Triamcinolone (Kenalog) is a long-acting corticosteroid that has minimal salt-retaining properties. It suppresses inflammation and is used in the treatment of various autoimmune rheumatic and inflammatory conditions.
Triamcinolone Uses:
- Intra-articular or soft tissue administration (triamcinolone hexacetonide [Canadian product]):
- Indicative treatment of subacute and persistent inflammatory joint diseases comprising:
- synovitis, tendinitis, bursitis, epicondylitis, rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), osteoarthritis, or post-traumatic arthritis.
- Indicative treatment of subacute and persistent inflammatory joint diseases comprising:
- Intralesional administration (triamcinolone acetonide [Kenalog-10 only]):
- Alopecia areata;
- discoid lupus erythematosus;
- keloids;
- contained hypertrophic,
- penetrated,
- inflammatory abrasions of granuloma annulare,
- lichen planus,
- lichen simplex chronicus (neurodermatitis),
- psoriatic plaques;
- necrobiosis lipoidica diabeticorum;
- cystic tumors of an aponeurosis or ligament (ganglia).
- Intramuscular administration (triamcinolone acetonide [Kenalog-40] only):
- Allergic states:
- Management of acute or debilitating allergic conditions difficult to sufficient trials of standard treatment in asthma,
- drug hypersensitivity reactions,
- perennial or seasonal allergic rhinitis,
- serum sickness, or
- transfusion reactions.
- Dermatologic diseases:
- Atopic dermatitis,
- bullous dermatitis herpetiformis,
- contact dermatitis,
- exfoliative erythroderma,
- mycosis fungoides, pemphigus, or
- acute erythema multiforme (Stevens-Johnson syndrome).
- Endocrine disorders:
- Primary or secondary adrenocortical deficiency (hydrocortisone or cortisone is the drug of choice),
- genetic adrenal hyperplasia,
- hypercalcemia linked with cancer, or
- nonsuppurative thyroiditis.
- GI diseases:
- To surge the patient over a vital period of the disease in Crohn disease or ulcerative colitis.
- Hematologic disorders:
- Obtained (autoimmune) hemolytic anemia,
- Diamond-Blackfan anemia,
- sheer red cell aplasia,
- limited cases of secondary thrombocytopenia.
- Neoplastic diseases:
- Placebo management of leukemia and lymphomas.
- Nervous system:
- Severe aggravations of multiple sclerosis;
- cerebral edema associated with a primary or metastatic brain tumor or craniotomy.
- Note: Treatment standards propose the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis.
- Ophthalmic diseases:
- Sympathetic ophthalmia,
- temporal arteritis,
- uveitis, and
- ocular inflammatory conditions unresponsive to relevant corticosteroids.
- Renal diseases:
- To provoke diuresis or diminution of proteinuria in idiopathic nephrotic syndrome or that is caused by lupus erythematosus.
- Respiratory diseases:
- Berylliosis,
- fulminating or disseminated pulmonary tuberculosis when used simultaneously with suitable antituberculosis chemotherapy,
- idiopathic eosinophilic pneumonias,
- symptomatic sarcoidosis.
- Rheumatic disorders:
- As adjunctive treatment for brief administration in serious gout flares;
- acute rheumatic carditis;
- ankylosing spondylitis;
- psoriatic arthritis;
- RA, including juvenile RA;
- treatment of dermatomyositis,
- polymyositis, and
- systemic lupus erythematosus.
- Miscellaneous:
- Trichinosis with neurologic or myocardial participation;
- tuberculous meningitis with subarachnoid block or imminent block when used with appropriate antituberculosis chemotherapy.
- Allergic states:
Read:
Triamcinolone (Kenalog) Dose in Adults
Triamcinolone (Kenalog) Dose in the treatment of Dermatoses (steroid-responsive):
- Acetonide (Kenalog-10): 1 mg Intralesional:
- The initial dose varies depending on the specific disease and lesion being treated; may be repeated at weekly or less frequent intervals; multiple sites may be injected if they are 1 cm or more apart
Triamcinolone (Kenalog) Gout, acute flares (alternative agent):
Note: Do not use if there is a doubt for contagious involvement. Patients whose urarthritis flare-up is limited to 1 to 2 joints and/or who are unable to take oral medications: Intra-articular: Acetonide (Kenalog-10):
- Larger joint (eg, knee): 40 mg;
- Medium joint (eg, wrist, ankle, elbow): 30 mg;
- Small joint: 10 mg.
