Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3996
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KENALOG-10 (Injection, Suspension)
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General: NOTE: CONTAINS BENZYL ALCOHOL . IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE
AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND
THE RESPONSE OF THE PATIENT. After a favorable response is noted, the
proper maintenance dosage should be determined by decreasing the initial drug
dosage in small decrements at appropriate time intervals until the lowest
dosage which will maintain an adequate clinical response is reached. Situations
which may make dosage adjustments necessary are changes in clinical status
secondary to remissions or exacerbations in the disease process, the patient's
individual drug responsiveness, and the effect of patient exposure to stressful
situations not directly related to the disease entity under treatment. In
this latter situation it may be necessary to increase the dosage of the corticosteroid
for a period of time consistent with the patient's condition. If after long-term
therapy the drug is to be stopped, it is recommended that it be withdrawn
gradually rather than abruptly. In pediatric patients, the initial dose of triamcinolone may vary
depending on the specific disease entity being treated. The range of initial
doses is 0.11 to 1.6 mg/kg/day in 3 or 4 divided doses (3.2 to
48 mg/mbsa/day). For the purpose of comparison, the following is the equivalent
milligram dosage of the various glucocorticoids: These dose relationships apply only to oral or intravenous
administration of these compounds. When these substances or their derivatives
are injected intramuscularly or into joint spaces, their relative properties
may be greatly altered.<br/>Intra-Articular Administration:<br/>Dosage: The initial dose of Kenalog-10 Injection (triamcinolone acetonide
injectable suspension, USP) for intra-articular administration may vary from
2.5 mg to 5 mg for smaller joints and from 5 to 15 mg for larger joints, depending
on the specific disease entity being treated. Single injections into several
joints, up to a total of 20 mg or more, have been given.<br/>Intralesional: For intralesional administration, the initial dose per injection
site will vary depending on the specific disease entity and lesion being treated.
The site of injection and volume of injection should be carefully considered
due to the potential for cutaneous atrophy. Multiple sites separated by one centimeter or more may be injected,
keeping in mind that the greater the total volume employed
the more corticosteroid becomes available for systemic absorption and systemic
effects. Such injections may be repeated, if necessary, at weekly or less
frequent intervals.<br/>Localization of Doses: The lower dosages in the initial dosage range of triamcinolone
acetonide may produce the desired effect when the corticosteroid is administered
to provide a localized concentration. The site and volume of the injection
should be carefully considered when triamcinolone acetonide is administered
for this purpose.<br/>Administration: STRICT ASEPTIC TECHNIQUE IS MANDATORY. The vial should
be shaken before use to ensure a uniform suspension. Prior to withdrawal,
the suspension should be inspected for clumping or granular appearance
(agglomeration). An agglomerated product results from exposure to freezing
temperatures and should not be used. After withdrawal, inject without delay
to prevent settling in the syringe.<br/>Injection Technique: For treatment of joints, the usual intra-articular injection technique
should be followed. If an excessive amount of synovial fluid is present in
the joint, some, but not all, should be aspirated to aid in the relief of
pain and to prevent undue dilution of the steroid. With intra-articular administration, prior use of a local anesthetic
may often be desirable. Care should be taken with this kind of injection,
particularly in the deltoid region, to avoid injecting the suspension into
the tissues surrounding the site, since this may lead to tissue atrophy. In treating acute nonspecific tenosynovitis, care should be taken
to ensure that the injection of Kenalog-10 Injection (triamcinolone acetonide
injectable suspension, USP) is made into the tendon sheath rather than the
tendon substance. Epicondylitis may be treated by infiltrating the preparation
into the area of greatest tenderness.<br/>Intralesional: For treatment of dermal lesions, Kenalog-10 Injection (triamcinolone
acetonide injectable suspension, USP) should be injected directly into the
lesion, ie, intradermally or subcutaneously. For accuracy of
dosage measurement and ease of administration, it is preferable to employ
a tuberculin syringe and a small-bore needle (23 to 25 gauge). Ethyl chloride
spray maybe used to alleviate the discomfort of the injection.
