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Triamcinolone acetonide ia / im inj 40mg/ml


Injections of triamcinolone acetonide.

Drugs List

  • KENALOG INTRA-ARTICULAR/INTRAMUSCULAR 40mg/1ml injection suspension
  • triamcinolone acetonide 40mg/1ml injection suspension
  • Therapeutic Indications


    Adrenal insufficiency - cortical
    Pain in joint
    Palliative treatment of neoplastic disease
    Suppression of inflammatory & allergic conditions

    Intra-articular administration:
    Alleviating joint pain, swelling and stiffness associated with rheumatoid arthritis and osteoarthrosis with an inflammatory component.

    Intra-muscular administration:
    Where sustained systemic corticosteroid treatment is required:
    Allergic states such as bronchial asthma, seasonal or perennial rhinitis,
    Endocrine disorders (For example, primary or secondary adrenocortical insufficiency)
    Collagen disease (for example, during an exacerbation of maintenance therapy in selected cases of systemic lupus erythematosus or acute rheumatic carditis)
    Dermatological disorders such as pemphigus, severe dermatitis and Stevens-Johnson syndrome
    Gastro-intestinal disorders (short term adjunctive treatment)
    Respiratory disorders (short term adjunctive treatment)
    Rheumatic disorders (short term adjunctive treatment)
    Haematological disorders such as acquired (autoimmune) haemolytic anaemia
    Neoplastic diseases (such as palliative management of leukaemia and lymphomas)
    Renal disease (for example, acute interstitial nephritis, minimal change nephrotic syndrome or lupus nephritis)



    Intra-muscular injection
    Initial dose: 40mg injected deeply into the upper, outer quadrant of the gluteal muscle. Repeat if required.

    Maximum dose: 100mg for injection.

    Patients with hay fever or pollen asthma who do not respond to conventional therapy may obtain a remission of symptoms lasting throughout the pollen season after a single dose of 40mg to 100mg given when allergic symptoms appear.

    Intra-articular, tendon sheath or intrabursal injection
    Smaller joints: 5mg to 10mg depending on the specific disease being treated.
    Larger joints: Up to 40mg depending on the specific disease being treated.

    Subsequent dosage depends on the patient's response and period of relief and should be given when symptoms recur and not at set intervals.

    Single injections into several sites for multiple joint involvement, up to a total of 80mg, have been given without undue reactions.

    It has been recommended that, when injections are given into the sheaths of short tendons, a preparation containing triamcinolone acetonide 10mg/ml should be used.


    Intra-muscular injection
    Children aged over 12 years
    (See Dosage: Adult)

    Children aged 6 to 12 years
    Initial dose: 40mg (injected deeply into the upper, outer quadrant of the gluteal muscle) titrated to the severity of the symptoms and the age and weight of the child.

    Intra-articular injection (unlicensed for under 6 years)
    Children aged 1 to 18 years
    2mg/kg (up to a usual maximum of 40mg).

    Additional Dosage Information

    Triamcinolone withdrawal
    Treatment should not be withdrawn abruptly from patients who have received more than one intramuscular injection during a three week period (i.e. more than physiological doses). The dose should be reduced and the dosage interval increased until a dose of not more than 40mg and a dosage interval of at least three weeks have been achieved as the dose of systemic corticosteroid is reduced.

    Abrupt withdrawal of short term systemic corticosteroid treatment is appropriate if it is considered that the disease is unlikely to relapse. A single dose, which is not repeated within a three week period, is unlikely to lead to clinically relevant hpa-axis suppression in the majority of patients. However, gradual withdrawal of systemic corticosteroid therapy should always be considered in:
    -Patients who have had repeated courses of systemic corticosteroids
    -When a course of triamcinolone has been prescribed within one year of cessation of long term therapy (months or years)
    -Patients who may have reasons for adrenocortical insufficiency other than exogenous corticosteroid therapy


    For intra-articular or deep intramuscular injection (into the gluteal site) only.


    Children under 1 year
    Injection into the Achilles tendon
    Uncontrolled systemic infection
    Injection into septic arthritic joints

    Precautions and Warnings

    Children under 6 years
    Exanthematous disorder
    Family history of glaucoma
    Acute glomerulonephritis
    Congestive cardiac failure
    Diabetes mellitus
    Epileptic disorder
    Gastrointestinal anastomosis
    Hepatic cirrhosis
    Hepatic impairment
    History of severe affective disorders
    History of steroid myopathy
    History of steroid-induced psychosis
    Latent or healed tuberculosis
    Metastatic carcinoma
    Myasthenia gravis
    Peptic ulcer
    Renal impairment

    Administration of live vaccines is not recommended
    May mask symptoms or signs of infections
    Exclude joint infection before injection
    Not all routes are licensed for all age groups
    Not all routes are licensed for all indications
    Contains benzyl alcohol
    Do not inject into unstable joints
    With tendon sheath injections avoid injecting into the tendon
    Prolonged or high dose may lead to adrenal suppression
    Psychological changes may occur during initiation & withdrawal of treatment
    Supervise patient closely during drug withdrawal
    Adrenal cortical atrophy may persist for years after stopping drug
    Advise patient to report any blurred vision or any other eye symptoms
    Antibody response to vaccines may be reduced
    Corticosteroids may cause growth retardation in children under 18 years
    Discontinue if psychiatric disturbances develop
    May cause anaphylactic / anaphylactoid reactions
    Post menopausal women may experience vaginal bleeding
    Sudden withdrawal may be inadvisable -see product information/SPC
    Maintain treatment at the lowest effective dose
    Avoid prolonged use
    Advise patient not to take NSAIDs unless advised by clinician
    Advise patient not to take St John's wort concurrently
    Advise patient not to overuse joints even if symptomatic benefit is felt
    Advise patient that menstrual irregularities may occur
    Advise patient to rest treated joint after intra-articular injection
    Advise patient to seek urgent medical attention if exposed to measles
    Advise those on systemic corticosteroids to avoid chickenpox/H zoster
    Consider issuing Steroid Treatment/Steroid Emergency Card
    If exposed to chickenpox or Herpes zoster seek urgent medical attention
    Patients on prolonged therapy require liberal protein intake