Patients with polyarticular involvement unable to take oral medications and who are not contenders for intra-articular injection:
- IM: Acetonide (Kenalog-40):
- Initial: 40 to 60 mg as a single dose;
- The dose may be repeated once or twice at ≥48-hour intervals if benefit fades or there is no flare resolution.
Triamcinolone (Kenalog) Dose in the treatment of Inflammatory/allergic conditions/other steroid-responsive systemic conditions:
- Acetonide (Kenalog-40): IM:
- Initial: 60 mg; adjust the dose to a range of 40 to 80 mg.
- For patients with hay fever or pollen asthma who are not responding to pollen administration and other conventional therapy, a single injection of 40 mg to 100 mg per season may be given.
Triamcinolone (Kenalog) Dose in the treatment of Multiple sclerosis (acute exacerbation):
Note: Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis.
- Acetonide (Kenalog-40): IM: 160 mg daily for 1 week, followed by 64 mg every other day for 1 month.
Triamcinolone (Kenalog) Dose in the treatment of Rheumatic conditions (excluding acute gout flares):
- Intra-articular (or similar injection as designated):
- Acetonide: Intra-articular, intramural, ligament casings:
- Preliminary: Smaller joints: 2.5 to 5 mg, larger joints: 5 to 15 mg;
- may need up to 10 mg for small joints and up to 40 mg for large joints;
- maximum dose/treatment (several joints at one time): 80 mg
- Zilretta only: Intra-articular:
- Single-dose: 32 mg.
- Note: For degenerative arthritis (OA) ache of the knee only (use for OA pain of shoulder and hip have not been evaluated);
- Use is not suitable for small joints (eg, hand). The safety and efficacy of repeat administration have not been studied.
- Hexacetonide [Canadian product]: Intra-articular:
- Standard dose: 2 to 20 mg; smaller joints (interphalangeal, metacarpophalangeal):
- 2 to 6 mg; large joints (knee, hip, shoulder): 10 to 20 mg.
- The frequency of injection into a single joint is every 3 to 4 weeks as required; to avoid possible joint damage use as infrequently as possible.
- Standard dose: 2 to 20 mg; smaller joints (interphalangeal, metacarpophalangeal):
- Acetonide: Intra-articular, intramural, ligament casings:
- IM: Acetonide (Kenalog-40):
- Initial: 60 mg; range: 2.5 to 100 mg/day
Triamcinolone (Kenalog) Dose in Childrens
Adjust dose varying upon the condition being treated and the reaction of the patient. The lowest possible dose must be used to regulate the condition; when dose reduction is possible, the dose should be reduced slowly.
Note: Aristospan Intra-Articular and Aristospan Intralesional have been suspended in the US for more than 1 year.
Triamcinolone (Kenalog) General dosing, treatment of inflammatory and allergic conditions:
- Children and Adolescents:
- Manufacturer's labeling: Acetonide (Kenolog-40):
- IM: Initial: 0.11 to 1.6 mg/kg/day (or 3.2 to 48 mg/m /day) in 3 to 4 divided doses
- Alternate dosing: Limited data available: Acetonide:
- Children 6 to 12 years: IM: 0.03 to 0.2 mg/kg/dose every 1 to 7 days.
- Manufacturer's labeling: Acetonide (Kenolog-40):
Triamcinolone (Kenalog) Dose in the treatment of Juvenile idiopathic arthritis (JIA), other rheumatic conditions:
- Manufacturer's labeling:
- Children and Adolescents:
- Acetonide (Kenalog-10 or -40): Intra-articular:
- Primary:
- Smaller joints: 2.5 to 5 mg,
- larger joints: 5 to 15 mg;
- highest dose/treatment (several joints at one time): 20 to 80 mg
- Primary:
- Hexacetonide (Aristospan 20 mg/ml): Intra-articular:
- Standard dose: 2 to 20 mg;
- smaller joints: 2 to 6 mg;
- larger joints: 10 to 20 mg.
- The rate of injection into a single joint is every 3 to 4 weeks as required; to avoid possible joint damage use as rarely as possible
- Standard dose: 2 to 20 mg;
- Acetonide (Kenalog-10 or -40): Intra-articular:
- Children and Adolescents:
- Alternate dosing: Limited data available:
- Children and Adolescents:
- Hexacetonide: Intraarticular:
- Large joints (typically knees, ankles): 1 to 1.5 mg/kg/dose;
- A maximum dose: 40 mg;
- Doses larger than 1.5 mg/kg have not been linked with added clinical benefit;
- Similar dosing for the acetonide salt can be used, but data shows that the response is greater and lasts longer with hexacetonide.
