Triamcinolone injection
KENALOG-40
Pronunciation: trye-am-SIN-oe-loen
“Ken-log, Try and sin, alone”
moon face → corticosteroid
What it isInjectable glucocorticoid-receptor agonist; intra-articular inflammation and selected severe inflammatory disorders.
Why this oneA depot suspension provides prolonged local or systemic steroid effect when oral therapy is impractical.
What limits itDo not inject into an infected joint; systemic exposure causes hyperglycemia and adrenal suppression, and repeated local injection damages tissue.
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyperglycemia, infection, osteoporosis and potentially severe mood, sleep or psychotic effects.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Systemic corticosteroid therapy (allergic, dermatologic, rheumatic, respiratory, etc.) — IM | Adults | Initial 60 mg IM (deep gluteal); usual range 40–80 mg | Adjust to response (some controlled on ≤20 mg) | ~100 mg/day (multiples of oral dose in emergencies) |
| Systemic corticosteroid therapy — IM | Pediatric | 0.11–1.6 mg/kg/day in 3–4 divided doses | Adjust to response | 1.6 mg/kg/day |
| Intra-articular / soft tissue | Adults | 2.5–5 mg smaller joints; 5–15 mg larger joints | Repeat as needed | Up to 80 mg total across several joints |
Renal Undefined
Hepatic Undefined
Long-acting; not suitable for acute stress situations. MS exacerbation: 160 mg/day x1 wk then 64 mg every other day x1 mo
Instructions
- IM: inject deeply into gluteal muscle; avoid deltoid (local atrophy)
- Not for IV use (suspension)
- Shake vial before use; discard if agglomerated
- Strict aseptic technique
- Withdraw gradually after long-term therapy
- Contains benzyl alcohol
Available strengths
- inj 10, 40, 80 mg/mL
- susp 32 mg/vial
- cream 0.025, 0.1, 0.5 %
- inhaler 147 mcg/g
- lotion 0.025, 0.1 %
- nasal spray 55 mcg/spray
- ointment 0.025, 0.05, 0.1, 0.5 %
- paste 0.1 %
- + 1 other marketed form not shown
Contraindications
- Idiopathic thrombocytopenic purpura (intramuscular administration)
Cautions
- Serious neurologic events (incl. death) with epidural administration — not approved for this use (spinal cord infarction, paraplegia, stroke)
- Not for IV use
- Increased risk of infection; may mask signs of infection
- Reactivation of latent TB, hepatitis B; varicella/measles can be severe or fatal in non-immune patients
- Not for traumatic brain injury (increased mortality)
- HPA axis suppression
- Cardio-renal: fluid/sodium retention, hypertension, hypokalemia
- Local atrophy at injection site
- Benzyl alcohol toxicity in neonates/preterm infants
- Osteoporosis/bone loss; growth suppression in children
- Psychiatric derangements
Adverse reactions
- Anaphylaxis/angioedema
- Fluid and sodium retention, potassium loss
- Hypertension
- Cushingoid state, growth suppression
- Peptic ulcer with possible perforation
- Osteoporosis, aseptic necrosis, muscle weakness
- Impaired wound healing, skin atrophy
- Posterior subcapsular cataracts, glaucoma, increased IOP
- Mood/psychiatric changes
- Injection site atrophy
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 10 mg/mL | inj | per unit | — | $2.33/mL | not offered |
| 40 mg/mL | inj | per unit | $4.83/mL | — | not offered |
| 80 mg/mL | inj | per unit | — | $17.87/mL | not offered |
Other forms: Triamcinolone (KENALOG)
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Memory aids: interaction avatars
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Self-check
- What formulation produces prolonged triamcinolone injection effects?
A depot suspension. - Into which joints must triamcinolone not be injected?
Infected joints.