Dosing and uses of Kenalog IV, Aristospan (triamcinolone)
Adult dosage forms and strengths
injectable suspension
- 5mg/mL
- 10mg/mL
- 20mg/mL
- 40mg/mL
Triamcinolone Acetonide
Treatment of rheumatic or arthritic disorders
60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRn
Intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day
Intra-articular/intrasynovial/soft-tissue injection: Large joints, 15-40 mg; small joints/tendon sheath inflammation, 2.5-10 mg
Triamcinolone Hexacetonide
Treatment of rheumatic or arthritic disorders
Intralesional injection: 0.5 mg/²; repeated PRn
Intra-articular injection (20 mg/mL suspension): 10-20 mg (large joint) ; 2-6 mg (small joints); repeated every 3-4 weeks PRn
Dosing Considerations
Dilute with local anesthetic (1% or 2% lidocaine without parabens) before intra-articular or intralesional injection
Dilute with D5/NS or D10/NS or NS or SWI before intralesional injection
Avoid diluents containing parabens or phenols
Pediatric dosage forms and strengths
injectable suspension
- 5mg/mL
- 10mg/mL
- 20mg/mL
- 40mg/mL
Triamcinolone Acetonide
Treatment of rheumatic conditions
0.11-1.6 mg/kg/day IM divided q3-4hr
6-12 years: 0.03-0.2 mg/kg IM every 1-7 days
>12 years: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRn
>12 years, intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day
Kenalog IV, Aristospan (triamcinolone) adverse (side) effects
Frequency not defined
Acne
Arrhythmia
Cardiac enlargement
Circulatory collapse
Adrenal suppression
Anaphylaxis
Vasculitis
Increased intracranial pressure
Thromboembolism
Euphoria
Arthragia
Stroke
Fracture
Joint tissues damage
Lupus erythematosus-like lesions
Hypertrichosis
Cataract
Delayed wound healing
Diabetes mellitus
Epistaxis
Neuritis
Hirsutism
Increased appetite
Indigestion
Tendon rupture
Insomnia
Myopathy
Osteoporosis
Pseudotumor cerebri (on withdrawal)
Psychosis
Vertigo
Warnings
Contraindications
Systemic fungal infection, except as intra-articular injection for localized joint conditions
Documented hypersensitivity
IM corticosteroids contraindicated for idiopathic thrombocytopenic purpura (ITP)
Triamcinolone diacetate injectable suspension contraindicated for intrathecal administration
Cerebral malaria
Benzyl alcohol-containing formulations associated with potentially fatal "gasping syndrome" in premature newborns
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids
Cautions
Triamcinolone acetonide injectable suspension is for intra-articular or intralesional use only, not for IV, IM, intraocular, epidural, or IT use
Not for use in neonates (contains benzyl alcohol)
Use caution in patients with cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy
May cause higher degree of muscle wasting
Psychiatric disorders including depression, personality changes, insomnia, euphoria, and mood swings, may occur
High doses of corticosteroids, including triamcinolone, may increase mortality in patients with traumatic brain injury
Ophthalmic effects: Cataracts, infections, glaucoma
Monitor patients for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia; decrease dose gradually
Increased susceptibility to infection and increased risk of exacerbation, dissemination, or reactivation of latent infection
Monitor blood pressure and serum sodium and potassium levels
Increased risk of gastrointestinal (GI) perforation with certain GI disorders
Monitor bone density in long-term use
Behavioral and mood disturbances
Pregnancy: Fetal harm can occur with use in 1st trimester
Rare instances of anaphylaxis reported
Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts
Acute myopathy, involving ocular and/or respiratory muscles, reported with high-dose corticosteroids, especially in patients with neuromuscular transmission disorders
Prolonged use of Kaposi's sarcoma reported to be associated with development of Kaposi's sarcoma
Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (eg, for Addison’s disease)
Epidural injection
- Serious neurologic events, some resulting in death, have been reported with epidural injection
- Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
- These serious neurologic events have been reported with and without use of fluoroscopy
- Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
Pregnancy and lactation
Pregnancy category: C
Lactation: Excreted in breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Kenalog IV, Aristospan (triamcinolone)
Mechanism of action
Potent glucocorticoid with minimal to no mineralocorticoid activity
Controls or prevents inflammation by suppressing migration of polymorphonuclear leukocytes and fibroblasts and reversing capillary permeability
Suppresses immune system by reducing volume and activity of lymphatic system
Absorption
Bioavailability: Complete with intra-articular injection
Duration: 8-12 hr (PO)
Peak plasma time: 8-10 hr (IM)
Distribution
Protein bound: 68%
Vd: 99.5 L
Metabolism
Metabolized in liver
Elimination
Half-life: Plasma, 2-3 hr; biologic, 18-36 hr
Renal clearance: 9.5 mL/min
Excretion: Urine (40%), feces (60%)