- Hexacetonide: Intraarticular:
- Children and Adolescents:
Triamcinolone (Kenalog) Dose in the treatment of severe Infantile hemangioma:
- Infants and Children ≤49 months:
- Intralesional:
- Dosage reliant on upon size of lesion:
- Commonly reported: 1 to 2 mg/kg/dose of the acetonide suspension (either 10 mg/mL or 40 mg/mL) administered in distributed doses along the lesion perimeter ~monthly (4 to 5 weeks most regularly reported interval);
- a maximum dose of up to 30 mg/dose has been used;
- others have reported: 1 to 30 mg of the 10 mg/mL acetonide injection divided into multiple injections along with the lesion; has also been used in combination with betamethasone intralesional injections.
- Dosage reliant on upon size of lesion:
- Intralesional:
Triamcinolone (Kenalog) Dose in the treatment of steroid-responsive dermatoses (including contact and atopic dermatitis):
- Acetonide (Kenalog-10): Intradermal:
- Adolescents:
- Up to 1 mg per injection site and may be repeated 1 or more times weekly; multiple areas may be injected if they are 1 cm or more apart, not to exceed 30 mg
- Adolescents:
- Hexacetonide (Aristospan 5 mg/mL): Intralesional, sublesional:
- Adolescents:
- Up to 0.5 mg/square inch of affected skin;
- initial range: 2 to 48 mg;
- The frequency of dose is determined by clinical response
- Adolescents:
Triamcinolone (Kenalog) Pregnancy Risk Category: C
- Corticosteroids have been associated with unfavorable events in animal reproduction research.
- Research has found a link between oral clefts and systemic corticosteroid treatment in the first trimester.
- However, this information is inconsistent and could be affected by the maternal indication for use.
- Monitor newborns for hypoadrenalism after the maternal use of corticosteroids during pregnancy.
- It is recommended that systemic corticosteroids be used during pregnancy to treat aching disorders.
- This will ensure that the maximum effective dose is administered for as little time as possible.
- Intra-articular Dosing is possible.
- Systemic corticosteroids should not be used as an initial treatment for dermatological conditions in pregnant women.
- They should be used only during the second and third trimesters at the lowest dose.
Triamcinolone use during breastfeeding:
- Breast milk contains corticosteroids.
- Producer notes that systemic maternal use of corticosteroids can cause adverse events in breastfeeding infants (e.g. growing repression or interfering with endogenic corticosteroid generation).
- Therefore, it is important to be cautious when administering corticosteroids to a nursing female.
- One case report describes a decrease in milk supply following a high-dose triamcinolone administration to a lactating mom with an formerly large milk supply.
- When used in regular doses, corticosteroids can be considered acceptable for breastfeeding mothers.
- However, it is important to monitor infants while breastfeeding.
- Based on a study with prednisolone, some strategies suggest waiting for 4 hours after the maternal doses of an oral corticosteroid to breastfeed before breastfeeding if there are concerns about infant exposure.
Dose in Kidney Disease:
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Side Effects of Triamcinolone (Kenalog):
- Hematologic & oncologic:
- Bruise
- Neuromuscular & skeletal:
- Joint swelling
- Respiratory:
- Cough
- Sinusitis
Less common side effects of Triamcinolone (Kenalog):
Most reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for systemic triamcinolone:
- Cardiovascular:
- Bradycardia
- Cardiac Arrhythmia
- Cardiac Failure
- Cardiomegaly
- Cerebrovascular Accident
- Circulatory Shock
- Edema
- Embolism (Fat)
- Hypertension
- Hypertrophic Cardiomyopathy (Premature Infants)
- Myocardial Rupture (Following Recent Myocardial Infarction)
- Syncope
- Tachycardia
- Thromboembolism
- Thrombophlebitis
- Vasculitis
- Central Nervous System:
- Abnormal Sensory Symptoms
- Arachnoiditis
- Depression
- Emotional Lability
- Euphoria
- Headache
- Idiopathic Intracranial Hypertension (Upon Discontinuation)
- Increased Intracranial Pressure
- Insomnia
- Malaise
- Meningitis
- Mood Changes