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| dailymed-instance:descripti... |
Kenalog-10 Injection (triamcinolone
acetonide injectable suspension, USP) is triamcinolone acetonide, a synthetic
glucocorticoid corticosteroid with marked anti-inflammatory action, in a sterile
aqueous suspension suitable for intralesional and intra-articular injection.
THIS FORMULATION IS SUITABLE FOR INTRA-ARTICULAR AND INTRALESIONAL USE ONLY. Each mL of the sterile aqueous suspension provides 10 mg triamcinolone
acetonide, with sodium chloride for isotonicity, 0.9% (w/v) benzyl alcohol
as a preservative, 0.75% carboxymethylcellulose sodium, and 0.04% polysorbate
80; sodium hydroxide or hydrochloric acid may have been added to adjust pH
between 5.0 and 7.5. At the time of manufacture, the air in the container
is replaced by nitrogen. The chemical name for triamcinolone acetonide is 9-Fluoro-11��,16��,17,21-tetrahydroxypregna-1,4-diene-3,20-dione
cyclic 16,17-acetal with acetone. Its structural formula is:
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Glucocorticoids, naturally occurring and synthetic, are adrenocortical
steroids that are readily absorbed from the gastrointestinal tract. Naturally occurring glucocorticoids (hydrocortisone and cortisone),
which also have salt-retaining properties, are used as replacement therapy
in adrenocortical deficiency states. Synthetic analogs such as triamcinolone
are primarily used for their anti-inflammatory effects in disorders of many
organ systems.
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Kenalog-10 Injection (triamcinolone acetonide injectable suspension,
USP) is contraindicated in patients who are hypersensitive to any components
of this product. Intramuscular corticosteroid preparations are contraindicated for
idiopathic thrombocytopenic purpura.
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Kenalog-10 Injection (triamcinolone
acetonide injectable suspension, USP) is supplied in 5 mL
multiple dose vials (NDC 0003-0494-20) providing 10 mg triamcinolone acetonide
per mL.<br/>Storage: Store at controlled room temperature, 20�����25��C
(68�����77��F), avoid freezing and protect from light.
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General: This product, like many other steroid formulations, is sensitive
to heat. Therefore, it should not be autoclaved when it is desirable to sterilize
the exterior of the vial. The lowest possible dose of corticosteroid should be used to control
the condition under treatment. When reduction in dosage is possible, the reduction
should be gradual. Since complications of treatment with glucocorticoids are dependent
on the size of the dose and the duration of treatment, a risk/benefit decision
must be made in each individual case as to dose and duration of treatment
and as to whether daily or intermittent therapy should be used. Kaposi's sarcoma has been reported to occur in patients
receiving corticosteroid therapy, most often for chronic conditions. Discontinuation
of corticosteroids may result in clinical improvement.<br/>Cardio-Renal: As sodium retention with resultant edema and potassium loss may
occur in patients receiving corticosteroids, these agents should be used with
caution in patients with congestive heart failure, hypertension, or renal
insufficiency.<br/>Endocrine: Drug-induced secondary adrenocortical insufficiency may be minimized
by gradual reduction of dosage. This type of relative insufficiency may persist
for months after discontinuation of therapy; therefore, in any situation of
stress occurring during that period, hormone therapy should be reinstituted.
Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid
should be administered concurrently.<br/>Gastrointestinal: Steroids should be used with caution in active or latent peptic
ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative
colitis, since they may increase the risk of a perforation. Signs of peritoneal irritation following gastrointestinal perforation
in patients receiving corticosteroids may be minimal or absent. There is an enhanced effect of corticosteroids in patients with
cirrhosis.<br/>Intra-Articular and Soft Tissue Administration: Intra-articularly injected corticosteroids may be systemically
absorbed. Appropriate examination of any joint fluid present is necessary
to exclude a septic process. A marked increase in pain accompanied by local swelling, further
restriction of joint motion, fever, and malaise are suggestive of septic arthritis.
