KENALOG-H
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KENALOG-H (KENALOG-H).
Triamcinolone acetonide is a corticosteroid that binds to the glucocorticoid receptor, leading to inhibition of phospholipase A2, reduced prostaglandin and leukotriene synthesis, and suppression of inflammatory mediators.
| Metabolism | Primarily hepatic via CYP3A4; undergoes 6β-hydroxylation and reduction. |
| Excretion | Renal excretion of metabolites (primarily conjugated and unconjugated) accounts for approximately 80-90% of an administered dose, with less than 5% excreted unchanged in urine. Biliary/fecal elimination accounts for the remainder, about 10-20%. |
| Half-life | The terminal elimination half-life is approximately 2-3 hours for triamcinolone acetonide. In the context of intra-articular or intralesional administration, the half-life at the site of action is prolonged due to slow release from the injection depot, providing sustained local effects. |
| Protein binding | Approximately 68-71% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Volume of distribution is approximately 0.5-1.0 L/kg (mean about 0.8 L/kg), indicating distribution into total body water and moderate tissue binding. |
| Bioavailability | Topical: bioavailability is low (approximately 1-5% through intact skin). Intramuscular: complete bioavailability (100%). Intra-articular: essentially 100% locally with negligible systemic absorption relative to dose. Oral: not available (no oral formulation for triamcinolone acetonide). |
| Onset of Action | Intra-articular: onset of anti-inflammatory effect is usually within 24-48 hours. Intramuscular: onset within 6-12 hours. Topical (as cream/ointment): onset within several days with consistent use. |
| Duration of Action | Intra-articular: relief of symptoms may persist from several days to several weeks (typically 1-3 weeks). Intramuscular: duration of adrenal suppression and clinical effect is approximately 1-2 weeks. Topical: duration depends on frequency of application and condition. |
| Molecular Weight | 434.5 Da (triamcinolone acetonide) |
2-40 mg (0.1-1 mL) intra-articular, intralesional, or soft tissue injection; intra-articular dose depends on joint size (large joint: 10-40 mg, medium joint: 5-25 mg, small joint: 2-10 mg); repeat every 2-3 weeks as needed.
| Dosage form | CREAM |
| Renal impairment | No dose adjustment required; however, use caution in patients with severe renal impairment due to potential fluid retention. |
| Liver impairment | No specific Child-Pugh based adjustments; use caution in severe hepatic impairment due to increased risk of corticosteroid side effects. |
| Pediatric use | 0.03-0.2 mg/kg (1-6 mg/m²) intramuscular or intralesional; repeat every 1-3 weeks; maximum single dose 30 mg. |
| Geriatric use | Use lowest effective dose; monitor for fluid retention, hyperglycemia, and osteoporosis; consider reduced initial dose (e.g., 5-20 mg intra-articular). |
| 1st trimester | Contraindicated. Triamcinolone acetonide is a corticosteroid that may increase the risk of orofacial clefts when used during the first trimester. Use only if clearly needed for life-threatening conditions. |
| 2nd trimester | Use with caution. Has been associated with intrauterine growth restriction and adrenal suppression in the fetus. Avoid chronic use. |
| 3rd trimester | Use with caution. May cause fetal adrenal suppression, but can be used for fetal lung maturation if indicated (though betamethasone or dexamethasone preferred). |
Clinical note
Comprehensive clinical and safety monograph for KENALOG-H (KENALOG-H).
| Placental transfer | Triamcinolone acetonide crosses the placenta. Approximately 60-70% of maternal drug concentration reaches fetal circulation. Higher transfer compared to prednisone. |
| Breastfeeding | Triamcinolone acetonide is excreted into breast milk in small amounts. Use with caution, especially at high doses or prolonged courses. Monitor infant for signs of adrenal suppression. |
■ FDA Black Box Warning
No FDA black box warnings for KENALOG-H.
| Serious Effects |
Systemic fungal infectionHypersensitivity to triamcinolone or any componentIntrathecal administration (associated with arachnoiditis)Live or attenuated virus vaccines (concurrent use)
| Precautions | May suppress hypothalamic-pituitary-adrenal axis, Increased risk of infections, Osteoporosis with long-term use, Adrenal insufficiency with abrupt withdrawal, Elevated intraocular pressure with ophthalmic use |
| Food/Dietary | No known food interactions with topical triamcinolone acetonide. |
| Clinical Pearls |
Loading safety data…
| Lactation Rating | L3 - Moderately Safe |
| Teratogenic Risk | First trimester: Significant teratogenic risk (orofacial clefts, neural tube defects, IUGR) with systemic corticosteroids. Second/third trimester: Increased risk of fetal growth restriction, adrenal suppression, and preterm birth with prolonged use. Use only if clearly needed. |
| Fetal Monitoring | Monitor maternal blood pressure, glucose tolerance, signs of infection. Fetal ultrasound for growth and adrenal function assessment. |
| Fertility Effects | Systemic corticosteroids may impair fertility via hypothalamic-pituitary-adrenal axis suppression and altered gonadotropin release; reversible upon discontinuation. |
| Kenalog-H (triamcinolone acetonide) is a high-potency topical corticosteroid. Limit use to 2 weeks continuously to avoid skin atrophy and systemic absorption. Avoid use on face, groin, axillae, or under occlusive dressings. Monitor for adrenal suppression if used over large areas. Not for ophthalmic use. |
| Patient Advice | Apply a thin layer only to affected skin, avoid healthy skin. · Do not use for longer than prescribed; overuse can cause skin thinning and stretch marks. · Avoid covering the area with bandages or wraps unless directed. · Wash hands after application unless treating hands. · Inform your doctor if you have an infection at the application site. |