- Myasthenia
- Neuritis
- Neuropathy
- Paraplegia
- Paresthesia
- Personality Changes
- Psychiatric Disturbance
- Quadriplegia
- Seizure
- Spinal Cord Infarction
- Vertigo
- Dermatologic:
- Acne Vulgaris
- Allergic Dermatitis
- Atrophic Striae
- Diaphoresis
- Ecchymoses
- Epidermal Thinning
- Erythema Of Skin
- Exfoliation Of Skin
- Hyperpigmentation
- Hypertrichosis
- Hypopigmentation
- Inadvertent Suppression Of Skin Test Reaction
- Skin Atrophy
- Skin Rash
- Subcutaneous Atrophy
- Thinning Hair
- Urticaria
- Xeroderma
- Endocrine & Metabolic:
- Calcinosis
- Decreased Glucose Tolerance
- Decreased Serum Potassium
- Diabetes Mellitus
- Drug-Induced Cushing's Syndrome
- Fluid Retention
- Glycosuria
- Growth Retardation
- Hirsutism
- Impaired Glucose Tolerance/Prediabetes
- Insulin Resistance
- Menstrual Disease
- Moon Face
- Negative Nitrogen Balance
- Redistribution Of Body Fat
- Secondary Adrenocortical Insufficiency
- Sodium Retention
- Weight Gain
- Gastrointestinal:
- Abdominal Distention
- Change In Bowel Habits
- Gastrointestinal Hemorrhage
- Gastrointestinal Perforation
- Hiccups
- Increased Appetite
- Nausea
- Pancreatitis
- Peptic Ulcer
- Ulcerative Esophagitis
- Genitourinary:
- Bladder Dysfunction
- Postmenopausal Bleeding
- Spermatozoa Disorder
- Hematologic & Oncologic:
- Nonthrombocytopenic Purpura
- Petechia
- Hepatic:
- Hepatomegaly
- Increased Liver Enzymes
- Hypersensitivity:
- Anaphylaxis
- Angioedema
- Infection:
- Increased Susceptibility To Infection
- Infection
- Sterile Abscess
- Local:
- Postinjection Flare
- Neuromuscular & Skeletal:
- Amyotrophy
- Aseptic Necrosis Of Femoral Head
- Aseptic Necrosis Of Humeral Head
- Bone Fracture
- Charcot Arthropathy
- Lupus Erythematous-Like Rash
- Osteoporosis
- Rupture Of Tendon
- Steroid Myopathy
- Vertebral Compression Fracture
- Ophthalmic:
- Blindness (Periocular; Rare)
- Cataract
- Cortical Blindness
- Exophthalmos
- Glaucoma
- Increased Intraocular Pressure
- Papilledema
- Renal:
- Increased Urine Calcium Excretion
- Respiratory:
- Pulmonary Edema
- Miscellaneous:
- Wound Healing Impairment
Contraindications to Triamcinolone (Kenalog):
- Allergy to triamcinolone, or any component of its formulation
- Immune thrombocytopenia (formerly known idiopathic thrombocytopenicpurpura) is now managed with intramuscular injections (IM).
Triamcinolone hexacetonide [Canadian product]:
- Allergy to triamcinolone, or any component of this formulation
- Severe neuroses, active tuberculosis and herpes simplex, systemic mycoses, parasitosis (Strongyloides) infections
- Children under 3 years old (due to benzyl Alcohol);
- Intrathecal or epidural management
There is limited evidence of corticosteroids causing allergenic cross-responsiveness.
However, cross-sensitivity is possible due to similarities in chemical compositions and/or pharmacologic activities.
Warnings and precautions
- Suppression of the adrenals:
- May trigger hypercortisolism or repression of hypothalamic-pituitary-adrenal (HPA) axis, mostly in younger children or in patients getting high doses for extended periods.
- Suppression of the HPA axis may cause adrenal crisis.
- It is important to withdraw and terminate a corticosteroid slowly and carefully.
- Patients who are being switched from systemic corticosteroids in order to inhale products from steroid withdrawal or adrenal insufficiency, such as an increase in allergy symptoms, need to be careful.
- Adults who are taking >20mg of prednisone or equivalent daily may be the most at risk.
- There have been deaths due to adrenal insufficiency among asthmatic patients after and during transfer from systemic corticosteroids spray steroids to systemic corticosteroids; spray steroids don't provide the systemic steroids needed to treat trauma, surgery, or other infections.
- Anaphylactoid reactions
- Patients who have received corticosteroids have not had as many anaphylactic reactions.
- Triamcinolone Acetonide has been implicated in cases of severe anaphylaxis including fatalities.
- Dermal changes:
- It is possible to see atrophy in the injection area.
- Avoid IM deltoid injections; subcutaneous atrophy could occur.
