Kenalog 40
Kenalog 40: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Kenalog
ATX code: H02AB08
Active ingredient: triamcinolone acetonide (triamcinolone acetonide)
Manufacturer: KRKA (Slovenia)
Description and photo update: 2018-26-10
Prices in pharmacies: from 578 rubles.
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Kenalog 40 is a glucocorticosteroid drug.
Release form and composition
Kenalog 40 is available in the form of a suspension for injection: white, the content of easily resuspended almost white or white particles is allowed, with a slight smell of benzyl alcohol, without foreign inclusions (1 ml each in colorless transparent glass ampoules, 5 ampoules in a blister; in a cardboard box 1 blister, 50 blisters in a cardboard box).
1 ml of suspension contains:
- active substance: triamcinolone acetonide - 40 mg;
- auxiliary components: benzyl alcohol, sodium carmellose, polysorbate, sodium chloride, water for injection.
Pharmacological properties
Pharmacodynamics
Kenalog 40 is a glucocorticosteroid (GCS) drug with anti-inflammatory, anti-allergic, anti-shock, desensitizing, immunosuppressive and antitoxic effects.
The active substance - triamcinolone - inhibits the release of gamma-interferon, interleukin-1 and 2 from lymphocytes and macrophages. By inhibiting the release of beta-lipotropin and adrenocorticotropic hormone by the pituitary gland, it does not reduce the content of circulating beta-endorphin. Suppresses the secretion of follicle-stimulating and thyroid-stimulating hormones. Increases the excitability of the central nervous system, reduces the number of eosinophils and lymphocytes. Against the background of increased production of erythropoietins, the number of erythrocytes increases. As a result of interaction with specific cytoplasmic receptors, a complex is formed that penetrates into the cell nucleus. The synthesized matrix ribonucleic acid induces the formation of proteins (including lipocortins) that mediate the effects of cells. Lipocortin acts to inhibit phospholipase A2,suppression of the release of arachidonic acid and inhibition of the synthesis of prostaglandins, endoperoxides, leukotrienes, which cause inflammatory processes.
Participation of triamcinolone in metabolic processes:
- proteins: by reducing the number of globulins, it reduces the level of protein concentration in the blood plasma with an increase in the albumin and globulin ratio. There is an increase in the synthesis of albumin in the kidneys and liver, an increase in protein catabolism in muscle tissue;
- fats: participating in lipid metabolism, the drug increases the synthesis of triglycerides and higher fatty acids, promotes the redistribution of fat mass, causes the development of hypercholesterolemia;
- carbohydrates: increases the absorption of carbohydrates from the gastrointestinal tract, the activity of glucose-6-phosphatase, the flow of glucose from the liver into the blood, the activity of phosphoenolpyruvate carboxylase. By increasing the synthesis of aminotransferases, it activates gluconeogenesis.
Triamcinolone has a slight mineralocorticosteroid activity. Taking part in water-electrolyte metabolism, it potentiates the excretion of potassium ions, retains sodium ions and water in the body, reduces the absorption of calcium ions from the gastrointestinal tract, increasing their renal excretion.
The anti-inflammatory effect of Kenalog 40 is due to its effect on eosinophils, causing inhibition of the release of inflammatory mediators. Against the background of a decrease in capillary permeability, stabilization of cell membranes and organelle membranes, it induces the formation of lipocortins, reduces the content of mast cells and hyaluronic acid.
The antiallergic effect of the drug is associated with its ability to suppress the synthesis and secretion of allergy mediators. By delaying the release of biologically active substances (including histamine) from sensitized mast cells and basophils, triamcinolone reduces the number of mast cells, B- and T-lymphocytes, circulating basophils, suppressing the development of lymphoid and connective tissue. Reduces the sensitivity of effector cells to allergy mediators, inhibits antibody production.
The antitoxic and antishock effect of Kenalog 40 is associated with the activation of liver enzymes that are involved in the metabolism of xenobiotics and endobiotics, an increase in blood pressure (BP), a decrease in the permeability of the vascular wall and membrane protective properties of the drug.
