Kenalog suspension for injection. 40mg / ml, 1ml # 5

Systemic use (i / m introduction):

• hay fever;

• chronic obstructive respiratory diseases (for example, bronchial asthma, chronic spastic bronchitis), with severe forms and negative results of local treatment;

• Skin conditions and contact dermatitis characterized by itching, scaling or blistering, for example, contact dermatitis, pemphigoid, psoriasis, dermatitis herpetiformis, atopic, exfoliative and eczematoid dermatitis.

Local application:

Intra-articular introduction:

• after systemic use, for residual inflammatory processes in one or more joints in chronic inflammatory diseases of the joints;

• with exudative arthritis, gout and false gout;

• with active forms of arthrosis;

• with dropsy of the joints;

• with blockade of the shoulder joint as a result of wrinkling of the articular bag;

• additionally with intra-articular injections of radionuclides or chemicals and with chronic inflammation of the inner layer of the joint capsule.

Introduction to the affected area

• with inflammation of the mucous membrane, with inflammation of the periosteum, as well as with exostoses (cystic formations near the joints);

• with certain skin diseases, for example, with isolated psoriatic plaques, chronic lichen simplex (limited neurodermatitis), granuloma annular, lichen planus, alopecia areata, discoid lupus erythematosus, and also with keloids.

Kenalog 10 mg / ml is recommended for administration to the affected area for inflammation of the tendons and tendon sheath, as well as for epicondylitis of the shoulder ('tennis elbow').

Shake the contents of the ampoule before use. Kenalog 40 mg / ml is a suspension, so it should not be administered IV. Caution should also be exercised with regard to unintentional intravascular injections, especially in the area of ??the left side of the face, scalp, and also in the buttock.

Systemic application (i / m)

The dose is determined individually; it depends on the nature of the disease and should be consistent with the goals of the therapy being undertaken.

For systemic treatment of adults and adolescents over 16 years of age (see contraindications), 1 ml of the drug (= 40 mg) is administered by slow deep intragranular injection. Do not enter i / v and s / c. In severe diseases, doses of the drug up to 80 mg may be required. With deep intraginal injection, the possible development of tissue atrophy should be avoided. After the injection, you should firmly press the sterile napkin to the injection site for 1-2 minutes.

For the treatment of hay fever and other seasonal allergic diseases, one injection of Kenalog 40 mg / ml per year during the pollen season is usually sufficient.

If several injections are required, an interval between injections of at least 4 weeks should be observed.

Local application

With intra-articular administration, the dose is determined by the size of the joint and the severity of the symptoms.

Usually, for adults and children over 12 years of age (see contraindications), the following doses of the drug are used:

Small joints (for example, phalanges of fingers and toes) - up to 10 mg.

Medium-sized joints (eg, shoulder, elbow) 20 mg

Large joints (for example, hip, knee) - 20-40 mg.

In case of damage to several joints, the total dose of the drug can be up to 80 mg. If it is necessary to use smaller doses, Kenalog 10 mg / ml should be used. To provide faster relief of symptoms, Kenalog 40 mg / ml can be administered in combination with a local anesthetic (not containing a vasoconstrictor). Injections should be carried out in such a way as to avoid creating a depot of the drug in the subcutaneous adipose tissue. When injecting, the conditions of the strictest asepsis should be observed. Before the intra-articular injection, the skin area is prepared as before surgery. The drug should be reapplied no earlier than 2 weeks later.

When administered intralesionally for small lesions: inflammation of the mucous membrane (bursitis), inflammation of the periosteum and exostoses in adults and children over the age of 12 years (see contraindications), depending on the size and location of the lesions being treated, up to 10 mg of the drug is administered and in case of large lesions size - from 10 to 40 mg of the drug. If it is necessary to use smaller doses, it is recommended to use Kenalog 10 mg / ml.

