Corticosteroid Dose Equivalency: Kenalog to Methylprednisolone
For lateral epicondylitis, 40 mg of Kenalog (triamcinolone acetonide) is approximately equivalent to 32 mg of methylprednisolone based on standard glucocorticoid potency ratios. 1
Glucocorticoid Equivalency Ratios
The FDA-approved prescribing information for triamcinolone acetonide provides the following standardized equivalency table for glucocorticoids 1:
- Methylprednisolone: 4 mg
- Triamcinolone: 4 mg
- Prednisone: 5 mg
- Prednisolone: 5 mg
- Hydrocortisone: 20 mg
- Cortisone: 25 mg
This establishes a 1:1 potency ratio between methylprednisolone and triamcinolone when administered orally or intravenously. 1
Critical Caveat for Local Injection
The FDA label explicitly states: "When these substances or their derivatives are injected intramuscularly or into joint spaces, their relative properties may be greatly altered." 1 This means the 1:1 equivalency may not hold for local injections used in lateral epicondylitis treatment.
For local injection therapy in lateral epicondylitis:
- Triamcinolone acetonide doses of 5-15 mg are typically used, with studies showing 5 mg and 10 mg having comparable efficacy 2
- The FDA label recommends 5-15 mg for larger joints and 2.5-5 mg for smaller joints 1
- Studies specifically treating lateral epicondylitis with triamcinolone used 5-10 mg doses with excellent results (80% and 74% respectively) 2
Clinical Application for Lateral Epicondylitis
If you are converting a 40 mg methylprednisolone dose for systemic use, the equivalent triamcinolone dose would be 40 mg based on the 1:1 ratio. 1 However, this is not the appropriate dose for local injection therapy in lateral epicondylitis.
For actual treatment of lateral epicondylitis:
- Use 5-10 mg of triamcinolone acetonide injected locally at the point of maximum tenderness 2, 3
- Higher doses (40 mg) are reserved for larger joint spaces (knee, shoulder) and are excessive for epicondylar injection 1, 4
- The peppering technique with local anesthetic has shown excellent results regardless of whether corticosteroid is added 5
The 40 mg dose you reference is likely intended for intra-articular use in large joints (knee, shoulder), not for lateral epicondylitis treatment. 1, 4