If this complication occurs and the diagnosis of sepsis is confirmed, appropriate
antimicrobial therapy should be instituted. Injection of a steroid into an infected site is to be avoided.
Local injection of a steroid into a previously infected joint is not usually
recommended. Corticosteroid injection into unstable joints is generally not
recommended. Intra-articular injection may result in damage to joint tissues
.<br/>Musculoskeletal: Corticosteroids decrease bone formation and increase bone resorption
both through their effect on calcium regulation (ie, decreasing absorption
and increasing excretion) and inhibition of osteoblast function. This, together
with a decrease in the protein matrix of the bone secondary to an increase
in protein catabolism, and reduced sex hormone production, may lead to inhibition
of bone growth in pediatric patients and the development of osteoporosis at
any age. Special consideration should be given to patients at increased risk
of osteoporosis (ie, postmenopausal women) before initiating corticosteroid
therapy.<br/>Neuro-Psychiatric: Although controlled clinical trials have shown corticosteroids
to be effective in speeding the resolution of acute exacerbations of multiple
sclerosis, they do not show that they affect the ultimate outcome or natural
history of the disease. The studies do show that relatively high doses of
corticosteroids are necessary to demonstrate a significant effect. An acute myopathy has been observed with the use of high doses
of corticosteroids, most often occurring in patients with disorders of neuromuscular
transmission (eg, myasthenia gravis), or in patients receiving concomitant
therapy with neuromuscular blocking drugs (eg, pancuronium). This acute myopathy
is generalized, may involve ocular and respiratory muscles, and may result
in quadriparesis. Elevation of creatinine kinase may occur. Clinical improvement
or recovery after stopping corticosteroids may require weeks to years. Psychic derangements may appear when corticosteroids are used,
ranging from euphoria, insomnia, mood swings, personality changes, and severe
depression to frank psychotic manifestations. Also, existing emotional instability
or psychotic tendencies may be aggravated by corticosteroids.<br/>Ophthalmic: Intraocular pressure may become elevated in some individuals. If
steroid therapy is continued for more than 6 weeks, intraocular pressure should
be monitored.<br/>Information for Patients: Patients should be warned not to discontinue the use of corticosteroids
abruptly or without medical supervision, to advise any medical attendants
that they are taking corticosteroids and to seek medical advice at once should
they develop fever or other signs of infection. Persons who are on corticosteroids should be warned to avoid exposure
to chicken pox or measles. Patients should also be advised that if they are
exposed, medical advice should be sought without delay.<br/>Drug Interactions: Aminoglutethimide: Aminoglutethimide may lead
to a loss of corticosteroid-induced adrenal suppression. Amphotericin B injection and potassium-depleting agents: When
corticosteroids are administered concomitantly with potassium-depleting agents
(ie, amphotericin B, diuretics), patients should be observed closely for development
of hypokalemia. There have been cases reported in which concomitant use of
amphotericin B and hydrocortisone was followed by cardiac enlargement and
congestive heart failure. Antibiotics: Macrolide antibiotics have been reported
to cause a significant decrease in corticosteroid clearance. Anticholinesterases: Concomitant use of anticholinesterase
agents and corticosteroids may produce severe weakness in patients with myasthenia
gravis. If possible, anticholinesterase agents should be withdrawn at least
24 hours before initiating corticosteroid therapy. Anticoagulants, oral: Coadministration of corticosteroids
and warfarin usually results in inhibition of response to warfarin, although
there have been some conflicting reports. Therefore, coagulation indices should
be monitored frequently to maintain the desired anticoagulant effect. Antidiabetics: Because corticosteroids may increase
blood glucose concentrations, dosage adjustments of antidiabetic agents may
be required. Antitubercular drugs: Serum concentrations of
isoniazid may be decreased. Cholestyramine: Cholestyramine may increase the
clearance of corticosteroids. Cyclosporine: Increased activity of both cyclosporine
and corticosteroids may occur when the two are used concurrently. Convulsions
have been reported with this concurrent use. Digitalis glycosides: Patients on digitalis glycosides
may be at increased risk of arrhythmias due to hypokalemia. Estrogens, including oral contraceptives: Estrogens
