What is the recommended dosage for a Kenalog (triamcinolone) injection?

Kenalog (Triamcinolone Acetonide) Injection Dosage

The recommended dosage of Kenalog injection varies by route of administration and clinical indication: 40 mg/mL for intramuscular or intra-articular use, with specific dosing ranging from 5-80 mg depending on the condition being treated. 1

Available Formulations

• Kenalog-40: 40 mg/mL concentration 1
• Kenalog-80: 80 mg/mL concentration 1
• Available in single-dose vials (1 mL) and multiple-dose vials (5 mL, 10 mL) 1
• Approved routes: Intramuscular or intra-articular use only 1

Dosing by Clinical Indication

Intra-Articular Injections

• Large joints: 20-40 mg per injection 2, 3
• Trigger finger: 20 mg dose demonstrates significantly higher clinical effectiveness (79% success at 6 months) compared to 10 mg (62%) or 5 mg (52%) doses 3
• Acute crystal-induced arthritis: 60 mg intramuscular triamcinolone acetonide for monoarticular or oligoarticular attacks 2

Intralesional Injections

• Alopecia areata: 5-10 mg/mL concentration injected into affected areas 4
• Resistant dermatologic lesions (lichen sclerosus): 10-20 mg/mL concentration 4
• Pes anserine bursa: 20-40 mg total dose (5-10 mg/mL concentration), using 0.05-0.1 mL per injection site 4
• Inflammatory nodulocystic acne: Intralesional treatment flattens most nodules within 48-72 hours 5

Systemic/Intramuscular Use

• Adrenal insufficiency (pediatric): 2-3 mg/kg (maximum 100 mg) over 3-5 minutes, followed by maintenance dosing 2

Critical Safety Considerations

Common Adverse Effects

• Local reactions: Skin atrophy, telangiectasia, pigmentary changes, striae, and folliculitis 4, 5
• Postinjection flare: Acute inflammatory response can occur 2 hours post-injection, mimicking septic arthritis with severe pain and swelling requiring aspiration 6
• Intraocular pressure elevation: Occurs in approximately 25% of patients receiving intravitreal injections 7

Contraindications and Precautions

• Active infections: Contraindicated at sites with impetigo or herpes 5
• Hypersensitivity: Contraindicated in patients with triamcinolone allergy 5
• Use with caution: Diabetes, heart failure, severe hypertension 5
• Not recommended: Extensive plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis 5

Clinical Pearls

• Higher doses are more effective: For trigger finger, the 20 mg dose provides superior outcomes with significantly improved VAS pain scores (4.5-point improvement) and QuickDASH scores (28.9-point improvement) compared to lower doses 3
• Facial applications require caution: Facial skin is thinner and more prone to steroid-induced atrophy, requiring careful monitoring with long-term use 4
• Intertriginous areas: Apply sparingly to skin folds to minimize atrophy risk 4
• Patient education: Inform patients about potential postinjection flare reactions, which can be severe enough to mimic septic arthritis 6
• Aspiration technique: If severe postinjection flare occurs, aspiration may yield "butterscotch"-colored fluid containing triamcinolone crystals visible on polarized light microscopy 6