Kenalog-40 is a long-acting corticosteroid injection for intramuscular (into the muscle) or intra-articular (into the joints) use. It may be used to treat many different types of inflammatory conditions, including severe allergic reactions, skin disorders (including those caused by autoimmune disorders), severe colitis, inflammation of the joints or tendons, blood cell disorders, inflammatory eye disorders, lung disorders, and problems caused by low adrenal gland hormones. Kenalog-40 contains triamcinolone acetonide 40mg/mL.

Kenalog-40 was FDA-approved on February 1, 1965.

• Rarely, anaphylactic reactions have occurred in patients receiving corticosteroids, including triamcinolone acetonide injections.
• Because Kenalog-40 is a suspension, it must not be administered intravenously.
• You may not be able to receive Kenalog-40 if you have a fungal infection, or a condition called idiopathic thrombocytopenic purpura (ITP).
• Kenalog-40 injection contains benzyl alcohol and exposure to excessive amounts has been associated with toxicity (such as hypotension and metabolic acidosis), particularly in neonates, and an increased risk of kernicterus (a type of brain damage caused by high levels of bilirubin in a baby's blood). The amount of benzyl alcohol that causes toxicity is unknown but the combined daily amount of benzyl alcohol from all sources must be considered.
• If given intramuscularly, Kenalog-40 should be injected deeply into a large muscle, such as a gluteal muscle, rather than a deltoid muscle, because of the increased risk of local atrophy (shrinkage of tissue).
• Kenalog-40 is long-acting and not useful in acute stress situations. Supportive corticosteroid treatments may be necessary in times of stress, such as trauma, surgery, or severe illness during treatment with Kenalog-40 and for a year afterward.
• High dosages should not be used for the treatment of traumatic brain injury.

Kenalog-40 is given through a needle and can be injected into different areas of the body: into a muscle, into the space around a joint or tendon, or a lesion on the skin. A healthcare provider will give you this injection.

Systemic (intramuscular)

The initial dose of Kenalog-40 Injection may vary from 2.5 mg to 100 mg per day depending on the condition being treated and the person being treated.

• The suggested initial intramuscular dose is 60mg, injected deep into the gluteal muscle then dosage is usually adjusted within the range of 40mg to 80mg. Some patients may be controlled on dosages as low as 20mg or less.
• The dose should be individualized and the lowest dose used to control the condition.
• Single seasonal injections of 40mg to 100mg may be effective for patients with hay fever or pollen asthma not responding to conventional therapy.
• For children, an initial dosage range of 0.11 to 1.6 mg/kg/day in 3 or 4 divided doses (3.2 to 48 mg/m²bsa/day) is suggested.

Intra-articular

Single local injections are usually sufficient but several injections may be needed.

Initial dose: 2.5mg – 5 mg (up to 10mg) for smaller joints and from 5mg – 15mg (up to 40mg)  for larger joints.

Other information

Kenalog-40 can weaken (suppress) your immune system, and you may get an infection more easily. Call your doctor if you have unusual bruising or bleeding, or signs of infection (fever, weakness, cold or flu symptoms, skin sores, diarrhea, frequent or recurring illness). Viral infections, such as chickenpox or measles may have a more serious or even fatal course in children and adults.

Long-term use of steroids can cause harmful effects on the eyes. If you receive Kenalog-40 for longer than 6 weeks, your doctor may want you to have regular eye exams.

Your doctor may instruct you to limit your salt intake while you are receiving Kenalog-40. You may also need to take potassium supplements. Follow all instructions.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using Kenalog-40.

You should not stop using Kenalog-40 suddenly after long-term repeated use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

You should not be treated with Kenalog-40 if you are allergic to it.

You may not be able to receive Kenalog-40 if you have an infection or a condition called idiopathic thrombocytopenic purpura (ITP).

Corticosteroids such as Kenalog-40 can affect your body’s response to vaccines. Administration of live or live attenuated vaccines is contraindicated.