Against the background of inhibition of the release of cytokines from lymphocytes and macrophages, the immunosuppressive effect of the drug appears. In inflammatory processes, this delays connective tissue reactions and reduces the formation of scar tissue.
Pharmacokinetics
Absorption of Kenalog 40 with intramuscular (i / m) administration occurs slowly, but completely.
When administered intramuscularly, the maximum therapeutic effect occurs within 24-28 hours and lasts 1-6 weeks. When injected into the joint cavity, the drug lasts for several weeks.
Plasma proteins bind 40% of a single dose.
The predominant metabolism of triamcinolone by 6-beta-hydroxylation occurs in the liver with the formation of inactive metabolites. Partially metabolized in the kidneys.
It is excreted through the kidneys in the form of inactive products.
Indications for use
According to the instructions, Kenalog 40 for local administration is indicated for the following diseases:
- osteoarthritis (except for the hip joint) in the presence of synovitis (intra-articular);
- inflammatory lesions of periarticular tissues with bursitis, tendinitis, tendosynovitis, epicondylitis, generalized fibromyalgia (periarticular);
- rheumatic diseases of inflammatory etiology - rheumatoid arthritis, arthritis in systemic connective tissue diseases, seronegative spondyloarthritis (intra-articular and periarticular);
- neurodermatitis, psoriasis, lichen planus, coin-like eczema, alopecia areata, discoid lupus erythematosus - in rare cases, in the absence of a response to other methods of local therapy (administration of the drug into the lesion).
In addition, in the treatment of severe allergic diseases, such as Quincke's edema, allergic rhinitis, severe bronchial asthma, allergic reactions to insect bites, drugs and serum, the systemic effect of triamcinolone is used.
Contraindications
Absolute:
- peptic ulcer of the stomach or duodenum;
- diverticulitis;
- thrombophlebitis;
- tuberculosis;
- glaucoma;
- newly created anastomosis;
- diabetes;
- an acute form of a bacterial, viral or fungal systemic infection (in the absence of appropriate therapy);
- osteoporosis;
- periarthricular infections, inflammatory process of an infectious genesis in the joint (including history);
- no signs of inflammation in the joint (including osteoarthritis without synovitis);
- Itsenko-Cushing's syndrome;
- condition after severe injury or surgery;
- pathological bleeding caused by the use of anticoagulants or endogenous;
- extra-articular bone fracture;
- a sharp narrowing of the joint space, ankylosis, resulting from pronounced bone destruction and joint deformation;
- joint instability that results from arthritis;
- aseptic necrosis of the epiphyses of the bones that form the joint;
- previous arthroplasty;
- idiopathic thrombocytopenic purpura (for intramuscular administration);
- children under 12 years of age (for intramuscular administration);
- individual intolerance to the components of Kenalog 40.
In conditions that, according to the doctor, threaten the patient's life, the only contraindication for short-term use is hypersensitivity to the components of the drug.
It is recommended to be careful when prescribing Kenalog to 40 patients with diseases of the cardiovascular system (including recent myocardial infarction), chronic renal failure, chronic hepatitis, liver cirrhosis, hyperthyroidism, hypothyroidism, esophagitis, ulcerative colitis, gastritis, systemic osteoporosis, psychosis, nephrourolithiasis, hyperlipidemia, immunodeficiency conditions [including acquired immune deficiency syndrome (AIDS) or infection with the human immunodeficiency virus], hypoalbuminemia (including nephrotic syndrome and other conditions suggesting its occurrence), poliomyelitis (except for the form of bulbar encephalitis), III, IV degrees of obesity during pregnancy and breastfeeding, as well as in old age.
Instructions for use of Kenalog 40: method and dosage
Do not inject Kenalog 40 intravenously or subcutaneously! It is recommended to avoid accidental intravascular injection.
The suspension is intended for intra-articular, intra-articular, intra-focal (periarticular) administration and in the area of direct skin lesion.
