KENALOG

Clinical safety rating: caution

Comprehensive clinical and safety monograph for KENALOG (KENALOG).

How it works

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.

What the body does with it

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

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for KENALOG (KENALOG).

Breastfeeding	Enters breast milk in low concentrations (M/P ratio unknown). Short-term, low-dose use is likely compatible; prolonged high-dose may suppress neonatal adrenal function. Monitor infant for growth and adrenal suppression.
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

Warnings & precautions

■ 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.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to triamcinolone or any component","Systemic fungal infections","Administration of live or live-attenuated vaccines in patients receiving immunosuppressive doses","Intrathecal or epidural administration (due to risk of serious neurologic events)","Idiopathic thrombocytopenic purpura (for intramuscular use)","Breastfeeding (use caution)"]

Clinical Precautions

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"]

Clinical Tips & Counseling

Drug interactions

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KENALOG

Clinical safety rating: caution

Comprehensive clinical and safety monograph for KENALOG (KENALOG).

How it works

What the body does with it

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

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for KENALOG (KENALOG).

Breastfeeding	Enters breast milk in low concentrations (M/P ratio unknown). Short-term, low-dose use is likely compatible; prolonged high-dose may suppress neonatal adrenal function. Monitor infant for growth and adrenal suppression.
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