Contraindications to Kenalog (Triamcinolone Acetonide) Use
Kenalog is absolutely contraindicated in patients with hypersensitivity to triamcinolone acetonide or any component of the formulation, and intramuscular preparations are contraindicated for idiopathic thrombocytopenic purpura. 1
Absolute Contraindications
Hypersensitivity Reactions
- Do not use in patients with known hypersensitivity to triamcinolone acetonide or any formulation components 2, 1
- IgE-mediated anaphylaxis has been documented, even after years of uneventful use, presenting with urticaria, hypotension, and facial numbness within 15-20 minutes of injection 3
- Patients with previous allergic reactions to triamcinolone should be offered alternative corticosteroids after appropriate skin testing 3
Hematologic Contraindication
- Intramuscular corticosteroid preparations are absolutely contraindicated for idiopathic thrombocytopenic purpura 1
Relative Contraindications and High-Risk Situations
Active Infections
- Avoid injection at sites with active skin infections including impetigo or herpes 4
- Exercise caution with large injections in patients with active tuberculosis or systemic fungal infections 4
- Patients with HIV may absorb steroids at higher rates and require additional monitoring 2
Pregnancy and Lactation
- All weight-loss medications containing corticosteroids are contraindicated in women who are pregnant or actively trying to conceive 5
- Women of reproductive potential require counseling about reliable contraception methods 5
Cardiovascular and Metabolic Conditions
- Use with caution in patients with uncontrolled diabetes, heart failure, or severe hypertension 4
- Monitor blood pressure regularly during treatment 2
Critical Clinical Pitfalls
Injection Site Selection
- Never inject into areas with lipohypertrophy, inflammation, edema, ulceration, or active infection 4
- Facial and intertriginous areas carry higher risk for adverse effects including atrophy and telangiectasia 4
Systemic Absorption Risks
- Repeated injections can suppress the hypothalamic-pituitary-adrenal axis, particularly with higher doses or prolonged use 4, 2
- Monitor for growth suppression in children receiving long-term therapy 2
- Consider ophthalmologic examination for patients on chronic therapy due to posterior subcapsular cataract risk 2
Post-Injection Complications
- Severe postinjection flares can mimic septic arthritis with acute onset of intense pain, swelling, and inability to ambulate within 2 hours of injection 6
- This represents an acute crystal-induced inflammatory response to triamcinolone acetonide crystals, confirmed by polarized light microscopy of synovial fluid 6
- Although rare, inform patients of this potential severe reaction before administration 6
Special Population Considerations
Pediatric Patients
- Growth velocity must be tracked in children receiving long-term administration 2
- Hypothalamic-pituitary-adrenal axis suppression monitoring is essential 2