- Immunosuppression:
- Corticosteroids can also be used for extended periods to increase the likelihood of secondary infections, activate dormant infection, cloak severe infections (including fungal infections), or limit the effectiveness of killed or inactivated vaccinations.
- Avoid exposure to chickenpox and measles. Corticosteroids should never be used to treat ocular herpes, cerebral malaria, fungal infections or viral hepatitis.
- Patients with dormant tuberculosis or TB reactivity require close observation. Limit active TB use (only fulminating and disseminated TB) in conjunction with antituberculosis therapy.
- Before initiating corticosteroids, it is important to rule out amebiasis in patients who have recently traveled to tropical climates.
- Kaposi Sarcoma:
- Kaposi Sarcoma can be caused by prolonged treatment with corticosteroids (case reports). If this happens, it is worth discontinuing therapy.
- Myopathy
- High-dose corticosteroids have been associated with severe myopathy in patients with neuromuscular transmission disorder or concomitant with neuromuscular blocking drugs.
- This may occur when high-dose corticosteroids are administered to patients with neuromuscular block agents.
- Psychiatric disorders:
- Corticosteroid abuse can cause psychiatric disorders, such as ecstasy and mood swings, personality changes, severe depression, and blunt psychotic indications.
- Corticosteroid treatment can worsen pre-existing mental conditions.
- Septic arthritis:
- This may occur in the course of intra-articular and soft tissue administration. If necessary, you should establish antimicrobic therapy.
- Cardiovascular disease
- Patients with hypertension and HF should use caution. It has been shown to be associated with fluid retention, electrolyte disruptions, hypertension, and fluid retention.
- Take care after acute MI. Corticosteroids have been linked to myocardial tears.
- Diabetes:
- Use corticosteroids with caution in patients with diabetes mellitus; may change glucose production/regulation which can lead to hyperglycemia.
- Gastrointestinal Disease:
- Patients with GI disorders (diverticulosis and diverticulitis), fresh intestinal anastomoses or active or latent pepticul, ulcerative colitis or any other pyogenic infections, should be restricted or avoided from using the device due to the risk of perforation.
- Head injury
- Patients who received high-dose IV methylprednisolone had an increased death rate. High-dose corticosteroids should never be used to treat a head injury.
- Hepatic impairment
- Patients with cirrhosis or hepatic impairment should be cautious. Long-term use of retaining fluid has been shown to be beneficial.
- Myasthenia gravis:
- Patients with myasthenia Gravis should be cautious. There has been an increase in symptoms, especially in the initial treatment with corticosteroids.
- Ocular disease:
- Patients with cataracts or glaucoma may need to be restrained. Long-term use has been associated with increased intraocular pressure, open angle glaucoma, cataracts, and open-angle glaucoma.
- Patients with a history ocular shepes simplex should be restrained; corneal perforation may have occurred. Do not use active ocular herpes simplux.
- Optic neuritis medication is not recommended. It may lead to more frequent episodes.
- Consider regular eye exams for frequent users.
- Osteoporosis
- Patients with osteoporosis should use restraint. Corticosteroids taken in high doses or for long periods of time have been shown to increase bone loss and fractures.
- Renal impairment
- Patients with impaired renal function may require fluid retention.
- Seizure disorders:
- Patients with seizure disorders should be treated with corticoids. Seizures have been reported in association with adrenal predicament.
- Thyroid disease:
- Dosage adjustments may be required for thyroid conditions.
- The metabolic clearance of corticoids is increased in hyperthyroid patients, while it drops in hypothyroid.
