Kenalog - glucocorticosteroid, which has immunosuppressive, anti-inflammatory, anti-allergic and antipruritic effect.
Release form and composition
Kenalog's dosage forms:
- Tablets for oral administration (50 pcs. In bottles of dark glass, in a cardboard bundle one bottle);
- Suspension for injection (in 1 ml ampoules, 5 ampoules in blisters, in a cardboard box 1 pack).
The active ingredient of the drug is triamcinolone acetonide. Its content: in 1 tablet - 4 mg, in 1 ml of suspension - 40 mg.
Indications for use
For oral administration:
- Rheumatoid arthritis;
- Allergic skin diseases;
- Acute allergic reactions;
- Systemic lupus erythematosus and other collagenoses;
- Hemolytic anemia;
- Hemorrhagic diathesis;
- Erythema multiforme;
- Severe forms of bronchial asthma;
For intramuscular administration (IM):
- Hay fever;
- Chronic obstructive respiratory diseases, including bronchial asthma and chronic spastic bronchitis (Kenalog is used for severe forms of diseases and in case of negative results of local treatment);
- Skin diseases and contact dermatitis characterized by scaling, itching and / or blistering, for example, psoriasis, pemphigoid, contact, atopic, herpetiform, eczematoid and exfoliative dermatitis.
For intraarticular administration:
- Residual inflammatory processes in one or several joints in case of chronic inflammatory diseases (after systemic use);
- Exudative arthritis and gout, including false;
- Active forms of arthrosis;
- Dropsy of the joints;
- The blockade of the shoulder joint, which developed as a result of the wrinkling of the articular sac;
- Chronic inflammation of the inner layer of the joint capsule (as an adjuvant in combination with intra-articular injections of radionuclides or chemicals).
For introduction into the affected area:
- Inflammation of the mucous bag and periosteum, exostoses (cystic formations near the joints);
- Some skin diseases, such as chronic simple lichen (limited neurodermatitis), isolated psoriatic plaques, ring-shaped granuloma, discoid lupus erythematosus, lichen planus, alopecia alopecia, and keloids.
For local (intra-articular and intra-focal) applications:
- Bacterial skin lesions;
- Fungal diseases;
- Skin lesions of a syphilitic or tuberculous character;
- Inflammation of the skin around the mouth (rosacea);
- Conditions after immunization;
- The presence of infection (for intraarticular injection);
- Children's age up to 12 years.
When systemic or repeated topical administration of a drug is necessary, it is important to consider the absolute and relative contraindications listed below.
- Peptic ulcer and 12 duodenal ulcer;
- Renal failure;
- The active form of tuberculosis;
- Arterial hypertension;
- History of thrombosis and embolism;
- Neoplasms with metastases;
- Myasthenia gravis;
- History of acute psychosis;
- Hidden foci of infection;
- Gonococcal and tuberculous arthritis;
- Itsenko-Cushing syndrome;
- Amoebic infections;
- Fungal infections of internal organs;
- Infected skin lesions;
- Viral infections, including those caused by the herpes simplex virus and Varcellus-Zoster;
- Poliomyelitis (with the exception of the bulbar-encephalitic form),
- Lymphadenitis after BCG vaccination,
- Vaccination period (depending on the specific situation, from 8 weeks before vaccination to 2 weeks after);
- Children's age up to 6 years - inside, up to 16 years - intramuscularly.
Relative contraindications, in the presence of which requires special monitoring of the patients:
- Peptic ulcer of the stomach and / or duodenum in history;
- Severe muscle diseases;
- Fresh intestinal anastomoses;
- Tendency to thrombosis and embolism;
- Chronic nephritis;
- Acute glomerulonephritis;
- Carcinomas with a tendency to metastasis;
- Swelling of the lymph nodes after immunization with BCG;
- Pregnancy (especially the first trimester);
- Lactation period (or breastfeeding should be discontinued).
Also, extreme caution is needed in the treatment of patients with tuberculosis, because corticosteroids can lead to process activation.
