Kenalog Dosing for a 14-Year-Old Weighing 118 Pounds
For intranasal triamcinolone acetonide (Nasacort) in a 14-year-old patient weighing 118 pounds (53.5 kg), the recommended dose is 2 sprays per nostril once or twice daily (220-440 mcg/day total). 1
Intranasal Formulation (Most Common Use)
The FDA-approved dosing for triamcinolone acetonide nasal spray in adolescents ≥12 years is straightforward:
- Initial dose: 2 sprays (55 mcg each) per nostril once daily = 220 mcg/day total 1
- Alternative dosing: 2 sprays per nostril twice daily = 440 mcg/day total 1
- Maintenance: Once symptoms are controlled, may reduce to 1 spray per nostril daily 1
This formulation is FDA-approved for patients ≥2 years and is available over-the-counter for allergic rhinitis. 1 The medication demonstrates efficacy within the first day of administration and does not suppress hypothalamic-pituitary-adrenal axis function at therapeutic dosages. 2
Important Clinical Context
The question likely refers to intranasal triamcinolone since this is the most common pediatric/adolescent use. 1 However, if intramuscular Kenalog is being considered (which is uncommon in this age group), this requires different considerations:
Intramuscular Formulation (Rarely Used in Adolescents)
Intramuscular triamcinolone acetonide (Kenalog-40) is not routinely recommended for adolescents and lacks established pediatric dosing guidelines in the evidence provided. 3, 4
- Adult studies used 360 mg IM for severe, chronic steroid-dependent asthma, but this was in elderly patients with life-threatening disease 3
- Maximum injection volume is 150 mg per injection site 1
- This route carries risks of transient weakness, diabetes, and systemic corticosteroid effects 3
For a 14-year-old, intramuscular Kenalog should only be considered in extraordinary circumstances under specialist supervision, as the evidence base is limited to adult populations with severe, refractory conditions. 3
Safety Considerations
- Intranasal triamcinolone shows no significant growth suppression effects in children, unlike some other intranasal steroids 1
- Common side effects include pharyngitis, epistaxis, and cough 1
- The medication is well-tolerated with once-daily dosing, which may improve compliance 2, 5
- Monitor for local side effects (nasal irritation, bleeding) but systemic absorption is minimal at therapeutic doses 2
Practical Prescribing
For this 14-year-old patient, prescribe triamcinolone acetonide nasal spray 55 mcg/spray: 2 sprays per nostril once daily (220 mcg/day), with option to increase to twice daily if needed for symptom control. 1 This provides effective treatment for allergic rhinitis with minimal systemic effects and excellent safety profile in adolescents. 1, 2