Select a medication above to begin.
Kenalog-40
triamcinolone acetonide
Adult Dosing .
Dosage forms: INJ: 40 mg per mL
corticosteroid-responsive conditions
- [40-80 mg IM x1]
- Start: 60 mg IM x1; Info: dose, frequency varies by condition; use lowest effective dose, shortest effective treatment duration; taper dose gradually to D/C if high-dose or long-term use
allergic conditions
- [40-100 mg IM x1]
- Info: for hay fever or pollen asthma; use lowest effective dose
multiple sclerosis, acute exacerbation
- [160 mg IM qd x1wk, then 64 mg IM qod x1mo]
- Info: use lowest effective dose, shortest effective treatment duration; taper dose gradually to D/C
gout, acute
- [small joints]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
rheumatoid arthritis
- [small joints]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
osteoarthritis
- [small joints]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
joint/joint structure inflammation
- [small joints]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: for acute bursitis, acute nonspecific tenosynovitis, epicondylitis, and synovitis; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: for acute bursitis, acute nonspecific tenosynovitis, epicondylitis, and synovitis; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ: 40 mg per mL
corticosteroid-responsive conditions
- [2 yo and older]
- Dose: 0.11-1.6 mg/kg/day IM divided tid-qid; Info: dose, frequency varies by condition; use lowest effective dose, shortest effective treatment duration; taper dose gradually to D/C if high-dose or long-term use
juvenile idiopathic arthritis
- [small joints, 2 yo and older]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints, 2 yo and older]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
joint/joint structure inflammation
- [small joints, 2 yo and older]
- Dose: 2.5-5 mg intra-articularly x1; Max: 10 mg/site up to 80 mg/total dose; Info: for acute bursitis, acute nonspecific tenosynovitis, epicondylitis, and synovitis; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
- [large joints, 2 yo and older]
- Dose: 5-15 mg intra-articularly x1; Max: 40 mg/site up to 80 mg/total dose; Info: for acute bursitis, acute nonspecific tenosynovitis, epicondylitis, and synovitis; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if long-term use
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- IV use
- intrathecal use
- intraocular use
- intradermal use
- epidural use
- neonates
- premature infants
- thrombocytopenic purpura (IM use)
- systemic fungal infection
- cerebral malaria
- amebiasis, latent
- amebiasis, active
- ocular HSV infection
- injection site infection
- joint infection (intra-articular use)
- joint infection hx (intra-articular use)
- joint, unstable (intra-articular use)
- abrupt withdrawal (high-dose or long-term use)
- caution: hypersensitivity to corticosteroids
- caution: renal impairment
- caution: cirrhosis
- caution: peds pts
- caution: adolescent pts
- caution: immunosuppressed pts
- caution: infection, active
- caution: infection risk
- caution: measles exposure (non-immune pts)
- caution: varicella exposure (non-immune pts)
- caution: HTN
- caution: pheochromocytoma risk
- caution: CHF
- caution: MI, recent
- caution: diabetes mellitus
- caution: PUD
- caution: ulcerative colitis
- caution: diverticulitis
- caution: intestinal anastomosis, recent
- caution: GI perforation risk
- caution: seizure disorder
- caution: psychiatric disorder
- caution: thyroid disorder
- caution: osteoporosis
- caution: osteoporosis risk
- caution: myasthenia gravis
Drug Interactions .