may decrease the hepatic metabolism of certain corticosteroids, thereby increasing
their effect. Hepatic enzyme inducers (eg, barbiturates, phenytoin, carbamazepine,
rifampin): Drugs which induce hepatic microsomal drug metabolizing
enzyme activity may enhance the metabolism of corticosteroids and require
that the dosage of the corticosteroid be increased. Ketoconazole: Ketoconazole has been reported to
decrease the metabolism of certain corticosteroids by up to 60%, leading to
an increased risk of corticosteroid side effects. Nonsteroidal anti-inflammatory agents (NSAIDS): Concomitant
use of aspirin (or other nonsteroidal anti-inflammatory agents) and corticosteroids
increases the risk of gastrointestinal side effects. Aspirin should be used
cautiously in conjunction with corticosteroids in hypoprothrombinemia. The
clearance of salicylates may be increased with concurrent use of corticosteroids. Skin tests: Corticosteroids may suppress reactions
to skin tests. Vaccines: Patients on prolonged corticosteroid
therapy may exhibit a diminished response to toxoids and live or inactivated
vaccines due to inhibition of antibody response. Corticosteroids may also
potentiate the replication of some organisms contained in live attenuated
vaccines. Routine administration of vaccines or toxoids should be deferred
until corticosteroid therapy is discontinued if possible .<br/>Carcinogenesis, Mutagenesis, Impairment of Fertility: No adequate studies have been conducted in animals to determine
whether corticosteroids have a potential for carcinogenesis or mutagenesis. Steroids may increase or decrease motility and number of spermatozoa
in some patients.<br/>Pregnancy:<br/>Teratogenic Effects: Pregnancy Category C: Corticosteroids have been shown to be teratogenic in many species
when given in doses equivalent to the human dose. Animal studies in which
corticosteroids have been given to pregnant mice, rats, and rabbits have yielded
an increased incidence of cleft palate in the offspring. There are no adequate
and well-controlled studies in pregnant women. Corticosteroids should be used
during pregnancy only if the potential benefit justifies the potential risk
to the fetus. Infants born to mothers who have received corticosteroids during
pregnancy should be carefully observed for signs of hypoadrenalism.<br/>Nursing Mothers: Systemically administered corticosteroids appear in human milk
and could suppress growth, interfere with endogenous corticosteroid production,
or cause other untoward effects. Caution should be exercised when corticosteroids
are administered to a nursing woman.<br/>Pediatric Use: This product contains benzyl alcohol as a preservative. Benzyl
alcohol, a component of this product, has been associated with serious adverse
events and death, particularly in pediatric patients. The���gasping syndrome���(characterized by central nervous system depression, metabolic acidosis, gasping
respirations, and high levels of benzyl alcohol and its metabolites found
in the blood and urine) has been associated with benzyl alcohol dosages>99
mg/kg/day in neonates and low-birth-weight neonates. Additional symptoms may
include gradual neurological deterioration, seizures, intracranial hemorrhage,
hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension,
bradycardia, and cardiovascular collapse. Although normal therapeutic dosesof this product deliver amounts of benzyl alcohol that are substantially lowerthan those reported in association with the���gasping syndrome,���the minimum
amount of benzyl alcohol at which toxicity may occur is not known. Premature
and low-birth-weight infants, as well as patients receiving high dosages,
may be more likely to develop toxicity. Practitioners administering this and
other medications containing benzyl alcohol should consider the combined daily
metabolic load of benzyl alcohol from all sources. The efficacy and safety of corticosteroids in the pediatric population
are based on the well-established course of effect of corticosteroids which
is similar in pediatric and adult populations. Published studies provide evidence
of efficacy and safety in pediatric patients for the treatment of nephrotic
syndrome (>2 years of age), and aggressive lymphomas and leukemias (>1 month
of age). Other indications for pediatric use of corticosteroids, eg, severe
asthma and wheezing, are based on adequate and well-controlled trials conducted
in adults, on the premises that the course of the diseases and their pathophysiology
are considered to be substantially similar in both populations. The adverse effects of corticosteroids in pediatric patients are
similar to those in adults .
