How many milliliters (mL) of injectable triamcinolone are required for a given dose?

Triamcinolone Injectable Volume Calculation

The volume of injectable triamcinolone required depends on the concentration used: for the standard 40 mg/mL formulation (Kenalog-40), divide the desired dose in milligrams by 40 to get the volume in milliliters. 1

Standard Concentrations and Volume Calculations

Available Formulations

• Kenalog-40: 40 mg/mL concentration 1
• Kenalog-80: 80 mg/mL concentration 1

Volume Calculation Formula

• For 40 mg/mL: Volume (mL) = Desired dose (mg) ÷ 40 1
• For 80 mg/mL: Volume (mL) = Desired dose (mg) ÷ 80 1

Common Clinical Scenarios with Specific Volumes

Dermatologic Injections

• Intralesional for keloids/hypertrophic scars: 40 mg/mL concentration requires 1 mL for a 40 mg dose 2
• Intralesional for acne: 10 mg/mL concentration (diluted from 40 mg/mL with sterile saline) requires 0.05-0.1 mL per injection site 2
• Intralesional for psoriasis: Up to 20 mg/mL concentration, with volume varying by lesion size 2

Joint and Soft Tissue Injections

• Shoulder injection: 40 mg dose using 40 mg/mL concentration = 1 mL 2
• Subacromial bursa: 2 mL of 10 mg/mL (20 mg total dose) 3

Esophageal Strictures

• Four quadrant injection: 0.5 mL aliquots of 40 mg/mL = 2 mL total volume (80 mg total dose) 2

Dilution Considerations

When diluting triamcinolone acetonide from 40 mg/mL stock:

• To achieve 10 mg/mL: Mix 1 part triamcinolone with 3 parts sterile normal saline 2
• To achieve 5 mg/mL: Mix 1 part triamcinolone with 7 parts sterile normal saline 2
• To achieve 3.3 mg/mL: Mix 1 part triamcinolone with approximately 11 parts sterile normal saline 2

Critical Dosing Limits

• Maximum dose per injection site: Should not exceed 150 mg regardless of volume 2
• Small lesion dosing: 0.05-0.1 mL per site delivers 0.25-1 mg when using 5-10 mg/mL concentration 2

Common Pitfall

The actual delivered dose can vary significantly based on injection technique, particularly with small-gauge needles which may concentrate the suspension in the syringe, leading to higher-than-intended doses from the final portion of the syringe 4. Always shake the vial thoroughly before drawing and use consistent technique to ensure accurate dosing. 4