KENALOG-80
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KENALOG-80 (KENALOG-80).
Triamcinolone acetonide is a synthetic corticosteroid with potent anti-inflammatory, immunosuppressive, and anti-proliferative effects. It binds to the glucocorticoid receptor, leading to modulation of gene expression and inhibition of phospholipase A2, which reduces prostaglandin and leukotriene synthesis. It also suppresses cytokine production and immune cell migration.
| Metabolism | Primarily hepatic via CYP3A4-mediated metabolism. Triamcinolone acetonide is metabolized to 6β-hydroxy and 20-dihydro metabolites, which are then conjugated and excreted renally. |
| Excretion | Primarily hepatic metabolism followed by renal excretion of inactive metabolites; less than 5% excreted unchanged in urine, with minor biliary/fecal elimination (<2%). |
| Half-life | Terminal elimination half-life: 2–4 hours for triamcinolone acetonide; prolonged in hepatic impairment (up to 6–8 hours). |
| Protein binding | Approximately 68% bound to albumin and corticosteroid-binding globulin (CBG). |
| Volume of Distribution | Vd: 1.4 L/kg, indicating extensive tissue distribution (higher than plasma volume). |
| Bioavailability | Intramuscular: 100% (complete); Oral: approximately 23% (low due to first-pass metabolism); Topical: variable (<1% systemic unless applied to compromised skin). |
| Onset of Action | Intramuscular: 24–48 hours; Intra-articular: 1–2 days; Topical: several days (due to slow release). |
| Duration of Action | Intramuscular: 2–3 weeks; Intra-articular: 1–2 months; Topical: up to 3 weeks depending on formulation. |
60 mg (1.5 mL) intramuscularly (deep IM) as a single dose for allergic/ inflammatory conditions; intra-articular or soft tissue injection: 10-40 mg for large joints, 5-25 mg for medium joints, 2.5-10 mg for small joints; intralesional: up to 1 mg per injection site, repeated as needed.
| Dosage form | INJECTABLE |
| Renal impairment | No specific GFR-based dose adjustments available; use with caution in severe renal impairment due to potential fluid retention and hypertension. |
| Liver impairment | No specific Child-Pugh based adjustments; caution in severe hepatic impairment due to increased risk of adverse effects. |
| Pediatric use | Not recommended for children under 12 years due to potential growth suppression; for children 12 years and older, similar to adult dosing based on severity and condition, typically 0.6-1.7 mg/kg/day in divided doses; adjust according to response. |
| Geriatric use | Use lowest effective dose due to increased risk of osteoporosis, hypertension, and diabetes; monitor blood pressure, blood glucose, and bone density; typical adult dose but with cautious titration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KENALOG-80 (KENALOG-80).
| Breastfeeding | Triamcinolone acetonide is excreted into breast milk in low amounts; M/P ratio not established. At single low doses, amounts are negligible. High-dose or chronic use could potentially suppress neonatal adrenal function or cause other effects. Caution advised. |
| Teratogenic Risk | Triamcinolone acetonide (KENALOG-80) is a corticosteroid. First trimester: associated with a small increased risk of oral clefts (odds ratio ~1.3-3.4) in some studies; also linked to intrauterine growth restriction (IUGR). Second/Third trimester: chronic use may cause fetal adrenal suppression, IUGR, and premature birth. Benefits must outweigh risks. |
■ FDA Black Box Warning
Intrathecal administration is contraindicated and can result in severe neurologic events including arachnoiditis, meningitis, paraparesis, and sensory disturbances. Systemic corticosteroids have been associated with increased risk of infection and potential for hypothalamic-pituitary-adrenal (HPA) axis suppression.
| Serious Effects |
["Systemic fungal infections","Intrathecal administration","Known hypersensitivity to triamcinolone acetonide or any component of the formulation","Administration into unstable joints, infected areas, or injection sites with septic arthritis","Live or attenuated virus vaccines in immunocompromised patients (relative)"]
| Precautions | ["HPA axis suppression with prolonged use or high doses; taper dose gradually","Increased susceptibility to infections; avoid live vaccines","Masking of infection signs; monitor for active infections","Osteoporosis risk with long-term use","Ocular effects: cataracts, glaucoma, central serous chorioretinopathy","Gastrointestinal perforation risk in patients with diverticulitis, peptic ulcer, or recent bowel anastomosis","Cardiovascular effects: hypertension, fluid retention, congestive heart failure","Musculoskeletal: myopathy, tendon rupture, avascular necrosis","Psychiatric disturbances: euphoria, insomnia, mood swings, psychosis","Growth suppression in children"] |
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| Fetal Monitoring | Monitor for maternal hyperglycemia, hypertension, and signs of infection. Fetal monitoring with serial ultrasound for growth restriction, amniotic fluid volume, and fetal well-being (non-stress test/biophysical profile) if chronic use. Newborn should be observed for adrenal suppression if maternal use near term. |
| Fertility Effects | High-dose corticosteroids may disrupt menstrual cycle and suppress ovulation. In males, high doses can reduce sperm count and motility. Reversible upon discontinuation. No known permanent fertility impairment. |
| Food/Dietary | No specific food interactions reported. However, because corticosteroids can increase blood glucose, advise patients with diabetes to monitor glucose levels closely after injection and adjust diet/insulin as needed. Avoid excessive salt intake if fluid retention or hypertension is a concern. |
| Clinical Pearls | Kenalog-80 (triamcinolone acetonide injectable suspension 80 mg/mL) is a high-potency, long-acting corticosteroid used for intra-articular, intrabursal, or intradermal injection. Avoid intravascular injection due to risk of embolic phenomena. Do not use for intravenous, intramuscular, or subcutaneous administration. Shake well before use. Use a tuberculin syringe for precise dosing in small joints. Monitor for signs of joint infection post-injection. Contraindicated in systemic fungal infections and in patients with idiopathic thrombocytopenic purpura. |
| Patient Advice | This medication is injected directly into a joint or soft tissue to reduce inflammation and pain. · Do not overuse the treated joint for at least 48 hours after injection to allow the medication to work and reduce risk of injury. · Common side effects include temporary pain or swelling at the injection site, facial flushing, and mood changes. · Contact your doctor immediately if you experience signs of infection (fever, increased redness, warmth, or pain) or allergic reaction (rash, difficulty breathing). · Inform your doctor about all other medications you take, especially blood thinners, NSAIDs, or other corticosteroids. · This medication may raise blood sugar; monitor closely if you have diabetes. · Do not receive any vaccines for 2 weeks before or after this injection without consulting your doctor. |