KENALOG
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KENALOG (KENALOG).
Triamcinolone acetonide is a synthetic corticosteroid with potent glucocorticoid and weak mineralocorticoid activity. It binds to the glucocorticoid receptor, leading to inhibition of phospholipase A2, decreased release of arachidonic acid, and reduced synthesis of prostaglandins and leukotrienes. It also suppresses cytokine production and immune cell migration.
| Metabolism | Primarily hepatic via CYP3A4; metabolites are inactive. A small fraction is excreted unchanged in urine. |
| Excretion | Renal (primarily as metabolites), ~30% unchanged; biliary/fecal minor (≤10%) |
| Half-life | Terminal half-life ~2-5 hours (triamcinolone acetonide); clinical duration prolonged due to crystalline depot formulation |
| Protein binding | 68% bound to albumin and corticosteroid-binding globulin (CBG) |
| Volume of Distribution | Vd ~1.2 L/kg; distributes extensively into tissues |
| Bioavailability | Oral: ~5-10% (due to first-pass); IM: 100% (absolute) |
| Onset of Action | Intra-articular: 24-48 hours; Intramuscular: 6-24 hours; Topical: hours to days |
| Duration of Action | Intra-articular: weeks (depot effect); Intramuscular: 2-4 weeks; Topical: days with daily application |
| Molecular Weight | 434.5 |
Kenalog (triamcinolone acetonide) 40-80 mg intramuscularly (deep gluteal) every 4 weeks; or 0.5-1 mg/kg intravenously every 24 hours (for acute conditions).
| Dosage form | LOTION |
| Renal impairment | No specific dose adjustment required for renal impairment; monitor for fluid retention and hypertension. |
| Liver impairment | Child-Pugh A: No adjustment. Child-Pugh B: Consider 50% dose reduction. Child-Pugh C: Avoid use due to increased risk of toxicity. |
| Pediatric use | 0.1-0.3 mg/kg intramuscularly every 2-4 weeks; maximum single dose 3 mg/kg, not to exceed 80 mg. |
| Geriatric use | Start at lowest effective dose (e.g., 20-40 mg IM); titrate carefully due to increased risk of osteoporosis, hyperglycemia, and immune suppression. |
| 1st trimester | Corticosteroids like triamcinolone are associated with a small increased risk of oral clefts when used systemically in the first trimester; however, the risk with topical, intra-articular, or inhaled routes is considered minimal. Use only if clearly needed. |
| 2nd trimester | Use caution; avoid prolonged or high-dose systemic use due to potential for fetal growth restriction. Topical/intra-articular use is generally safe. |
| 3rd trimester | Systemic use near term may cause neonatal adrenal suppression. Use only if benefits outweigh risks. Intra-articular or topical use is acceptable. |
Clinical note
Comprehensive clinical and safety monograph for KENALOG (KENALOG).
| Placental transfer | Triamcinolone crosses the placenta; the degree of transfer is moderate, but may be reduced compared to prednisolone due to partial inactivation by placental 11-beta-hydroxysteroid dehydrogenase. Fetal exposure is estimated at 10-30% of maternal levels. |
| Breastfeeding |
■ FDA Black Box Warning
In patients on immunosuppressant doses of corticosteroids, exposure to chickenpox or measles may be severe or fatal. Prophylaxis with varicella zoster immune globulin or pooled intravenous immunoglobulin may be indicated. Systemic corticosteroids are not recommended for epidural injection; serious neurologic events (including spinal cord infarction, paraplegia, and death) have been reported.
| Serious Effects |
Systemic fungal infectionHypersensitivity to triamcinolone or any component of the formulationIntrathecal administration (contraindicated)
| Precautions | Adrenal suppression with prolonged use or rapid withdrawal, Increased susceptibility to infections, Masking of signs of infection, Growth suppression in children, Osteoporosis, Gastrointestinal perforation (especially in inflammatory bowel disease), Cushing's syndrome with prolonged therapy, Hyperglycemia/diabetes, Hypertension, Ocular effects: cataracts, glaucoma, increased intraocular pressure, Psychiatric disturbances |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they can increase the effects of corticosteroids. Limit salt intake if edema is present. Maintain adequate calcium and vitamin D intake to mitigate bone loss risk. Avoid potassium-depleting foods or supplements if hypokalemia is a concern. |
Loading safety data…
| Triamcinolone is excreted into breast milk in low amounts. With maternal doses up to 40 mg/day, infant exposure is unlikely to be clinically significant. However, high-dose or prolonged systemic use may suppress infant adrenal function. Monitor infant for signs of adrenal suppression if mother is on high doses. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | First trimester: Increased risk of orofacial clefts (odds ratio ~1.3-3.4). Second and third trimesters: Risk of fetal growth restriction, adrenal suppression, and potential neurodevelopmental effects. Chronic use may cause premature birth or low birth weight. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose, and signs of adrenal suppression. Fetal ultrasound for growth parameters if used long-term. Newborns exposed in utero should be monitored for adrenal insufficiency. |
| Fertility Effects | May cause menstrual irregularities or reversible suppression of gonadotropins leading to temporary infertility. No permanent effects reported. |
| Clinical Pearls | Intra-articular injection should be avoided in unstable joints. Avoid subcutaneous injection as it may cause fat atrophy. Use preservative-free formulation for intrathecal use. Do not administer live vaccines during therapy. Taper dose to avoid adrenal insufficiency after long-term use. |
| Patient Advice | Do not stop taking this medication abruptly without consulting your doctor. · Report any signs of infection such as fever, sore throat, or persistent pain. · Avoid contact with people who have chickenpox or measles. · Use caution when engaging in activities that require alertness; may cause dizziness. · Inform your doctor if you have diabetes, as this medication may increase blood glucose levels. · Avoid alcohol consumption as it may increase the risk of gastrointestinal bleeding. |