From the FDA Drug Label
KENALOG-40 40 mg per 10 mL Injectable Suspension For intramuscular or intra-articular use only
Studies indicate that following a single intramuscular dose of 60 mg to 100 mg of triamcinolone acetonide, adrenal suppression occurs within 24 to 48 hours and then gradually returns to normal, usually in 30 to 40 days.
The appropriate intramuscular dosing of Kenalog (Triamcinolone) for a herniated disc is 60 mg to 100 mg as a single dose, as supported by the studies indicating the duration of therapeutic action and adrenal suppression [1] [2].
From the Research
Intramuscular Kenalog (triamcinolone acetonide) is not typically recommended as a first-line treatment for bulging discs, and the standard approach involves epidural steroid injections delivered directly to the affected area. For epidural administration, triamcinolone acetonide is typically dosed at 40-80 mg per injection session, as seen in studies such as 3. If intramuscular Kenalog is being considered as an alternative when epidural injection isn't possible, a typical dose would be 40-80 mg given as a deep intramuscular injection, with effects lasting approximately 1-3 weeks. However, intramuscular steroid injections provide systemic rather than targeted relief and carry risks of systemic side effects including elevated blood glucose, mood changes, insomnia, and adrenal suppression, as noted in 4. These injections should be limited to no more than 3-4 times per year with at least 6 weeks between injections to minimize side effects. Patients should be informed that while this may provide temporary pain relief, it doesn't address the underlying disc pathology, and a comprehensive treatment plan including physical therapy, proper body mechanics, and possibly other interventions would be necessary for long-term management. Recent studies, such as 5, have also explored alternative treatments like platelet-rich plasma (PRP) epidural injections, which have shown promising results in treating lumbar disc herniation, but more research is needed to fully understand its efficacy and safety compared to traditional steroid injections. Key considerations for treatment include:
- The potential benefits and risks of intramuscular steroid injections
- The importance of a comprehensive treatment plan for long-term management
- The need for further research on alternative treatments like PRP epidural injections, as seen in 5
- The standard approach of epidural steroid injections, as discussed in 6 and 3.