Triamcinolone (systemic): Drug Interaction
|
Acetylcholinesterase Inhibitors |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. |
|
Amphotericin B |
Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. |
|
Amphotericin B |
Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Amphotericin B. |
|
Androgens |
Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens. |
|
Antidiabetic Agents |
Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antihepaciviral Combination Products |
May increase the serum concentration of Triamcinolone (Systemic). |
|
Calcitriol (Systemic) |
Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol (Systemic). |
|
Coccidioides immitis Skin Test |
Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. |
|
Corticorelin |
Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. |
|
Cosyntropin |
Corticosteroids (Orally Inhaled) may diminish the diagnostic effect of Cosyntropin. |
|
Cosyntropin |
Corticosteroids (Systemic) may diminish the diagnostic effect of Cosyntropin. |
|
CYP3A4 Inducers (Strong) |
May decrease the serum concentration of Corticosteroids (Systemic). |
|
CYP3A4 Inhibitors (Strong) |
May increase the serum concentration of Corticosteroids (Systemic). |
|
Deferasirox |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. |
|
Deferasirox |
Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. |
|
Denosumab |
May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. |
|
DilTIAZem |
May increase the serum concentration of Corticosteroids (Systemic). |
|
Estrogen Derivatives |
May increase the serum concentration of Corticosteroids (Systemic). |
|
Indacaterol |
May enhance the hypokalemic effect of Corticosteroids (Systemic). |
|
Isoniazid |
Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid. |
|
Loop Diuretics |
Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics. |
|
Loop Diuretics |
Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Loop Diuretics. |
|
Nicorandil |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nicorandil. Gastrointestinal perforation has been reported in association with this combination. |
|
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). |
|
Nonsteroidal Anti-Inflammatory Agents (Nonselective) |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). |
|
Ocrelizumab |
May enhance the immunosuppressive effect of Immunosuppressants. |
|
Pidotimod |
Immunosuppressants may diminish the therapeutic effect of Pidotimod. |
|
Quinolones |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. |
|
Ritodrine |
Corticosteroids may enhance the adverse/toxic effect of Ritodrine. |
|
Ritonavir |
May enhance the adverse/toxic effect of Triamcinolone (Systemic). Specifically, risks of developing iatrogenic Cushing syndrome and secondary adrenal insufficiency may be increased. Ritonavir may increase the serum concentration of Triamcinolone (Systemic). |
|
Salicylates |
May enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. |
|
Sargramostim |
Corticosteroids (Systemic) may enhance the therapeutic effect of Sargramostim. Specifically, corticosteroids may enhance the myeloproliferative effects of sargramostim. |
|
Siponimod |
Immunosuppressants may enhance the immunosuppressive effect of Siponimod. |
|
Somatropin |
Corticosteroids (Systemic) may diminish the therapeutic effect of Somatropin. |
|
Tacrolimus (Systemic) |
Corticosteroids (Systemic) may decrease the serum concentration of Tacrolimus (Systemic). Conversely, when discontinuing corticosteroid therapy, tacrolimus concentrations may increase. |
|
Tertomotide |
Immunosuppressants may diminish the therapeutic effect of Tertomotide. |
|
Thiazide and Thiazide-Like Diuretics |
Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Thiazide and Thiazide-Like Diuretics |
Corticosteroids (Orally Inhaled) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Tobacco (Smoked) |
May diminish the therapeutic effect of Corticosteroids (Orally Inhaled). |
|
Trastuzumab |
May enhance the neutropenic effect of Immunosuppressants. |
|
Urea Cycle Disorder Agents |
Corticosteroids (Systemic) may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Corticosteroids (Systemic) may increase protein catabolism and plasma ammonia concentrations, thereby increasing the doses of Urea Cycle Disorder Agents needed to maintain these concentrations in the target range. |
|
Warfarin |
Corticosteroids (Systemic) may enhance the anticoagulant effect of Warfarin. |
|
Risk Factor D (Consider therapy modification) |
|
|
Aprepitant |
May increase the serum concentration of Corticosteroids (Systemic). Management: No dose adjustment is needed for single 40 mg aprepitant doses. For other regimens, reduce oral dexamethasone or methylprednisolone doses by 50%, and IV methylprednisolone doses by 25%. Antiemetic regimens containing dexamethasone reflect this adjustment. |
|
Axicabtagene Ciloleucel |
Corticosteroids (Systemic) may diminish the therapeutic effect of Axicabtagene Ciloleucel. Management: Avoid use of corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity. |
|
Baricitinib |
Immunosuppressants may enhance the immunosuppressive effect of Baricitinib. Management: Use of baricitinib in combination with potent immunosuppressants such as azathioprine or cyclosporine is not recommended. Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted. |
|
Desirudin |
|
|
Echinacea |
May diminish the therapeutic effect of Immunosuppressants. |
|
Fingolimod |
Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). |
|
Fosaprepitant |
