What is the recommended dosing for Kenalog (triamcinolone)

Kenalog (Triamcinolone Acetonide) Dosing

Kenalog dosing varies significantly by route of administration and clinical indication, ranging from 2.5 mg for small joint injections to 80 mg for intramuscular systemic therapy, with the FDA-approved range being 2.5-100 mg per day depending on the specific disease entity. 1

Systemic Intramuscular Administration

For systemic therapy, the suggested initial dose is 60 mg injected deeply into the gluteal muscle, with dosage typically adjusted within the range of 40-80 mg depending on patient response and duration of relief. 1

• Some patients may be well controlled on doses as low as 20 mg or less 1
• For hay fever or pollen asthma, a single injection of 40-100 mg may provide remission throughout the pollen season 1
• The injection must be made deeply into the gluteal muscle using a minimum needle length of 1½ inches for adults (longer needles may be required in obese patients) 1
• Critical pitfall: Atrophy of subcutaneous fat may occur if the injection is not properly given into the muscle 1

Intra-Articular Joint Injections

For joint injections, initial dosing is 2.5-5 mg for smaller joints and 5-15 mg for larger joints, with adult doses up to 10 mg for smaller areas and up to 40 mg for larger areas typically sufficient. 1

• Single injections into several joints up to a total of 80 mg have been given 1
• For shoulder injections specifically, 40 mg of triamcinolone acetonide is the standard dose for subacromial or glenohumeral administration 2
• For trigger finger, a 20-mg dose demonstrates significantly higher clinical effectiveness (79% success at 6 months) compared to 10-mg (62%) or 5-mg (52%) doses 3
• A single local injection is frequently sufficient, but several injections may be needed for adequate symptom relief 1

Intralesional Injections for Dermatologic Conditions

For dermatologic applications, triamcinolone acetonide 5-10 mg/mL is recommended, with injection volumes of 0.05-0.1 mL per site producing localized therapeutic effect. 4, 2

• For alopecia areata: 5-10 mg/mL injected into affected areas 4, 5
• For nail psoriasis affecting the nail matrix: 5-10 mg/mL 6, 4
• For recurrent, severe, or treatment-refractory paronychia: intralesional triamcinolone acetonide 6
• For nodular acne: 10 mg/mL (may be diluted to 5 or 3.3 mg/mL) 2
• For hypertrophic scars and keloids: 40 mg/mL 2
• For lichen sclerosus with steroid-resistant areas: 10-20 mg/mL after excluding malignancy 5
• Maximum of 150 mg per injection site should not be exceeded 6

Administration Technique and Safety Considerations

Strict aseptic technique is mandatory, and the vial must be shaken before use to ensure uniform suspension. 1

• Prior to withdrawal, inspect the suspension for clumping or granular appearance (agglomeration); discard if agglomerated 1
• After withdrawal, inject without delay to prevent settling in the syringe 1
• For intra-articular injections, if excessive synovial fluid is present, some (but not all) should be aspirated before injection 1
• Critical pitfall: Care must be taken to avoid injecting into tissues surrounding the injection site, particularly in the deltoid region, as this may lead to tissue atrophy 1

Monitoring and Adverse Effects

Local adverse effects include skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis, which are dose-dependent and typically occur with repeated injections at higher concentrations. 4, 2

• Postinjection flares can occur, ranging from mild joint effusion to severe disabling pain mimicking septic arthritis 7
• For long-term systemic use, monitor blood pressure, consider ophthalmologic examination, evaluate for hypothalamic-pituitary-adrenal axis suppression, and track growth velocity in children 5
• Facial and intertriginous areas are at higher risk for developing adverse effects 2
• Avoid injection at sites of active infection (impetigo, herpes) 2

Pediatric Dosing

In pediatric patients, the initial dose may vary from 0.11 mg/kg/day to 1.6 mg/kg/day in 3-4 divided doses (3.2 mg/m²bsa/day to 48 mg/m²bsa/day). 1

Tapering and Discontinuation

If after long-term therapy the drug is to be stopped, it should be withdrawn gradually rather than abruptly. 1

• Dosage adjustments are necessary based on changes in clinical status, individual drug responsiveness, and patient exposure to stressful situations 1
• The proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest effective dosage is reached 1