Overview
triamcinolone
corticosteroid
- 11-beta-hydroxysteroid dehydrogenase type 1 substrate
- CYP3A4 substrate
- affects growth hormone diagnostic test results
- GI mucosal injury/bleeding risk
- hyperglycemic effects
- hypernatremia
- hypertensive effects
- hypokalemia
- immunosuppressive effects
- interferes w/ ACTH analog test
- lowers seizure threshold
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- desmopressin
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- mifepristone
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- afamitresgene autoleucel
- aldesleukin
- amifampridine
- amphotericin
- arsenic trioxide
- axicabtagene ciloleucel
- brexucabtagene autoleucel
- budesonide
- ceritinib
- ciltacabtagene autoleucel
- cladribine oral
- cobicistat
- darunavir
- epinephrine inhaled
- furosemide
- hydrocortisone
- idecabtagene vicleucel
- iohexol
- lifileucel
- lisocabtagene maraleucel
- lopinavir/ritonavir
- lutetium Lu 177 dotatate
- macimorelin
- midodrine
- natalizumab
- obecabtagene autoleucel
- pimecrolimus topical
- rabies vaccine
- ritonavir
- tisagenlecleucel
- triamcinolone
- vamorolone
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- acetazolamide
- afatinib
- albuterol
- albuterol inhaled
- alendronate
- aliskiren
- almotriptan
- aloe
- alogliptin
- amiloride
- amlodipine
- amphetamine
- angiotensin II
- anthrax vaccine
- apalutamide
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- asparaginase
- aspirin
- atenolol
- atogepant
- atomoxetine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- bempedoic acid
- benazepril
- benzphetamine
- betamethasone
- betaxolol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bisoprolol
- brentuximab vedotin
- brigatinib
- bromocriptine
- bumetanide
- bupropion
- butalbital
- cabazitaxel
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carbamazepine
- carboplatin
- carfilzomib
- carvedilol
- celecoxib
- cetuximab
- chikungunya vaccine
- chlorothiazide
- chlorthalidone
- cinacalcet
- cisplatin
- clevidipine
- clonidine
- cocaine
- colesevelam
- copanlisib
- corticotropin
- cortisone
- cosyntropin
- COVID-19 vaccine
- crizotinib
- cyclosporine
- cysteamine
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deferasirox
- deflazacort
- desvenlafaxine
- deuruxolitinib
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- digoxin
- dihydroergotamine
- diltiazem
- dimethyl fumarate
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- diroximel fumarate
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- dronabinol
- droxidopa
- dulaglutide
- ebola vaccine, live
- eletriptan
- emapalumab
- empagliflozin
- enalapril
- enalaprilat
- encorafenib
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ergotamine
- erlotinib
- ertugliflozin
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- etelcalcetide
- ethacrynic acid
- ethanol
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- everolimus
- exenatide
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fingolimod
- fludrocortisone
- flurbiprofen
- formoterol inhaled
- foscarnet
- fosinopril
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galantamine
- galcanezumab
- gefitinib
- ginkgo
- glimepiride
- glipizide
- glyburide
- guanfacine
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- hoodia
- human papillomavirus vaccine
- hydralazine
- hydrochlorothiazide
- ibandronate
- ibrutinib
- ibuprofen
- ibuprofen lysine
- imatinib
- indapamide
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- insulin
- iopamidol
- irbesartan
- isoproterenol
- isradipine
- ivosidenib
- Japanese encephalitis vaccine
- ketamine
- ketoprofen
- ketorolac
- labetalol
- lanreotide
- lanthanum
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levomilnacipran
- licorice
- linagliptin
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium citrate
- magnesium salicylate
- mannitol
- meclofenamate
- mefenamic acid
- meloxicam
- meningococcal vaccine
- metformin
- methamphetamine
- methazolamide
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- metoclopramide
- metolazone
- metoprolol
- metyrapone