Dosing and Administration
Kenalog tablets should be taken orally. The dose is determined individually, can be assigned from 4 to 20 mg per day for 2-3 doses. After improving the state, the dose is gradually (once every 2-3 days) reduced by 1-2 mg to the minimum maintenance one - 1 mg. And only then, when there will be a need, cancel the drug.
Suspension Kenalog is intended for intramuscular, intra articular and intra focal injections. The method of administration and the dose of the drug are determined individually depending on the nature of the disease and the goals of therapy.
- Intramuscular administration.
Adults and adolescents over 16 years of age are given 1 ml each (40 mg of triamcinolone acetonide) in the form of a slow, deep intraday injection, after which a sterile napkin is pressed tightly to the injection site for 1-2 minutes. In severe diseases, the dose may be increased to 80 mg.
For hay fever and other seasonal allergic diseases, as a rule, a single dose (1 time per year) of 40 mg during the pollen season is sufficient.
If it is necessary to administer several doses of the drug, at least 4-week intervals should be observed between injections.
- Intra-articular application.
The dose is determined depending on the size of the joint and the severity of the symptoms of the disease. Recommended doses for adults and children over 12:
- Small joints (such as phalanges of the toes and hands) - up to 10 mg;
- Medium-sized joints (for example, the elbow and shoulder) - 20 mg;
- Large joints (such as the knee and hip) - 20-40 mg.
With the defeat of several joints, the maximum allowable dose is 80 mg.
If necessary, rapid relief of symptoms of the disease Kenalog can be combined with a local anesthetic (not containing vasoconstrictor substances).
Repeated use of the drug can be no earlier than 2 weeks.
- Intra-focal application.
Doses for adults and children over 12 years of age are determined based on the size and location of lesions. As a rule, for small foci (bursitis, exostoses and periosteum inflammation), up to 10 mg of the drug is administered, for large foci - 10-40 mg.
Before injection, the suspension is diluted with saline and fan-shaped is injected into the area, which is characterized by the greatest pain. If necessary, Kenalog is mixed with a local anesthetic.
When treating exostoses, the suspension is administered using a thick cannula directly into the cyst space.
Repeated injection is allowed after at least 2 weeks.
- Introduction to the area of subcutaneous lesions.
In this case, 1 ml of the suspension directly in the syringe is mixed with a local anesthetic, which does not contain vasoconstrictor substances. The injection is carried out horizontally in the area between the skin and the subcutaneous layer.
Approximate dose - 1 mg of the drug per 1 square centimeter of the surface of the lesion.
When treating several foci at the same time, the daily dose for adults should not exceed 30 mg, for children - 10 mg.
For keloids, the agent can be injected directly into the scar tissue without dilution.
Repeated injections are carried out at intervals of 2 weeks.
The duration of treatment is determined by the doctor depending on the type, nature and severity of the disease. The duration of therapy can range from a single intramuscular injection (for example, for hay fever) to a course of several years (for example, for severe forms of bronchial asthma).
If there is no improvement after 3-5 injections given locally (intra-articular, intra-focal or in the area of subcutaneous lesions), Kenalog should be canceled and another treatment method prescribed.
Regardless of the method and frequency of use of the drug, in rare cases hypersensitivity reactions are observed (caused, inter alia, by the presence of benziol alcohol in the suspension), for example, hot flashes, skin blisters, circulatory disorders and cardiac activity.
When conducting repeated injections into subcutaneous adipose tissue, there is a probability of tissue atrophy near the site of the previous injection of the drug, most often characterized by a reversible nature.
After intra-articular injection, the sensation of heat and the development of aseptic necrosis of bone tissue (humerus, femoral head) is possible. In some cases, transient painful irritation appears at the injection site.
Repeated topical administration can have the following undesirable reactions: thinning or striation of the skin, skin blisters, inflammation of the hair follicles, dilation of small skin vessels, increased hair growth, steroid acne, inflammation and changes in skin pigmentation around the mouth.