Like adults, pediatric patients should be carefully observed with frequent
measurements of blood pressure, weight, height, intraocular pressure, and
clinical evaluation for the presence of infection, psychosocial disturbances,
thromboembolism, peptic ulcers,cataracts, and osteoporosis. Pediatric patients
who are treated with corticosteroids by any route, including systemically
administered corticosteroids, may experience a decrease in their growth velocity.
This negative impact of corticosteroids on growth has been observed at low
systemic doses and in the absence of laboratory evidence of HPA axis suppression
(ie, cosyntropin stimulation and basal cortisol plasma levels). Growth velocity
may therefore be a more sensitive indicator of systemic corticosteroid exposure
in pediatric patients than some commonly used tests of HPA axis function.
The linear growth of pediatric patients treated with corticosteroids should
be monitored, and the potential growth effects of prolonged treatment should
be weighed against clinical benefits obtained and the availability of treatment
alternatives. In order to minimize the potential growth effects of corticosteroids,
pediatric patients should be titrated to the lowest effective
dose.<br/>Geriatric Use: No overall differences in safety or effectiveness were observed
between elderly subjects and younger subjects, and other reported clinical
experience has not identified differences in responses between the elderly
and younger patients, but greater sensitivity of some older individuals cannot
be ruled out.
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Treatment of acute overdosage is by supportive and symptomatic
therapy. For chronic overdosage in the face of severe disease requiring continuous
steroid therapy, the dosage of the corticosteroid may be reduced only temporarily,
or alternate day treatment may be introduced.
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TRIAMCINOLONE ACETONIDE
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KENALOG-10 (Injection, Suspension)
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(listed alphabetically under each subsection) The following adverse reactions may be associated with corticosteroid
therapy: Allergic reactions: Anaphylactoid reaction, anaphylaxis,
angioedema. Cardiovascular: Bradycardia, cardiac arrest, cardiac
arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure,
fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants,
myocardial rupture following recent myocardial infarction , pulmonary edema, syncope, tachycardia,
thromboembolism, thrombophlebitis, vasculitis. Dermatologic: Acne, allergic dermatitis, cutaneous
and subcutaneous atrophy, dry scaly skin, ecchymoses and petechiae, edema,
erythema, hyperpigmentation, hypopigmentation, impaired wound healing, increased
sweating, lupus erythematosus-like lesions, purpura, rash, sterile abscess,
striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp
hair, urticaria. Endocrine: Decreased carbohydrate and glucose
tolerance, development of cushingoid state, glycosuria, hirsutism, hypertrichosis,
increased requirements for insulin or oral hypoglycemic agents
in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities,
secondary adrenocortical and pituitary unresponsiveness (particularly in times
of stress, as in trauma, surgery, or illness), suppression of growth in pediatric
patients. Fluid and electrolyte disturbances: Congestive
heart failure in susceptible patients, fluid retention, hypokalemic alkalosis,
potassium loss, sodium retention. Gastrointestinal: Abdominal distention, bowel/bladder
dysfunction (after intrathecal administration), elevation in serum liver enzyme
levels (usually reversible upon discontinuation), hepatomegaly, increased
appetite, nausea, pancreatitis, peptic ulcer with possible perforation and
hemorrhage, perforation of the small and large intestine (particularly in
patients with inflammatory bowel disease), ulcerative esophagitis. Metabolic: Negative nitrogen balance due to protein
catabolism. Musculoskeletal: Aseptic necrosis of femoral
and humeral heads, calcinosis (following intra-articular or intralesional
use), Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis,
pathologic fracture of long bones, post injection flare (following intra-articular
use), steroid myopathy, tendon rupture, vertebral compression fractures. Neurologic/Psychiatric: Convulsions, depression,
emotional instability, euphoria, headache, increased intracranial pressure
with papilledema (pseudotumor cerebri) usually following discontinuation of
treatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality
changes, psychic disorders, vertigo. Arachnoiditis, meningitis, paraparesis/paraplegia,
and sensory disturbances have occurred after intrathecal administration . Ophthalmic: Exophthalmos, glaucoma, increased
intraocular pressure, posterior subcapsular cataracts, rare instances of blindness
associated with periocular injections. Other: Abnormal fat deposits, decreased resistance
to infection, hiccups, increased or decreased motility and number of spermatozoa,
malaise, moon face, weight gain.
