Kenalog

What is it?

An anti-inflammatory corticosteroid (glucocorticoid) preparation available in pre-filled syringes and vials for injection, containing 40mg triamcinolone acetonide per ml.

Medical Uses

Pain in joints, stiffness and swelling due to rheumatoid arthritis, osteoarthritis. Inflammation of connective tissue (bursa) around joint (bursitis), tendon sheath (tenosynovitis), inflammation of the elbow joint (epicondylitis). Also, used for collagen disorders, deficiency of hormones of adrenal cortex, serious dermatitis, allergic disorders, kidney disease, malignancy.

Dosage

Adults by intramuscular injection, 40mg by deep injection into gluteal muscle; further doses according to patient's condition. For allergic states, e. g. hay fever, 40 to 100mg as single dose. Joint disorders, 5 to 40mg by intra-articular injection (directly into joint) according to joint size. Maximum dose if more than one joint is being treated is 80mg. Children, age 6 to 12 years, in proportion to adult dose according to age, severity of condition, bodyweight and joint size.

Special Care

Elderly, pregnancy, breastfeeding, only for short-term treatment in children. Infections, especially tuberculosis, fungal and viral. Liver failure, cirrhosis, kidney disorders, congestive heart failure, recent heart attack, diarrhoea of unknown cause, ulcerative colitis, stomach ulcer, diverticulitis, recent scar tissue affecting digestive tract, inflammatory conditions of the veins, glaucoma. Also, cancers that have spread, diabetes, certain skin diseases, high blood pressure, psychotic conditions, epilepsy, osteoporosis, herpes simplex infections affecting the eyes, cerebral malaria, under-active thyroid gland, stress, previous steroid myopathy, intercurrent illnesses, myasthenia gravis. Also, accidental injuries and planned surgery - patient must be monitored. Patients should avoid exposure to measles infection - if inadvertently exposed, preventative treatment with immunoglobulins may be needed. Likewise, exposure to chickenpox or herpes zoster should be avoided - treatment with varicellazoster immunoglobulin may be required. Taking drug in morning or every second day helps to reduce risk of suppression of adrenal glands. Patients should carry a 'steroid treatment card'. treatment should be short-term. Withdraw treatment gradually.

Avoid Use

Whole body fungal infections, unless particular counter measures are being employed.

Possible Drug and Food Interactions

Anticholinesterases, phenobarbitone, cardiac glycosides, diuretics, carbamazapine, anti- hypertensives, anticoagulants taken by mouth, rifampicin, oestrogens, hypoglycaemics, phenytoin, aminoglutethimide, primidone, ephedrine, rifabutin. Also, salicylates, NSAIDs, cyclosporin, live vaccines, azole antifungals, carbenoxolone, erythromycin, methotrexate.

Known Side Effects

Depending upon dose and duration of treatment, steroid side effects including electrolyte disturbances and fluid imbalances, water retention, loss of potassium, gastrointestinal disturbance, central nervous system effects, salt retention, impaired wound healing, effects on bones, osteoporosis, cataracts, cushingoid effects, skin changes, depression, high blood pressure, glaucoma. Also, muscle weakness, stomach ulcer, hyperglycaemia, changes in sperm mobility, euphoria, mood swings. Also, retarded growth in children.