The IM drug is administered in the treatment of systemic diseases by slow and deep injection. Shake the contents of the ampoule before use.
The doctor prescribes the dose of Kenalog 40 individually, taking into account the nature of the disease.
Recommended dosage for systemic use: i / m - 40 mg; to achieve the desired clinical effect in severe diseases, it is possible to increase the dose of the drug to 80 mg. After injection, a sterile napkin should be pressed tightly to the injection site for a while. The frequency of administration is determined by the doctor individually, the period between injections is 1 month. When treating seasonal allergic diseases, Kenalog 40 is administered once during the pollen season.
The doctor determines the dose for intra-articular administration taking into account the severity of the symptoms and the size of the joint.
A site of the body skin for intra-articular injection is prepared in compliance with the aseptic conditions provided for surgical operations.
Recommended dosage of Kenalog 40 for local administration:
- small joints (including phalanges of fingers and toes): up to 10 mg;
- medium-sized joints such as shoulder or elbow: up to 20 mg;
- large joints (including hip, knee): 20–40 mg.
The total single dose of the drug in the treatment of several joints should not exceed 80 mg. You can repeat the injection no earlier than after half a month.
Shown is the combined administration of Kenalog 40 with a local anesthetic that does not have a vasoconstrictor effect.
With intra-articular administration, it is impossible to allow the creation of a depot suspension in the subcutaneous fat tissue.
The recommended dosage for intralesional administration of the drug, taking into account the size and location of the lesions:
- small lesions (bursitis, periostitis): up to 10 mg;
- large lesions: 10 mg to 40 mg.
The suspension can be mixed with a local anesthetic.
To inject the drug into the area of skin lesion, it is necessary to add a local anesthetic that does not contain a vasoconstrictor component into a syringe with 1 ml of the drug. To provide anesthesia for the infiltrate, the injection should be performed horizontally into the area between the subcutaneous layer and the skin. The dose of the drug is determined at the rate of 1 mg of the drug per 1 cm 2 of the skin surface.
The maximum daily dose for the treatment of several lesions is 30 mg.
In the presence of keloid scars, Kenalog 40 can be used in its pure form (without dilution) by injecting directly into the scar tissue.
The recommended frequency of procedures is no more than 1 time in half a month.
Special care should be taken when administering the drug to elderly patients. Due to the high risk of developing reactions that threaten the patient's life, treatment should be carried out in a hospital setting under the close supervision of a physician.
When used for the treatment of doses exceeding 40 mg once a month, the abolition of Kenalog 40 must be made by gradually reducing a single dose or increasing the interval between injections.
Rapid cancellation of systemic glucocorticosteroids is allowed only with a short course of therapy and no danger of exacerbation of the disease. For most patients, a single dose over several weeks usually does not cause clinically significant depression of the hypothalamic-pituitary-adrenal system.
Gradual withdrawal of glucocorticosteroids is required in the following cases:
- The use of repeated courses of systemic glucocorticosteroids.
- The period after the cancellation of long-term glucocorticosteroid therapy does not exceed 12 months before the appointment of Kenalog 40.
- There is a predisposition to the occurrence of adrenal insufficiency due to other reasons not associated with the use of exogenous GCS.