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| dailymed-instance:warning |
General: Exposure to excessive amounts of benzyl alcohol has been associated
with toxicity (hypotension, metabolic acidosis), particularly in neonates,
and an increased incidence of kernicterus, particularly in small preterm infants.
There have been rare reports of deaths, primarily in preterm infants, associated
with exposure to excessive amounts of benzyl alcohol. The amount of benzyl
alcohol from medications is usually considered negligible compared to that
received in flush solutions containing benzyl alcohol. Administration of high
dosages of medications containing this preservative must take into account
the total amount of benzyl alcohol administered. The amount of benzyl alcohol
at which toxicity may occur is not known. If the patient requires more than
the recommended dosages or other medications containing this preservative,
the practitioner must consider the daily metabolic load of benzyl alcohol
from these combined sources (see PRECAUTIONS: Pediatric
Use). Because Kenalog-10 Injection (triamcinolone acetonide injectable
suspension, USP) is a suspension, it should not be administered
intravenously. Strict aseptic technique is mandatory. Rare instances of anaphylactoid reactions have occurred in patients
receiving corticosteroid therapy . Increased dosage of rapidly acting corticosteroids is indicated
in patients on corticosteroid therapy subjected to any unusual stress before,
during, and after the stressful situation. Kenalog-10 Injection (triamcinolone acetonide injectable suspension,
USP) is a long-acting preparation, and is not suitable for
use in acute stress situations.<br/>Cardio-Renal: Average and large doses of corticosteroids can cause elevation
of blood pressure, salt and water retention, and increased excretion of potassium.
These effects are less likely to occur with the synthetic derivatives except
when they are used in large doses. Dietary salt restriction and potassium
supplementation may be necessary. All corticosteroids increase calcium excretion. Literature reports suggest an apparent association between use
of corticosteroids and left ventricular free wall rupture after a recent myocardial
infarction; therefore, therapy with corticosteroids should be used with great
caution in these patients.<br/>Endocrine: Corticosteroids can produce reversible hypothalamic-pituitary adrenal
(HPA) axis suppression with the potential for glucocorticosteroid insufficiency
after withdrawal of treatment. Metabolic clearance of corticosteroids is decreased in hypothyroid
patients and increased in hyperthyroid patients. Changes in thyroid status
of the patient may necessitate adjustment in dosage.<br/>Infections:<br/>General: Patients who are on corticosteroids are more susceptible to infections
than are healthy individuals. There may be decreased resistance and inability
to localize infection when corticosteroids are used. Infection with any pathogen
(viral, bacterial, fungal, protozoan or helminthic) in any location of the
body may be associated with the use of corticosteroids alone or in combination
with other immunosuppressive agents. These infections may be mild to severe.