- miglitol
- milnacipran
- minoxidil
- mirabegron
- mitotane
- modafinil
- moexipril
- monomethyl fumarate
- motixafortide
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nadolol
- naproxen
- naratriptan
- nateglinide
- naxitamab
- nebivolol
- necitumumab
- neostigmine
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nisoldipine
- norepinephrine
- olmesartan medoxomil
- olodaterol inhaled
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- ozanimod
- panitumumab
- pazopanib
- pentobarbital
- perindopril
- pexidartinib
- phendimetrazine
- phenobarbital
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pindolol
- pioglitazone
- piroxicam
- pneumococcal vaccine
- poliovirus vaccine
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- ponesimod
- porfimer
- posaconazole
- pralsetinib
- pramlintide
- prazosin
- prednisolone
- prednisone
- primidone
- propranolol
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinapril
- ramipril
- ramucirumab
- regorafenib
- repaglinide
- respiratory syncytial virus vaccine
- rifabutin
- rifampin
- rimegepant
- ripretinib
- risedronate
- rivastigmine
- rizatriptan
- ropinirole
- rosiglitazone
- rotigotine transdermal
- sacituzumab govitecan
- salmeterol inhaled
- salsalate
- saxagliptin
- selinexor
- selpercatinib
- semaglutide
- siponimod
- sipuleucel-T
- sirolimus albumin-bound
- sitagliptin
- smallpox/mpox vaccine, live
- sodium acid phosphate
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- solriamfetol
- somapacitan
- somatrogon
- somatropin
- sorafenib
- spironolactone
- St. John's wort
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- telmisartan
- temsirolimus
- terazosin
- terbutaline
- teriflunomide
- tesamorelin
- testosterone
- tick-borne encephalitis vaccine
- timolol
- tirzepatide
- tivozanib
- tocilizumab
- tolmetin
- topiramate
- torsemide
- trametinib
- trandolapril
- trastuzumab
- triamterene
- typhoid vaccine
- ubrogepant
- upadacitinib
- vadadustat
- valsartan
- vandetanib
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- warfarin
- willow bark
- yohimbe
- zavegepant
- ziv-aflibercept
- zolmitriptan
- zonisamide
Caution Advised
- abatacept
- abemaciclib
- abrocitinib
- acalabrutinib
- adagrasib
- adalimumab
- alemtuzumab
- anakinra
- anifrolumab
- anti-thymocyte globulin
- atazanavir
- atidarsagene autotemcel
- avacopan
- azacitidine
- azathioprine
- baricitinib
- beclomethasone inhaled
- beclomethasone nasal
- belimumab
- belinostat
- bendamustine
- bimekizumab
- blinatumomab
- bortezomib
- bosentan
- brivaracetam
- brodalumab
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- canakinumab
- cannabidiol
- carmustine
- cenobamate
- certolizumab pegol
- chlorambucil
- chloramphenicol
- ciprofloxacin
- cladribine injection
- clarithromycin
- clobazam
- clobetasol ophthalmic
- clofarabine
- clomipramine
- clonazepam
- clorazepate
- clozapine
- crovalimab
- cyclophosphamide
- cytarabine
- dabrafenib
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- deucravacitinib
- dexamethasone ophthalmic
- diazepam
- difluprednate ophthalmic
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- echinacea
- eculizumab
- efavirenz
- efgartigimod alfa
- eleuthero
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- epcoritamab
- epirubicin
- eribulin
- eslicarbazepine acetate
- etanercept
- ethosuximide
- etoposide
- etravirine
- felbamate
- fexinidazole
- floxuridine
- fludarabine
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- gabapentin
- ganaxolone
- gemcitabine
- gemtuzumab ozogamicin
- ginseng, Asian
- glofitamab
- golimumab
- guselkumab
- hydrocortisone ophthalmic
- hydroxychloroquine
- hydroxyurea
- ibritumomab tiuxetan
- idarubicin
- idelalisib
- ifosfamide
- inebilizumab
- infliximab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- isoniazid
- isotretinoin
- itraconazole
- ixabepilone
- ixekizumab
- ketoconazole
- lacosamide
- lamotrigine
- lebrikizumab
- levetiracetam
- levofloxacin
- levoketoconazole
- lindane topical
- lomustine
- lonafarnib
- loncastuximab tesirine
- lorazepam
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- mavacamten
