Is Kenalog (triamcinolone) 40 appropriate for an 18-year-old?

Kenalog 40 (Triamcinolone) Use in 18-Year-Olds

Kenalog 40 (triamcinolone acetonide injectable suspension) is appropriate for use in 18-year-old patients as they are considered adults for dosing purposes according to FDA labeling. 1

Indications and Safety Profile

• Kenalog 40 is a corticosteroid injectable suspension that can be administered intramuscularly for various inflammatory conditions 1
• At 18 years of age, patients are considered adults for dosing purposes, making the standard adult dosing appropriate 1
• The FDA-approved labeling specifically indicates that bedaquiline (another medication) should be included in longer MDR-TB regimens for patients aged ≥18 years, demonstrating that 18 is considered the adult threshold for many medications 2

Administration Considerations

• Intramuscular injection is the preferred route of administration, with the gluteal area being the recommended injection site 1
• The deltoid area should be avoided due to a significantly higher incidence of local atrophy when injected at this site 1, 3
• Deep intramuscular injection technique should be used to minimize the risk of local atrophy 1

Potential Adverse Effects

• Common side effects include local atrophy at injection site, which is more common in younger patients 3
• Subcutaneous atrophy is relatively frequent yet underappreciated, and is more common in young women and girls who receive preparations with lesser water solubility 3
• Potential for HPA axis suppression with the risk for glucocorticosteroid insufficiency after treatment withdrawal 1
• Immunosuppression with increased risk of infection is a significant concern with corticosteroid therapy 1
• Postinjection flares can occur, ranging from mild joint effusion to disabling pain 4

Precautions Specific to Younger Adults

• While 18-year-olds are considered adults for dosing purposes, they may still be at higher risk for certain adverse effects such as:
  • Local atrophy at injection sites 3
  • Growth suppression (though this is more relevant for younger adolescents and children) 2
  • HPA axis suppression 1

Monitoring Recommendations

• Monitor for signs of infection as corticosteroids can mask infection symptoms 1
• Watch for potential adrenal insufficiency, especially during times of stress 1
• Be alert for local reactions at the injection site 4
• Consider the total metabolic load of benzyl alcohol (a preservative in Kenalog) from all medication sources 1

Contraindications

• Hypersensitivity to triamcinolone acetonide or components of the formulation 1
• Avoid administration by intraarticular, intrabursal, or intratendinous routes in the presence of acute local infection 1
• Not suitable for use in acute stress situations as it is a long-acting preparation 1

Kenalog 40 has shown positive results in treating various conditions with efficacy rates of 85-96% in certain degenerative-dystrophic diseases of the locomotor system 5, but must be used with appropriate caution in younger adults.