Kenalog 40 mg / ml is diluted with physiological sodium chloride solution and injected fan-shaped into the area characterized by the greatest pain. Avoid creating large drug depots. Kenalog 40 mg / ml can also be mixed with a local anesthetic. In the treatment of exostoses, Kenalog 40 mg / ml is injected using a thick cannula after suction directly into the cyst space.

The drug should be reapplied no earlier than 2 weeks later.

When injected into the area of ??subcutaneous lesions, 1 ml of the drug at a concentration of 40 mg / ml is diluted with a local anesthetic that does not contain a vasoconstrictor, and mixed in a syringe. The injection is carried out horizontally into the area between the skin and the subcutaneous layer to provide anesthesia for the infiltrate. As an indicative dose, 1 mg of the drug per 1 cm2 of the surface of the skin lesion is recommended. When treating several lesions in one dose, the daily dose of the drug for adults should not exceed 30 mg, and for children (see contraindications) -10 mg. If it is necessary to use smaller doses of the drug, it is recommended to use Kenalog 10 mg / ml. With keloids, Kenalog 40 mg / ml can be injected directly into the scar tissue without dilution; do not enter p / c. The drug should be reapplied no earlier than 2 weeks later.

The duration of the drug depends on the nature and severity of the disease and is determined by the doctor. It ranges from a single intramuscular injection for hay fever to a course lasting for several years, for example, in severe forms of bronchial asthma. If after 3-5 locally administered injections (intraarticular, intralesional injections, injections into the area of ??subcutaneous lesions), a satisfactory response is not observed, the drug should be discontinued and another form of treatment should be prescribed.

Suspension for injection

active substance:

triamcinolone acetonide

For topical use:

• chickenpox;

• conditions after immunization;

• skin lesions of a tuberculous or syphilitic nature;

• fungal diseases;

• bacterial skin lesions;

• inflammation of the skin around the mouth (rosacea).

Do not administer Kenalog 40 mg / ml intra-articularly if there is an infection nearby.

In case of systemic or repeated local use of the drug, the following contraindications with respect to the systemic use of glucocorticoids should be taken into account:

Absolute contraindications:

• ulcers of the stomach and duodenum;

• severe bone atrophy;

• history of mental illness;

• viral diseases, such as herpes pemphigus (herpes simplex), shingles (herpes zoster, viremic phase), chickenpox;

• infections caused by amoeba;

• fungal infections of internal organs;

• poliomyelitis of childhood, with the exception of the bulbar-encephalitis form;

• depending on the specific situation, from 8 weeks before vaccinations to 2 weeks after vaccinations;

• glaucoma.

Use for severe infections only in combination with causal therapy.

Kenalog 40 mg / ml should not be used intramuscularly in children under 12 years of age and in adolescents under 16 years of age.

Relative contraindications

Be careful with gastric and duodenal ulcers in the history of the disease, with severe muscle diseases, diverticulitis, fresh intestinal anastomoses, with a tendency to thrombosis and embolism, with carcinomas with a tendency to metastases, with diabetes mellitus (see side effects), with acute glomerulonephritis, with chronic nephritis, with swelling of the lymph nodes in the period after BCG immunization.

During treatment with corticosteroids, activation of the tuberculous process may occur.

In children (see above), Kenalog 40 mg / ml should be used only when absolutely necessary.

pharmachologic effect

GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of ??inflammation. Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ??inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

Inhibits the activity of phospholipase A2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; inhibits the formation of antibodies.

Suppresses the release of ACTH and ?-lipotropin by the pituitary gland, but does not reduce the level of circulating ?-endorphin. Inhibits the secretion of TSH and FSH.

Pharmacokinetics

With systemic use, it is metabolized mainly in the liver and partially in the kidneys. The main metabolic pathway is 6 -? - hydroxylation. It is excreted by the kidneys.

Side effect

In rare cases, regardless of the nature and frequency of use of the drug, hypersensitivity reactions are observed, for example, redness (hot flashes), the formation of skin blisters, impaired cardiac activity and blood circulation, due to incl. and the presence of benzyl alcohol in the preparation.

