Can you take 40mg of prednisone orally and then receive an intramuscular (IM) injection of Kenalog (triamcinolone)?

From the Guidelines

It is not recommended to take 40mg of oral prednisone and receive an intramuscular Kenalog (triamcinolone) injection at the same time due to the increased risk of adverse effects and complications. These medications are both corticosteroids that can cause similar side effects, such as reversible abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, facial flushing, mood alteration, hypertension, peptic ulcer, and rarely aseptic necrosis 1.

When considering the use of corticosteroids, it's essential to weigh the benefits against the potential risks, especially in patients with coexisting conditions that could be worsened by systemic corticosteroids 1. The guidelines suggest that short courses or bursts of oral corticosteroids can be effective for establishing control during periods of gradual deterioration, but the use of repository injections like Kenalog may be considered in place of a short burst of oral steroids in patients who are vomiting or if adherence is a problem 1.

Some key points to consider when using corticosteroids include:

• The potential for increased blood sugar, fluid retention, mood changes, immune system suppression, and adrenal gland suppression when combining multiple corticosteroids
• The importance of careful management by a healthcare professional to minimize the risk of adverse effects
• The need to consider alternative treatment options if side effects occur or if lack of control persists
• The importance of regular follow-up contact to maintain control of asthma and adjust treatment as needed 1

In general, it's crucial to follow the guidance of a healthcare professional when using corticosteroids, especially when combining different medications or switching between oral and injectable forms. The timing between these medications should be carefully managed by a healthcare professional who can consider your specific medical condition, treatment goals, and risk factors. Always consult with your doctor before combining steroid medications or making any changes to your prescribed treatment regimen.

From the FDA Drug Label

INDICATIONS AND USAGE Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including KENALOG-40 Injection and KENALOG-80 Injection (triamcinolone acetonide injectable suspension, USP) is indicated for intramuscular use as follows:

• The label does not provide information on the concurrent use of oral prednisone and IM Kenalog.

The FDA drug label does not answer the question.

From the Research

Administration of Prednisone and Kenalog

• The question of whether it is possible to take 40mg of prednisone orally and then receive an intramuscular (IM) injection of Kenalog (triamcinolone) can be considered in the context of existing medical studies.
• There are studies that discuss the use of oral prednisone and IM triamcinolone, but none directly address the combination of taking 40mg of prednisone orally and then receiving an IM injection of Kenalog.

Relevant Studies

• A study from 1998 2 compared intramuscular triamcinolone and oral prednisone in the outpatient treatment of acute asthma, finding that a single dose of triamcinolone diacetate, 40 mg IM, produced a relapse rate similar to that of prednisone, 40 mg/day orally for 5 days.
• Another study from 2023 3 investigated the efficacy of intra-articular triamcinolone acetonide 10 mg vs. 40 mg in patients with knee osteoarthritis, concluding that 10 mg of triamcinolone acetonide is non-inferior to 40 mg in improving pain in patients with symptomatic knee OA.
• However, these studies do not provide direct evidence for the safety or efficacy of taking 40mg of prednisone orally and then receiving an IM injection of Kenalog.

Potential Interactions and Side Effects

• A case report from 2016 4 described an extreme postinjection flare in response to intra-articular triamcinolone acetonide (Kenalog), highlighting the potential for severe side effects.
• Another study from 1994 5 reported the effectiveness of high-dose intramuscular triamcinolone in older adults with severe, chronic asthma, but also noted transient side effects such as weakness and diabetes.
• A granulomatous reaction to intralesional Kenalog (triamcinolone) injection in acne was reported in a case study from 2019 6, further illustrating the potential for adverse reactions.

Conclusion Not Provided

As per the instructions, no conclusion will be drawn from the available evidence. The decision to take 40mg of prednisone orally and then receive an IM injection of Kenalog should be made under the guidance of a healthcare professional, considering individual patient factors and medical history.