May increase the serum concentration of Corticosteroids (Systemic). The active metabolite aprepitant is likely responsible for this effect. |
|
Hyaluronidase |
Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. |
|
Leflunomide |
Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. |
|
Mitotane |
May decrease the serum concentration of Corticosteroids (Systemic). |
|
Neuromuscular-Blocking Agents (Nondepolarizing) |
May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. |
|
Nivolumab |
Immunosuppressants may diminish the therapeutic effect of Nivolumab. |
|
Roflumilast |
May enhance the immunosuppressive effect of Immunosuppressants. |
|
Sipuleucel-T |
Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Management: Evaluate patients to see if it is medically appropriate to reduce or discontinue therapy with immunosuppressants prior to initiating sipuleucel-T therapy. |
|
Tisagenlecleucel |
Corticosteroids (Systemic) may diminish the therapeutic effect of Tisagenlecleucel. Management: Avoid use of corticosteroids as premedication or at any time during treatment with tisagenlecleucel, except in the case of life-threatening emergency (such as resistant cytokine release syndrome). |
|
Tofacitinib |
Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. |
|
Vaccines (Inactivated) |
Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. |
|
Vaccines (Live) |
Corticosteroids (Systemic) may enhance the adverse/toxic effect of Vaccines (Live). Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Doses equivalent to less than 2 mg/kg or 20 mg per day of prednisone administered for less than 2 weeks are not considered sufficiently immunosuppressive to create vaccine safety concerns. Higher doses and longer durations should be avoided. |
|
Risk Factor X (Avoid combination) |
|
|
Aldesleukin |
Corticosteroids may diminish the antineoplastic effect of Aldesleukin. |
|
BCG (Intravesical) |
Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). |
|
Cladribine |
May enhance the immunosuppressive effect of Immunosuppressants. |
|
Desmopressin |
Corticosteroids (Systemic) may enhance the hyponatremic effect of Desmopressin. |
|
Desmopressin |
Corticosteroids (Orally Inhaled) may enhance the hyponatremic effect of Desmopressin. |
|
Indium 111 Capromab Pendetide |
Corticosteroids (Systemic) may diminish the diagnostic effect of Indium 111 Capromab Pendetide. |
|
Loxapine |
Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. |
|
Macimorelin |
Corticosteroids (Systemic) may diminish the diagnostic effect of Macimorelin. |
|
Mifamurtide |
Corticosteroids (Systemic) may diminish the therapeutic effect of Mifamurtide. |
|
MiFEPRIStone |
May diminish the therapeutic effect of Corticosteroids (Systemic). MiFEPRIStone may increase the serum concentration of Corticosteroids (Systemic). Management: Avoid mifepristone in patients who require long-term corticosteroid treatment of serious illnesses or conditions (e.g., for immunosuppression following transplantation). Corticosteroid effects may be reduced by mifepristone treatment. |
|
Natalizumab |
Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. |
|
Pimecrolimus |
May enhance the adverse/toxic effect of Immunosuppressants. |
|
Tacrolimus (Topical) |
May enhance the adverse/toxic effect of Immunosuppressants. |
Monitoring parameters:
- Blood pressure,
- blood glucose,
- electrolytes;
- weight;
- intraocular pressure (use >6 weeks);
- bone mineral density;
- growth and development in children;
- HPA axis suppression
How to administer Triamcinolone (Kenalog)?
- Mix well before usage to certify suspension is consistent.
- Examine visually to make sure that there are no lumps; administer instantly after removal so does not settle down in the syringe.
- Do not administer any product IV or via the epidural or intrathecal route.
Acetonide:
- Kenalog-10 injection:
- For intra-articular or intralesional administration only. When administered intralesional, inject precisely into the lesion (i.e., intradermally or subcutaneously). One mL syringes with a 23- to 25-gauge needle are better for intralesional injections.
- Kenalog-40 injection:
- For intra-articular, soft tissue, or IM administration. When administered IM, inject deep into the gluteal muscle utilizing the least possible needle length of 1 1/2 inches. Overweight patients might need a longer needle. Alternative sites for consequent injections. Avoid IM injections into the deltoid muscle area.
- Zilretta injection:
- For intra-articular administration only. Do not administer IV, IM, SubQ, intrathecally, intraocularly, intradermally, or via epidural.
- Make suspension only consuming the dilutant provided in the kit (refer to manufacturer labeling for making instructions and administration methods).
- Quickly inject subsequently preparation. If required, can store the suspension in the flask ≤ 4 hours at ambient circumstances; tenderly twirl container to mix any settled microspheres before formulating syringe for injection.
- Aspiration of synovial liquid may be done based on clinical judgment prior to administration.
Hexacetonide [Canadian product]:
- For intra-articular and soft tissue administration only; use a 25- or 26-gauge needle.
Mechanism of action of Triamcinolone (Kenalog):
- It is an adrenal cortical steroid that has marginal sodium-preserving capabilities.
- It decreases inflammation through the repression of migration polymorphonuclear WBCs, and reverses enhanced capillary absorbtivity.
- It suppresses the immune response by reducing the activity and quantity in the lymphatic system.