    Patients (or parents of children) without a definite history of chicken pox should be advised to avoid close personal contact with chicken pox or herpes zoster and seek urgent medical attention if exposed as chicken pox can prove fatal in immunocompromised patients. If exposed while on triamcinolone acetonide or within three months of previous use, passive immunisation with varicella/zoster immunoglobulin (VZIG) should be administered within 10 days of the exposure. If chicken pox occurs, treat urgently under specialist care. Do not stop triamcinolone acetonide therapy, an upward dosage adjustment may be required.

    Consider referring patients to an ophthalmologist for evaluation if they present with symptoms such as blurred vision or other visual disturbances. Possible causes may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

    Pregnancy and Lactation


    Use triamcinolone acetonide with caution during pregnancy.

    The manufacturer advises that triamcinolone should only be used when the benefits to the mother and child outweigh the risks. Administration of corticosteroids to pregnant women may increase the risk of intra-uterine growth retardation. Animal studies have shown foetal development abnormalities. At the time of writing, there is limited published information regarding the use of triamcinolone acetonide during human pregnancy. Triamcinolone crosses the placental barrier.


    Use triamcinolone acetonide with caution during breastfeeding.

    The manufacturer advises that corticosteroids may pass into breast milk. At the time of writing, there is limited published information concerning the use of triamcinolone during breastfeeding. Infants of mothers taking high doses of systemic corticosteroids for prolonged periods may have a degree of adrenal suppression. Alternatives such as prednisolone and prednisone which are compatible with breastfeeding, are the corticosteroids of choice for systemic treatment during breastfeeding. If high doses of triamcinolone are repeatedly given then a 3-4 hour wait before breastfeeding may be preferred, however treatment is unlikely to result in large amounts in breast milk.


    Advise patients not to overuse joints in which symptomatic benefit has been obtained.

    Advise female patients that menstrual irregularities may occur.

    Advise patients that they should carry steroid cards which give clear guidance on the precautions to be taken to minimise risk.

    Advise patients to avoid exposure to chicken pox and measles in patients who have not previously had these diseases. If exposed the patient should seek urgent medical advice.

    Advise patients should not self administer with NSAID's unless under guidance from a clinician.

    Side Effects

    Abscess (sterile)
    Aggravation of pre-existing psychiatric conditions
    Behavioural disturbances
    Blurred vision
    Candidiasis (gastro-intestinal)
    Cardiac arrhythmias
    Charcot-like arthropathy
    Congestive cardiac failure
    Corneal thinning
    Cushingoid changes
    Cutaneous atrophy
    Dermatological disturbances
    Endocrine disturbances
    Exacerbation of ophthalmic fungal disease
    Exacerbation of ophthalmic viral disease
    Facial erythema
    Facial flushing (transient)
    Fluid and electrolyte disturbances
    Gastro-intestinal symptoms
    Hypersensitivity reactions
    Hypokalaemic alkalosis
    Impaired carbohydrate tolerance, increased need for anti-diabetic therapy
    Increased appetite
    Increased calcium excretion
    Increased intra-ocular pressure
    Increased susceptibility and severity of infections
    Increased sweating
    Irritation (localised)
    Joint discomfort
    Lipoatrophy at injection site
    Lupus erythematosus
    Menstrual disturbances
    Muscle weakness
    Musculoskeletal disturbances
    Necrotising angiitis
    Neurological disorders
    Ophthalmic disturbances
    Peptic ulceration with perforation and haemorrhage
    Post-injection flare
    Posterior subcapsular cataracts
    Psychiatric disorders
    Psychotic reactions
    Raised intracranial pressure
    Rare instances of blindness with intralesional therapy around face and head
    Recurrence of dormant tuberculosis
    Scleral thinning
    Secondary adrenocortical and pituitary unresponsiveness
    Sleep disturbances
    Subcutaneous atrophy
    Suppression of clinical signs of infection
    Suppression of the hypothalamic-pituitary-adrenal axis
    Tendon rupture
    Transient pain and swelling
    Ulcerative oesophagitis
    Weight gain
    Withdrawal symptoms
    Wound healing retarded

    Withdrawal Symptoms and Signs

    Too rapid a reduction of corticosteroid dosage following prolonged treatment can lead to acute adrenal insufficiency, hypotension and death. A 'withdrawal syndrome' may also occur including fever, myalgia, arthralgia, rhinitis, conjunctivitis, painful itchy skin nodules and weight loss.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2020

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Kenalog Intra-articular / Intramuscular Injection. E.R. Squibb and Sons Limited. May 2020.

    NICE Evidence Services Available at: Last accessed: 22 November 2019

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Triamcinolone Last revised: 31 October 2018
    Last accessed: 22 November 2019

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