With repeated injections into the subcutaneous adipose tissue, tissue atrophy may occur in the vicinity of the previous injection site, which is usually reversible.

After intra-articular injections, there may be aseptic necrosis of bone tissue (head of the femur and humerus), as well as a feeling of heat; in some cases, a transient painful irritation may appear at the injection site.

With repeated topical application, lining of the skin, thinning of the skin, dilation of small skin vessels, steroid acne, skin blisters, increased hair growth, inflammation of hair follicles, changes in pigmentation and inflammation of the skin around the mouth can be observed.

With systemic or repeated topical application, side affects characteristic of systemic treatment with glucocorticoids can be observed: full moon face syndrome, Cushing's syndrome, muscle weakness, muscle tissue atrophy, bone atrophy, decreased glucose tolerance, diabetes mellitus (deterioration of compensation with existing diabetes mellitus or activation of latent diabetes mellitus), impaired secretion of sex hormones (menstrual irregularities, increased hair growth, impotence), changes in the skin, for example, striae rubrae, bleeding on the skin and mucous membranes (petechien, ekchymosen), steroid acne, increased potassium excretion, functional suppression or atrophy of the adrenal glands, inflammatory processes in the vessels (vasculitis, withdrawal syndrome after prolonged therapy),ulcerative inflammation of the gastrointestinal tract, stomach ulcers, suppression of immunity and an increased risk of infections, delayed healing of wounds and bone fractures, tendon ruptures, growth disorders in children, aseptic necrosis of bone tissue (femoral head or humerus), headaches, increased sweating, dizziness , an increase in intracranial pressure, accompanied by a symptom of congestive papilla of the optic nerve, glaucoma, cataracts, mental disorders, increased risk of thrombosis, pancreatitis.accompanied by a symptom of congestive papilla of the optic nerve, glaucoma, cataracts, mental disorders, increased risk of thrombosis, pancreatitis.accompanied by a symptom of congestive papilla of the optic nerve, glaucoma, cataracts, mental disorders, increased risk of thrombosis, pancreatitis.

Side effects of corticoids, such as weight gain, water retention in the body and high blood pressure, are usually not observed after using Kenalog. However, medical supervision is recommended when taking the drug.

Application during pregnancy and lactation

You should not use the drug Kenalog during the first 5 months of pregnancy, since animal studies indicate a teratogenic effect (the appearance of fetal abnormalities), and there are no data on the safety of using the drug during pregnancy. With prolonged use of the drug, a violation of the growth of the fetus inside the uterus cannot be excluded. When using the drug at the end of pregnancy, there is a risk of atrophy of the fetal adrenal glands.

Glucocorticoids pass into breast milk, therefore, breastfeeding during treatment with the drug should be discontinued.

Application for impaired renal function

Be careful with acute glomerulonephritis, with chronic nephritis.

Application in children

Kenalog 40 mg / ml should not be used intramuscularly in children under 12 years of age and in adolescents under 16 years of age.

special instructions

In case of systemic drug treatment, it is recommended to prescribe a diet enriched with proteins and vitamins.

For intralesional administration in the treatment of tendons, tendon sheath inflammation and 'tennis elbow', it is recommended to use Kenalog 10 mg / ml.

With repeated use of the drug, the intervals between injections should be observed and, if necessary, the intervals between injections should be increased.

Drug interactions

With systemic or repeated local application, it is necessary to take into account the interactions characteristic of systemic therapy with glucocorticoids, which can weaken the hypoglycemic effect of antidiabetic drugs and the anticoagulant effect of coumarin derivatives.

With the simultaneous use of the drug with cardiac glycosides, an intensification of their action may be observed; when combined with saluretics, the excretion of potassium from the body may increase.

Concomitant use with NSAIDs or antirheumatic drugs may contribute to the development of gastrointestinal bleeding.

When taken simultaneously with rifampicin, the corticoid effect of the drug may be weakened.