With increasing doses of corticosteroids, the rate of occurrence of infectious
complications increases. Corticosteroids may also mask some signs of current
infection.<br/>Fungal Infections: Corticosteroids may exacerbate systemic fungal infections and therefore
should not be used in the presence of such infections unless they are needed
to control drug reactions. There have been cases reported in which concomitant
use of amphotericin B and hydrocortisone was followed by cardiac enlargement
and congestive heart failure (see PRECAUTIONS: Drug
Interactions: Amphotericin B injection and potassium-depleting
agents).<br/>Special Pathogens: Latent disease may be activated or there may be an exacerbation
of intercurrent infections due to pathogens, including those caused by Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, Toxoplasma. It is recommended that latent amebiasis or active amebiasis be
ruled out before initiating corticosteroid therapy in any patient who has
spent time in the tropics or in any patient with unexplained diarrhea. Similarly, corticosteroids should be used with great care in patients
with known or suspected Strongyloides (threadworm) infestation.
In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection
and dissemination with widespread larval migration, often accompanied by severe
enterocolitis and potentially fatal gram-negative septicemia. Corticosteroids should not be used in cerebral malaria.<br/>Tuberculosis: If corticosteroids are indicated in patients with latent tuberculosis
or tuberculin reactivity, close observation is necessary as reactivation of
the disease may occur. During prolonged corticosteroid therapy, these patients
should receive chemoprophylaxis.<br/>Vaccination: Administration of live or live, attenuated vaccines is contraindicated
in patients receiving immunosuppressive doses of corticosteroids. 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, eg, for
Addison's disease.<br/>Viral Infections: Chicken pox and measles can have a more serious or even fatal course
in pediatric and adult patients on corticosteroids. In pediatric and adult
patients who have not had these diseases, particular care should be taken
to avoid exposure. The contribution of the underlying disease and/or prior
corticosteroid treatment to the risk is also not known. If exposed to chicken
pox, prophylaxis with varicella zoster immune globulin (VZIG)may be indicated.
If exposed to measles, prophylaxis with immunoglobulin (IG) may be indicated.
(See the respective package inserts for complete VZIG and IG prescribing information.)
If chicken pox develops, treatment with antiviral agents should be considered.<br/>Neurologic: Reports of severe medical events have been associated with the
intrathecal route of administration .<br/>Ophthalmic: Use of corticosteroids may produce posterior subcapsular cataracts,
glaucoma with possible damage to the optic nerves, and may enhance the establishment
of secondary ocular infections due to bacteria, fungi, or viruses. The use
of oral corticosteroids is not recommended in the treatment of optic neuritis
and may lead to an increase in the risk of new episodes. Corticosteroids should
not be used in active ocular herpes simplex. Adequate studies to demonstrate the safety of Kenalog Injection
use by intraturbinal, subconjunctival, sub-Tenons, retrobulbar and intraocular
(intravitreal) injections have not been performed. Several instances of blindness
have been reported following injection of corticosteroid suspensions into
the nasal turbinates and intralesional injection about the head. Endophthalmitis,
eye inflammation, increased intraocular pressure and visual disturbances including
vision loss have been reported with intravitreal administration. Administration
of Kenalog Injection (triamcinolone acetonide injectable suspension, USP)
intraocularly or into the nasal turbinates is not recommended. Intraocular injection of corticosteroid formulations containing
benzyl alcohol, such as Kenalog Injection, is not recommended because of potential
toxicity from the benzyl alcohol.
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| dailymed-instance:indicatio... |
The intra-articular or soft tissue administration of
Kenalog-10 Injection (triamcinolone acetonide injectable suspension, USP)
is indicated as adjunctive therapy for short-term administration (to tide
the patient over an acute episode or exacerbation) in acute gouty arthritis,
acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis,
rheumatoid arthritis, synovitis or osteoarthritis. The intralesional administration of Kenalog-10 Injection
(triamcinolone acetonide injectable suspension, USP) is indicated for alopecia
areata; discoid lupus erythematosus; keloids; localized hypertrophic, infiltrated,
inflammatory lesions of granuloma annulare, lichen planus, lichen simplex
chronicus (neurodermatitis), and psoriatic plaques; necrobiosis lipoidica
diabeticorum. Kenalog-10 Injection may also be useful in cystic tumors of
an aponeurosis or tendon (ganglia).
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KENALOG-10
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