What is the proper usage and dosage of Kenalog (triamcinolone) steroid?

Kenalog (Triamcinolone Acetonide) Steroid: Proper Usage and Dosage

Kenalog (triamcinolone acetonide) is an injectable corticosteroid available in 40 mg/mL and 80 mg/mL formulations, indicated for intramuscular or intra-articular administration only. 1

Formulations and Administration Routes

• Kenalog is available as an injectable suspension in two concentrations:

  • Kenalog-40: 40 mg/mL (available in 1 mL, 5 mL, and 10 mL vials)
  • Kenalog-80: 80 mg/mL (available in 1 mL and 5 mL vials) 1

• Administration routes are limited to:

  • Intramuscular injection
  • Intra-articular injection 1

Dosage Guidelines by Indication

Allergic Rhinitis

• For intranasal formulation (Nasacort Allergy 24HR):
  • Ages 2-5 years: 1 spray per nostril daily
  • Ages 6-11 years: 2 sprays per nostril daily
  • Ages ≥12 years: 2 sprays per nostril 1-2 times daily 2

Dermatological Conditions

• For lichen sclerosus with topical steroid-resistant areas:
  • Intralesional triamcinolone 10-20 mg after excluding malignancy 2
• For alopecia areata:
  • Intralesional injection of triamcinolone acetonide 5-10 mg/mL into affected areas 2

Joint Conditions

• For knee osteoarthritis:
  • 10 mg intra-articular injection is non-inferior to 40 mg for pain relief, with effects lasting approximately 12 weeks 3
• For trigger finger:
  • 20 mg dose shows higher clinical effectiveness (79%) at 6 months compared to 10 mg (62%) or 5 mg (52%) 4

Atopic Dermatitis

• Not recommended for chronic use due to risk of rebound flares
• If used as transitional therapy in severe cases:
  • Dosage range: 0.5-1.0 mg/kg
  • Requires tapering schedule to prevent adrenal suppression 2

Important Precautions and Monitoring

• Avoid prolonged use due to potential side effects including:

  • Skin atrophy and telangiectasia (with topical use)
  • Hypothalamic-pituitary-adrenal axis suppression
  • Growth suppression in children
  • Hypertension, glucose intolerance, and decreased bone density 2, 5

• For long-term administration (if necessary):

  • Monitor blood pressure
  • Consider ophthalmologic examination
  • Evaluate for hypothalamic-pituitary-adrenal axis suppression
  • Monitor bone density in adults
  • Track growth velocity in children 2

Potential Adverse Effects

• Common side effects include:

  • Injection site reactions
  • Pharyngitis, epistaxis, and cough (with intranasal use) 2

• Severe reactions may include:

  • Post-injection flares mimicking septic arthritis with joint swelling and intense pain 6
  • Systemic effects with prolonged use (hypertension, glucose intolerance, weight gain) 2

Clinical Pearls

• For facial application, consider alternative agents like topical calcineurin inhibitors due to increased risk of steroid-induced atrophy 5
• For maintenance therapy, consider reducing application frequency while maintaining efficacy 5
• The unique pharmacokinetics of intramuscular triamcinolone acetonide allows for longer duration of action compared to other corticosteroids 7
• When treating trigger finger, higher doses (20 mg) provide better long-term outcomes than lower doses 4

Contraindications

• History of hypersensitivity to triamcinolone acetonide or any components of the formulation 2
• Caution in patients with HIV who may absorb steroids at a higher rate 2