- melphalan
- mercaptopurine
- methacholine inhaled
- methsuximide
- midazolam
- mirikizumab
- mitapivat
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- mosunetuzumab
- moxifloxacin
- nadofaragene firadenovec intravesical
- nafarelin
- nafcillin
- nefazodone
- nelarabine
- nelfinavir
- nipocalimab
- obinutuzumab
- ocrelizumab
- ofatumumab
- ofloxacin
- oxaliplatin
- oxcarbazepine
- paclitaxel
- pacritinib
- panobinostat
- pegcetacoplan
- pentostatin
- perampanel
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- pozelimab
- prednisolone ophthalmic
- pregabalin
- procarbazine
- promethazine
- quizartinib
- ravulizumab
- repotrectinib
- ribociclib
- rifapentine
- rilonacept
- risankizumab
- ritlecitinib
- rituximab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- rufinamide
- ruxolitinib
- ruxolitinib topical
- sarilumab
- satralizumab
- secukinumab
- siltuximab
- sirolimus
- sodium picosulfate
- sotorasib
- spesolimab
- stiripentol
- sulfasalazine
- sutimlimab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- teriparatide
- tezepelumab
- thioguanine
- thiotepa
- tiagabine
- tildrakizumab
- tipranavir
- tofacitinib
- topotecan
- tralokinumab
- tramadol
- treosulfan
- tuberculin purified protein derivative
- tucatinib
- ublituximab
- ustekinumab
- valproic acid
- vedolizumab
- venetoclax
- vigabatrin
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- anaphylaxis
- adrenal insufficiency
- steroid psychosis
- steroid myopathy
- Cushing syndrome
- septic arthritis (intra-articular use)
- calcinosis (intra-articular use)
- osteonecrosis
- tendon rupture
- infection
- diabetes mellitus
- pseudotumor cerebri
- ICP incr.
- seizures
- hypokalemic alkalosis
- cardiac arrest
- arrhythmia
- HTN
- CHF
- pancreatitis
- GI perforation
- PUD
- exophthalmos
- arthropathy, Charcot-like
- osteoporosis (long-term use)
- glaucoma (long-term use)
- cataracts (long-term use)
- immunosuppression (long-term use)
- Kaposi sarcoma (long-term use)
- withdrawal sx if abrupt D/C (high-dose or long-term use)
- growth suppression (long-term use in peds pts)
Common Reactions
- joint swelling
- post-injection flare (intra-articular use)
- Cushingoid appearance
- hirsutism
- weight gain
- erythema
- abdominal discomfort
- appetite changes
- emotional lability
- rash
- urticaria
- nausea
- vomiting
- sodium retention
- fluid retention
- hypokalemia
- BP elevated
- edema
- diaphoresis
- muscle atrophy
- impaired wound healing (long-term use)
- skin atrophy (long-term use)
- petechiae
- ecchymosis
- skin pigmentation abnormality
- acne
- headache
- dizziness
- vertigo
- insomnia
- depression
- anxiety
- glucose intolerance
- Cushing syndrome (long-term use)
- menstrual irregularities
- IOP incr.
Safety/Monitoring .
Monitoring Parameters
electrolytes; BP; weight; TB, HBV screening at baseline if prolonged tx; 2h postprandial glucose, height (peds), chest x-ray if prolonged tx; ophthalmic exam if tx >6wk; BMD if prolonged tx or in pts 65 yo and older; consider upper GI x-ray if PUD hx or significant dyspepsia
Benzyl Alcohol Content
avoid use in neonates; serious, potentially fatal gasping syndrome may occur
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 1st trimester or w/ long-term use; possible risk of orofacial cleft based on conflicting human data and animal data; possible risk of low birth wt and premature birth based on limited human data w/ other corticosteroids; possible risk of fetal adrenal suppression based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on limited human data w/ other corticosteroids and drug properties; possible risk of suppressed infant growth and endogenous steroid production based on drug's mechanism of action; possible decr. milk production based on limited human data w/ high-dose depot steroid injection
Pharmacology .
Metabolism: liver; CYP450: 3A4 substrate
Excretion: unknown, probably urine; Half-life: 146.9h
Subclass: Corticosteroids, Localized ; Corticosteroids, Systemic ; Osteoarthritis, Local Agents
Mechanism of Action
exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.