease
  • Glaucoma, cataracts, or herpes infection in the eyes
  • Diarrhea-inducing parasitic infections such as threadworms
  • Nerve-muscle disorders such as myasthenia gravis
  • Gastric ulcers or diverticulitis
  • Colostomy or ileostomy
  • Osteoporosis
  • Thyroid or adrenal issues

Interactions

A total of 515 drugs are known to interact with Kenalog-40 (triamcinolone). These include:

  • antibiotic or antifungal medications
  • oral contraceptives
  • hormone replacement therapy
  • blood thinners such as Warfarin
  • some diuretics
  • diabetes medication including oral tablets and insulin
  • tuberculosis drug therapies
  • non-steroidal anti-inflammatories such as asprin, ibuprofen, diclofenac and more
  • epilepsy medications
  • certain vitamin supplements and herbal preparations

Frequently Asked Questions

If you miss an appointment for your scheduled Kenalog-40 injection, you should contact your doctor as soon as possible. If it is just a single dose, it can be given at the next available time.

Kenalog-40 can bring sustained relief from symptoms caused by an over-response of the immune system.

No. Most physicians will be able to easily obtain this readily available medication.

This scenario is unlikely because Kenalog-40 is always administered by a doctor in a medical setting. A high initial dose is unlikely to cause issues but long-term use of high doses can cause bruising, thinning skin and hair, acne, increased facial hair, menstrual changes, and decreased libido.

After injection of the medication into a joint, you should avoid high-impact sports or strenuous exertion until your doctor advises otherwise.

Avoid contact with sick people as you will be more susceptible to infections. Be particularly wary of coming into contact with chickenpox or measles as they can be especially harmful to people using Kenalog-40.

Avoid getting any vaccination that contains live organisms. These include measles, mumps, rubella, flu, chickenpox, shingles, and yellow fever. Toxoid vaccines such as Diptheria-tetanus should also be avoided at this time.

A single 60-100 mg dose given intramuscularly takes between 24 and 48 hours to achieve adrenal suppression. Adrenal function gradually normalizes over 30 to 40 days.

Kenalog-40 is considered a medium to strong potency corticosteroid.

Long-term use of any steroids can harm the eyes. If you are receiving Kenalog-40 for more than 6 weeks, your doctor might order regular eye examinations to ensure no harm is done.

While there is no current data about pregnant women receiving this medication to inform of any drug-associated risks, we do know that this medication crosses the placental barrier.

There is no data available on the use of injectable triamcinolone during breastfeeding. Special care should be taken when nursing a newborn or preterm infant. Your doctor may prefer an alternate drug. The use of a once-off local injection such as for tendinitis would not be expected to cause any adverse effects in the infant. It might, however, cause a temporary decrease or loss of milk supply.

Sudden stopping of the medication may cause withdrawal symptoms that include a rebound of the inflammation.

Average to large doses of corticosteroids, including Kenalog-40, can cause increased potassium excretion in the urine. Since potassium helps to maintain normal fluid levels inside the cells, it is important to ensure the supply.

No, controlled clinical trials have shown that corticosteroids can help control symptoms during acute flare-ups of multiple sclerosis, there is no evidence that they affect the disease’s ultimate outcome.

The medication seems to be safe for use in the elderly population. There were no observed overall safety or effectiveness differences between elderly or younger subjects in clinical trials.