Initial:
- Suppression of the adrenals:
- Acetonide (IM): 24-48 hours
- Intra-articular: >24 Hours
Duration:
- Adrenal suppression:
- IM (acetonide): 30 to 40 days;
- Intra-articular: 28 to 42 days
Metabolism:
- Hepatic.
Half-life elimination:
- Plasma: 300 minutes.
Excretion:
- Urine (75% primarily);
- bile and feces (25%).
International Brand Names of Triamcinolone:
- Arze-Ject-A
- Kenalog
- Kenalog-80
- P-Care K40
- P-Care K80
- Pod-Care 100K
- Pro-C-Dure 5
- Pro-C-Dure 6
- ReadySharp Triamcinolone
- Zilretta
- Aristospan
- Kenalog-10
- Kenalog-40
- Acetidrona
- Aftab
- Albicort
- Amcinol
- Aristocort
- Aristocort A
- Atrinat
- Avcort
- Bluxam
- Cenalog
- Cenolon
- Cynocort
- Danizax
- Delphicort
- Deltrianolona
- Epirelefan
- Flamicort
- Forticinolone
- Intralon
- Introlan
- Ioncort
- Kenacort
- Kenacort A
- Kenacort E
- Kenacort IM
- Kenacort Retard
- Kenacort T
- Kenacort-A
- Kenacort-A I.M.
- Kenalog
- Kenalog-40
- Kilcort
- Konicort
- Ledercort
- Lederlon
- Lederspan
- Loncort
- MaQaid
- Maquaid
- Oracort
- Panbicort
- Polkortolon
- Rabeolone
- Rheudenolone
- Shincort
- Sivkort
- Softram
- Solu-Volon
- Sterocort
- Stucort
- T-Cort
- Thainocort
- Tracinone
- Tramsicort
- Trecilon
- Tri-Ject
- Triam
- Triamcort
- TriamHEXAL
- Triamhexal
- Triamon
- Trica
- Tricort
- Trigon Depot
- Trilac
- Trimcort
- Trinakor
- Trincort
- Trispan
- Trispane
- Volon A
- Volon A 10
- Volon A 40
Triamcinolone Brand Names in Pakistan:
Triamcinolone Injection 10 Mg/Ml in Pakistan |
|
|
Tramacort |
Trigon Pharmaceuticals Pakistan (Pvt) Ltd. |
Triamcinolone Injection 40 Mg/Ml in Pakistan |
|
|
Amrokort |
Amros Pharmaceuticals. |
|
Cinokort |
Polyfine Chempharma (Pvt) Ltd. |
|
Danacort |
Danas Pharmaceuticals (Pvt) Ltd |
|
Dexafort |
Cirin Pharmaceuticals (Pvt) Ltd. |
|
K-Kort |
Ophth-Pharma (Pvt) Ltd. |
|
Kenacort-A |
Glaxosmithkline |
|
Lawrcort |
Lawrence Pharma |
|
Lonacort |
Zafa Pharmaceutical Laboratories (Pvt) Ltd. |
|
M-Kort |
Mediate Pharmaceuticals (Pvt) Ltd |
|
Medikort |
Medicraft Pharmaceuticals (Pvt) Ltd. |
|
Triam |
Z-Jans Pharmaceutical (Pvt) Ltd. |
|
Tricort |
Akhai Pharmaceuticals. |
|
Triton Inj |
Mass Pharma (Private) Limited |
|
Vibra |
Fassgen Pharmaceuticals |
|
Welkort |
Welmark Pharmaceuticals |
Triamcinolone Oint 0.1 %W/W in Pakistan |
|
|
Kenalog In Orabase |
Glaxosmithkline |
|
Lonacort 0.1% |
Zafa Pharmaceutical Laboratories (Pvt) Ltd. |
Triamcinolone Cream 1 Mg/G in Pakistan |
|
|
K-Kort |
Ophth-Pharma (Pvt) Ltd. |
Triamcinolone Nasal Spray 15 Mg/Actu in Pakistan |
|
|
Hinase |
Hilton Pharma (Pvt) Limited |
Triamcinolone Nasal Spray 55 Mcg/Actu in Pakistan |
|
|
Nasacort-Aq |
Sanofi Aventis (Pakistan) Ltd. |
|
Nasarin |
Schazoo Zaka |
Triamcinolone Paste 10 Mg in Pakistan |
|
|
Tri-Domec Paste |
Platinum Pharmaceuticals (Pvt.) Ltd. |
Triamcinolone Tablets 4 Mg in Pakistan |
|
|
Kenacort |
Glaxosmithkline |