Tell your doctor if you have ever had:

• an active or chronic infection, including tuberculosis
• idiopathic thrombocytopenic purpura (ITP)
• high blood pressure, heart problems, a recent heart attack
• cataracts, glaucoma, or herpes infection of the eyes
• a colostomy or ileostomy, or stomach surgery
• a head injury
• a nerve-muscle disorder, such as myasthenia gravis
• a parasite infection that causes diarrhea (such as threadworms)
• a previously unstable or infected joint or one you suspect is currently infected
• a problem with your thyroid or adrenal gland
• a peptic ulcer, diverticulitis, ulcerative colitis
• kidney of liver disease
• low bone mineral density.

Children are more susceptible to the effects of corticosteroids and the use of Kenalog-40 can lead to bone growth inhibition in pediatric patients and growth suppression

Tell your doctor if you are pregnant or breastfeeding.

Corticosteroids such as Kenalog-40 are teratogenic in many species when given in doses equivalent to the human dose and animal studies have shown a higher incidence of cleft palate in the offspring. There are no adequate and well-controlled studies in pregnant women. Administer only if the potential benefit justifies the risk.

Systemically administered corticosteroids such as Kenalog-40 appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. Be cautious when administering to a breastfeeding woman.

Call your doctor for instructions if you miss an appointment for a scheduled Kenalog-40.

When Kenalog-40 is used as a single dose, you will not be on a regular dosing schedule.

Since Kenalog-40 is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Using too much Kenalog-40 is not likely to cause serious problems. However, long-term use of high doses can lead to thinning skin, easy bruising, changes in body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.

After injection of triamcinolone into a joint, avoid overusing that joint through strenuous activity or high-impact sports. You could cause damage to the joint.

Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using Kenalog-40.

Do not receive a "live" vaccine or a toxoid vaccine while using Kenalog-40, or you could develop a serious infection. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine. Toxoid vaccines include diphtheria-tetanus toxoid (DT or Td).

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Kenalog-40 may cause serious side effects. Call your doctor at once if you have:

• (after injection into a joint space) increased pain or swelling, joint stiffness, fever, and general ill feeling
• blurred vision, tunnel vision, eye pain, or seeing halos around lights
• unusual changes in mood or behavior
• swelling, rapid weight gain, feeling short of breath
• stomach cramps, vomiting, diarrhea, bloody or tarry stools, rectal irritation
• sudden numbness or weakness (especially on one side of the body)
• a seizure (convulsions)
• severe headache, blurred vision, pounding in your neck or ears
• increased pressure inside the skull--severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes
• signs of low adrenal gland hormones--flu-like symptoms, headache, depression, weakness, tiredness, diarrhea, vomiting, stomach pain, craving salty foods, and feeling light-headed.

Certain side effects may be more likely with long-term use or repeated doses of Kenalog-40, such as osteoporosis.

Steroids can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using Kenalog-40.

Common side effects of Kenalog-40 may include:

• skin changes (acne, dryness, redness, bruising, discoloration)
• increased hair growth, or thinning hair
• nausea, bloating, appetite changes
• stomach or side pain
• cough, runny or stuffy nose
• fluid retention
• headache, sleep problems (insomnia)
• a wound that is slow to heal
• sweating more than usual
• changes in your menstrual periods.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Tell your doctor about all your current medicines. Many drugs can affect Kenalog-40, especially:

• antibiotics or antifungal medications
• birth control pills or hormone replacement therapies
• blood thinners (such as warfarin or dabigatran)
• digoxin
• diuretics ("water pills")
• insulin or oral diabetes medicine
• medicine to treat tuberculosis
• nonsteroidal anti-inflammatory drugs (NSAIDs) (such as aspirin, ibuprofen, naproxen, diclofenac, and indomethacin) or
• seizure medications.

This list is not complete and many other drugs may affect Kenalog-40. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.