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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KENALOG-H (KENALOG-H).
| Breastfeeding | Enters breast milk; M/P ratio unknown. Use with caution, monitor infant for adrenal suppression. Avoid high doses or prolonged use. |
| 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 |
■ FDA Black Box Warning
No FDA black box warnings for KENALOG-H.
| Serious Effects |
["Systemic fungal infections","Hypersensitivity to triamcinolone or any component","Idiopathic thrombocytopenic purpura (ITP) for intralesional 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"] |
Loading safety data…
| 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. |