Side effects
- from the hematopoietic system: lymphopenia, granulocytosis, monocytopenia;
- from the cardiovascular system: bradycardia (including cardiac arrest), arrhythmias; with a predisposition of patients - the development of heart failure (or an increase in its severity), changes in electrocardiography characteristic of hypokalemia, increased blood pressure, thrombosis, hypercoagulation; with systemic use - in patients with acute and subacute myocardial infarction - an increase in the focus of necrosis, a slowdown in the formation of scar tissue (risk of rupture of the heart muscle);
- from the nervous system: insomnia, headache, dizziness, euphoria, hallucinations, depression, manic-depressive psychosis, disorientation, paranoia, anxiety, nervousness, cerebellar pseudotumor, convulsions, increased intracranial pressure;
- on the part of the respiratory system: lowering of the timbre of the voice, dryness and irritation of the mucous membrane of the pharynx and mouth;
- on the part of the sensory organs: ophthalmic hypertension (increased intraocular pressure, glaucoma), damage to the optic nerve, posterior subcapsular cataract, increased risk of developing secondary bacterial, viral or fungal eye infections, exophthalmos, trophic changes in the cornea, sudden loss of vision due to deposits in the eye chambers triamcinolone crystals;
- on the part of the musculoskeletal system: osteonecrosis, steroid myopathy, osteoporosis, premature closure of the epiphyseal growth zones in children (slowing down the processes of ossification and growth), atrophy (decrease in muscle mass);
- from the digestive system: decreased or increased appetite, nausea, vomiting, flatulence, hiccups, erosive esophagitis, steroid duodenal stomach ulcer, pancreatitis, bleeding and perforation of the gastrointestinal tract, increased activity of alkaline phosphatase and liver enzymes;
- on the part of metabolism: increased levels of low density lipoproteins, total cholesterol and triglycerides, porphyria, hypocalcemia, hypernatremia, weight gain, peripheral edema, negative nitrogen balance, hypokalemic syndrome (fatigue, unusual weakness, arrhythmia, hypokalemia, muscle spasm, myalgia);
- from the endocrine system: sodium retention, decreased glucose tolerance, inhibition of adrenal function, steroid diabetes mellitus (manifestation of latent diabetes mellitus), Itsenko-Cushing's syndrome; with long-term therapy - delayed growth and sexual development in children;
- on the part of the skin: increased sweating, subcutaneous hemorrhages, steroid acne, dermatitis, facial erythema, ecchymosis, delayed wound healing, skin atrophy, striae, thinning of the skin, telangiectasia, hypo- or hyperpigmentation, pharyngeal and mouth candidiasis, avascular necrosis, septic necrosis (especially with systemic lupus erythematosus or rheumatoid arthritis);
- from the genitourinary system: violation of the menstrual cycle;
- laboratory parameters: leukocytosis (without neoplastic process and signs of inflammation);
- allergic reactions: urticaria, skin rash, itching, bronchospasm, angioedema, anaphylactic shock, respiratory arrest.
Overdose
- symptoms: nausea, vomiting, agitation, sleep disorder, depression, euphoria, hyperglycemia, glucosuria, Itsenko-Cushing's syndrome;
- treatment: no specific antidote. Appointment of symptomatic therapy against the background of gradual drug withdrawal. Hemodialysis is not effective.
special instructions
Before the appointment and during the period of treatment with the drug, it is necessary to regularly conduct a complete blood count, monitor the level of sugar and electrolytes in the blood plasma.
To exclude a septic process, a study of the synovial fluid in each joint is required. Signs of the development of septic arthritis include a significant increase in pain, local edema, fever, malaise, and progressive limitation of joint mobility. If sepsis is confirmed, the patient should be prescribed appropriate antimicrobial therapy.
With intercurrent infections, tuberculosis, septic conditions, the simultaneous use of antibacterial agents is indicated.
Due to the risk of rupture, injecting the suspension into the Achilles tendon and unstable joints should be avoided.
During the period of application of Kenalog 40, vaccination with the use of live viral vaccines is contraindicated. Immunization with bacterial or inactivated viral vaccines against the background of the use of triamcinolone does not give the expected increase in the amount of antibodies and does not provide the development of the expected protective effect. Therefore, the suspension should not be used 2 months before vaccination and within 0.5 months after it.
During the period of application of GC, contact with patients with contagious diseases (including measles, chickenpox) should be avoided, since casual contact with infected persons increases the risk of infection.
When prescribing Kenalog 40 after operations and bone fractures, one should take into account the property of GCS to slow down the healing of wounds and fractures.
With cirrhosis of the liver, hypothyroidism, the effect of triamcinolone is enhanced.
Kenalog 40 influences the parameters of allergic skin tests for hypersensitivity.
