What is the typical dosing range for Kenalog (Triamcinolone) intramuscular (IM) injections?

Kenalog (Triamcinolone Acetonide) IM Dosing

For systemic intramuscular administration, the typical initial dose of Kenalog is 60 mg injected deeply into the gluteal muscle, with a usual dosing range of 40-80 mg depending on patient response and duration of relief. 1

Standard Systemic IM Dosing

• Initial dose: 60 mg IM into the gluteal muscle is the suggested starting point 1
• Dosing range: 40-80 mg IM can be adjusted based on patient response and duration of symptom relief 1
• Lower doses: 20 mg or less may be sufficient for some well-controlled patients 1
• Minimum needle length: 1½ inches is recommended for adults; obese patients may require longer needles 1

Condition-Specific Dosing

Allergic Conditions (Hay Fever/Pollen Asthma)

• Single injection: 40-100 mg IM may provide remission of symptoms lasting throughout the pollen season in patients not responding to conventional therapy 1

Severe Asthma

• High-dose regimen: 360 mg IM as a single injection has been reported effective in elderly patients with severe, chronic, steroid-dependent asthma, though this exceeds standard FDA-labeled dosing 2
• Repeated injections at doses sufficient to control symptoms have been used in severe intrinsic asthma cases 3

Multiple Sclerosis (Acute Exacerbations)

• 160 mg daily for 1 week, followed by 64 mg every other day for 1 month 1

Pediatric Dosing

• Initial dose range: 0.11-1.6 mg/kg/day divided into 3-4 doses (equivalent to 3.2-48 mg/m²/day) 1
• Dosing varies depending on the specific disease entity being treated 1

Local/Intra-articular Dosing (for comparison)

• Smaller joints: 2.5-5 mg (up to 10 mg for adults) 1
• Larger joints: 5-15 mg (up to 40 mg for adults) 1
• Multiple joints: Up to 80 mg total in a single session 1

Critical Administration Considerations

Injection Technique

• Deep gluteal injection is mandatory for systemic administration to avoid subcutaneous fat atrophy 1
• Strict aseptic technique must be maintained 1
• Shake vial before use to ensure uniform suspension; inspect for clumping or granular appearance (agglomeration) and discard if present 1
• Inject without delay after withdrawal to prevent settling in the syringe 1

Dosing Principles

• Individualize based on disease severity and patient response, not on a fixed schedule 1
• Taper gradually rather than stopping abruptly after long-term therapy 1
• Adjust for clinical changes: remissions, exacerbations, or stressful situations may require dose modifications 1

Common Pitfalls to Avoid

• Do not use initial doses >30 mg/day oral equivalent for conditions like polymyalgia rheumatica (though IM depot formulations follow different kinetics) 4
• Avoid subcutaneous injection as this leads to tissue atrophy 1
• Do not inject into blood vessels - use careful technique 1
• Monitor for side effects including weight gain, menstrual disturbances, hypertension, edema, and ecchymoses, which occurred in 13.8% of patients in one asthma study 3