KENACORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KENACORT (KENACORT).
Glucocorticoid receptor agonist; inhibits phospholipase A2, reduces prostaglandin and leukotriene synthesis; suppresses cytokine production and immune cell migration.
| Metabolism | Hepatic via CYP3A4 to inactive metabolites (11-keto and 6β-hydroxy derivatives). |
| Excretion | Renal: 25-30% as unchanged drug and metabolites. Biliary/fecal: 50-70% as metabolites, with enterohepatic circulation. |
| Half-life | Terminal elimination half-life: 2-5 hours (triamcinolone acetonide). Clinical context: Short half-life supports alternate-day dosing for chronic conditions; however, adrenal suppression may persist longer. |
| Protein binding | 68-78% bound to albumin and corticosteroid-binding globulin. |
| Volume of Distribution | 0.7-1.4 L/kg. Clinical meaning: Indicates extensive distribution into tissues, with higher Vd reflecting accumulation in fat and muscle. |
| Bioavailability | Oral: 20-40% due to first-pass metabolism; Intramuscular: 100% (depot formulation). |
| Onset of Action | Intramuscular: 1-2 hours; Intra-articular: 24-48 hours; Oral: 2-4 hours. |
| Duration of Action | Intramuscular: 2-4 weeks; Intra-articular: 7-21 days; Oral: 1-2 days. Clinical notes: Duration is prolonged in synovial spaces due to low solubility and depot effect. |
| Molecular Weight | 434.5 |
| Action Class | Glucocorticoids |
| Brand Substitutes | P cort 40mg Injection, Makcort 40mg/ml Injection, Acecort 40mg Injection, Deltakort 40mg Injection, Presticort-T Injection, Trilone 4mg Tablet, Tacit 4mg Tablet, Kencort 4mg Tablet, Mericort 4mg Tablet, Cortim 4mg Tablet, Comcort 10mg Injection, Darcort 10mg Injection, Corty 10mg Injection, Acort 10mg Injection, Triroid 10mg Injection |
Kenacort (triamcinolone acetonide) is a corticosteroid. For adults, typical dosing is 40-80 mg intramuscularly (deep intragluteal) as a single injection; oral tablets: 4-48 mg/day divided every 6-12 hours; intra-articular: 5-40 mg depending on joint size.
| Dosage form | SYRUP |
| Renal impairment | No specific GFR-based dose adjustments are routinely recommended; however, use with caution in severe renal impairment due to potential fluid retention. |
| Liver impairment | In Child-Pugh Class A: no adjustment. Class B: reduce dose by 50%. Class C: avoid use or reduce to 25% of usual dose. |
| Pediatric use | Intramuscular: 0.1-0.2 mg/kg/dose (max 40 mg) as a single injection; oral: 0.1-0.2 mg/kg/day divided every 6-12 hours. |
| Geriatric use | Start at lowest effective dose (e.g., oral 4 mg/day or IM 40 mg) due to increased risk of osteoporosis, hypertension, and immunosuppression; monitor closely. |
| 1st trimester | Triamcinolone (KENACORT) is a corticosteroid. Use in first trimester only if benefit outweighs risk; associated with increased risk of cleft palate (odds ratio ~1.3) in some studies. Avoid high doses. |
| 2nd trimester | Use with caution; associated with fetal growth restriction and adrenal suppression with prolonged use. Monitor fetal growth. |
| 3rd trimester | Use with caution prior to delivery; may cause transient neonatal adrenal suppression. Avoid repeated doses. |
Clinical note
Comprehensive clinical and safety monograph for KENACORT (KENACORT).
| Placental transfer | Triamcinolone crosses the placenta; however, studies suggest lower fetal exposure compared to betamethasone or dexamethasone due to placental metabolism. |
| Breastfeeding | Triamcinolone enters breast milk in low amounts; with high doses or prolonged use, potential for adrenal suppression in infant. Consider risk-benefit; using lowest effective dose and monitoring infant for growth and development. |
■ FDA Black Box Warning
Avoid intraoperative use in epidural space; risk of spinal cord infarction, paraplegia, and central nervous system depression.
| Serious Effects |
Systemic fungal infectionHypersensitivity to triamcinolone or any component
| Precautions | Increased risk of infections, Adrenal suppression with prolonged use, Osteoporosis with long-term use, Cushing's syndrome with systemic absorption, Growth suppression in children, Ocular effects (glaucoma, cataracts) |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase systemic levels. For patients on long-term therapy, limit high-sodium foods to reduce fluid retention; increase potassium-rich foods (bananas, oranges) to counteract hypokalemia. |
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| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: Increased risk of cleft palate (OR 1.3-3.4) with systemic use. Second/third trimesters: Fetal adrenal suppression, intrauterine growth restriction (IUGR), and oligohydramnios with prolonged high doses. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose (especially in pregestational diabetes), and signs of infection. Fetal ultrasound for growth parameters and amniotic fluid index every 4 weeks during prolonged therapy. Assess for preterm labor. |
| Fertility Effects | May suppress ovarian function, leading to menstrual irregularities and anovulation at high doses. Reversible upon dose reduction or discontinuation. No permanent effect on fertility. |
| Clinical Pearls | KENACORT (triamcinolone acetonide) is a potent corticosteroid. For intra-articular injection, use strict aseptic technique. Avoid overuse to prevent joint destruction and steroid arthropathy. In dermatological use, limit application to small areas due to systemic absorption risk. Monitor for adrenal suppression if used long-term or on extensive areas. |
| Patient Advice | Do not stop this medication abruptly; follow your doctor's tapering schedule. · Report signs of infection (fever, sore throat) or worsening of injected joint pain. · Avoid live vaccines while on high doses or long-term therapy. · For topical use, apply a thin layer and avoid covering with bandages unless directed. · Notify your dentist or surgeon that you are taking corticosteroids before any procedure. · Do not use on broken skin or in eyes, mouth, or vagina. |