Influence on the ability to drive vehicles and complex mechanisms
Due to the risk of developing side effects from the nervous system (including lethargy, hallucinations, disorientation, convulsions) during the first weeks of therapy, patients should be careful when driving complex mechanisms and vehicles. In the event of the appearance of these or other symptoms of discomfort, it is necessary to stop performing potentially hazardous activities.
Application during pregnancy and lactation
Triamcinolone has a teratogenic effect, therefore, during the period of gestation, Kenalog 40 must be prescribed with caution due to the lack of information about the safety of its use in humans.
It is assumed that a long course of therapy can cause impaired intrauterine development, the use of the drug in the third trimester of pregnancy increases the risk of adrenal atrophy in the fetus.
Kenalog 40 passes into breast milk, therefore, when breastfeeding, its appointment should be made after assessing the balance of benefits and risks.
Pediatric use
The intramuscular injection of the drug is contraindicated in children under 12 years of age.
The use of Kenalog 40 in children during the period of intensive growth should be prescribed only for absolute indications and under the close supervision of a physician.
With impaired renal function
Care should be taken in chronic renal failure, nephrourolithiasis, nephrotic syndrome.
For violations of liver function
Kenalog 40 is prescribed with caution for chronic hepatitis, liver cirrhosis.
Use in the elderly
Planning the use, especially long-term use, of Kenalog 40 in the elderly should be carried out taking into account the increased risk of serious consequences and more frequent undesirable effects, such as arterial hypertension, osteoporosis, susceptibility to infections, diabetes mellitus, thinning of the skin.
Due to the high risk of developing reactions that threaten the patient's life, treatment should be carried out in a hospital setting under the close supervision of a physician.
Drug interactions
When used simultaneously with Kenalog 40:
- cardiac glycosides: their toxicity increases, against the background of the development of hypokalemia, the risk of arrhythmias increases;
- ketoconazole: reduces the clearance of triamcinolone, increasing its toxicity;
- acetylsalicylic acid: its excretion is accelerated, the abolition of triamcinolone can contribute to a sharp increase in the concentration of salicylates in the blood and the risk of side effects;
- cyclosporine: increases the toxicity of triamcinolone, inhibiting its metabolism;
- live viral vaccines and other types of immunization: the risk of virus activation and the development of infections increases;
- isoniazid, mexiletine: their metabolism increases;
- paracetamol: the likelihood of developing hepatotoxic reactions increases;
- folic acid (with prolonged therapy): the level of its concentration in blood plasma increases;
- somatropin (against the background of high doses of triamcinolone): the therapeutic effect decreases;
- nitrates, m-anticholinergics (including tricyclic antidepressants, antihistamines): increase intraocular pressure;
- hypoglycemic agents: their effectiveness decreases;
- coumarin derivatives; the anticoagulant effect is enhanced;
- vitamin D: weakens its effect on calcium absorption in the intestinal lumen;
- indomethacin: increases the risk of developing undesirable effects of the drug.
Analogs
Analogs of Kenalog 40 are: Polcortolone, Dexazon, Metipred, Acortin, Diprospan, Dexamethasone, Hydrocortisone, Kortineff, Cortef.
Terms and conditions of storage
Store at 8–25 ° C, keep away from freezing. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Kenalog 40
Reviews about Kenalog 40 are mostly positive. Evaluating its therapeutic efficacy, patients point to the anti-inflammatory and rapid analgesic effect of the drug after the first injection (in many cases, the only one). Even considering that the drug is hormonal, in very serious conditions, many patients resort to using it to relieve pain. It is recommended to use only as directed by a doctor.
The disadvantages of Kenalog 40 include a very large list of contraindications for use and the risk of side effects.
Price for Kenalog 40 in pharmacies
The price for Kenalog 40 per pack (5 ampoules) can range from 558 rubles.
Kenalog 40: prices in online pharmacies
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Drug name Price Pharmacy |
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Kenalog 40 40 mg / ml suspension for injection 1 ml 5 pcs. 578 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