With systemic and repeated topical administration, side effects of glucocorticoids may occur, such as:
- Digestive system: erosive and ulcerative lesions of the gastrointestinal tract, steroid gastric ulcer, acute pancreatitis;
- Metabolism: edema, negative nitrogen balance, electrolyte imbalance, growth retardation in children;
- Endocrine system: menstrual disorders, impotence, redistribution of adipose tissue, hirsutism, acne, stretch marks, moon face, suppression of function or atrophy of the adrenal glands, increased blood glucose levels, diabetes mellitus (activation of latent form or worsening of compensation in case of existing disease);
- Central nervous system: sleep disorders, weakness, headaches and dizziness, increased sweating, seizures, mental disorders, increased intracranial pressure (with a symptom of congestive nipple of the optic nerve);
- Cardiovascular system: arterial hypertension, inflammatory processes in vessels (vasculitis, withdrawal syndrome after prolonged therapy);
- Water and electrolyte balance: increased excretion of potassium;
- Musculoskeletal system: osteoporosis, myopathy, atrophy of muscle and bone tissue, tendon ruptures, delayed healing of wounds and bone fractures, aseptic necrosis of bone tissue (head of the hip or humerus);
- Skin: skin changes, including steroid acne, hemorrhages under the skin;
- Coagulant system: thromboembolism;
- Organ vision: increased intraocular pressure or exophthalmos, posterior subcapsular cataract, glaucoma, visual impairment;
- Immune system: immunosuppression and increased risk of infections.
Suspension Kenalog is not allowed to be administered intravenously!
With systemic use of the drug is recommended to follow a diet enriched with vitamins and proteins.
In severe infectious diseases, Kenalog can only be used in combination with causal therapy.
It should take into account the likelihood of some reactions with the simultaneous use of Kenalog with the following medicinal substances:
- Indirect anticoagulants, heparin, streptokinase, urokinase - their effectiveness decreases, the likelihood of erosive-ulcerative lesions and bleeding of the gastrointestinal tract increases;
- Anabolic steroids and androgens - the risk of acne and peripheral edema increases;
- Thyroid hormones and antithyroid drugs - possible changes in the function of the thyroid gland;
- Histamine H1 Receptor Blockers — Triamcinolone's effectiveness decreases;
- Hormonal contraceptives - potentiates the effect of triamcinolone;
- Immunosuppressants - increases the risk of viral and bacterial infections;
- Potassium-sparing diuretics - hypokalemia is possible;
- Nonsteroidal anti-inflammatory drugs, including acetylsalicylic acid - increases the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract;
- Oral hypoglycemic agents and insulin - their effect is weakened;
- Laxatives - hypokalemia is possible;
- Cardiac glycosides - increases the risk of developing heart rhythm disorders and other toxic effects;
- Tricyclic antidepressants - may increase mental disorders caused by taking triamcinolone;
- Amphotericin B, carbonic anhydrase inhibitors - there is a risk of circulatory failure, left ventricular myocardial hypertrophy and the development of hypokalemia;
- M-holinoblokatory (including atropine) - may increase intraocular pressure;
- Ephedrine - triamcinolone metabolism accelerates;
- Isoniazid - decreases its concentration in the blood (mainly in patients with rapid acetylation);
- Meksiletin - possible acceleration of its biotransformation and a decrease in plasma concentration;
- Paracetamol - increases the risk of increasing its hepatotoxicity, calcium excretion, the development of peripheral edema, hypernatremia, hypocalcemia, osteoporosis;
- Rifampicin, phenytoin, carbamazepine, barbiturates - triamcinolone metabolism accelerates and, as a result, its effect decreases;
- Depolarizing muscle relaxants in case of hypocalcemia associated with the use of triamcinolone - may increase the duration of the neuromuscular blockade.
Terms and conditions of storage
Store at a temperature of 15-30 ° C in a place protected from sunlight.
Shelf life - 5 years.