Kenalog-40
(Triamcinolone Acetonide)

What Kenalog-40 is and what it is used for

The name of this medicine is Kenalog IA/IM Injection. Each injection contains triamcinolone acetonide 40 mg/ml as the active ingredient. Triamcinolone acetonide belongs to a group of medicine called corticosteroids (steroids). Kenalog IA/IM Injection is for the treatment of joint pain, swelling and stiffness in inflammatory disorders such as rheumatoid arthritis. It is also for the treatment of various allergic disorders including asthma, seasonal allergies, blood disorders, hormone problems, rheumatic fever, and problems associated with digestive system, kidneys, lungs or skin.

How to take Kenalog-40

The effect of the injection will vary from patient to patient and further injections may be given to you when symptoms return and not at regular intervals. The usual doses are; Use in inflammatory joint disorders: The dose of injection into a joint or tendon sheath depends upon the size of the joint to be treated and the severity of the condition which is being treated. Doses of 5-10 mg (0.125-0.25 ml) for smaller joints and up to 40 mg (1.0 ml) for larger joints usually give relief of symptoms. This medicine should not be used for injection into the Achilles tendon. Use in allergic disorders: The usual starting dose is 40 mg (1.0 ml) injected deeply into the upper outer area of the buttock. If you require a further injection, this should be made into the same area on the other buttock. Some patients with hay fever or pollen asthma find that one injection of 40-100 mg lasts throughout the pollen season. Your doctor will advise you whether it is wise for you to have further injections. Deep intramuscular injection must be given into the large muscles of the buttock and not into the upper arm or the thigh. This medicine should not be given into a vein. If you are receiving long-term intramuscular treatment with Kenalog IA/IM injection your doctor may advise you to eat more protein. This should help to reduce the gradual loss of weight that can sometimes occur with long-term treatment. Treatment with steroids is usually kept as short as possible and must not be stopped abruptly. Joints may become permanently damaged by repeated injections over a long period of time. When the treatment is stopped you may notice flu-like symptoms, runny nose or itchy eyes or skin. During times of illness or stress, patients on long-term treatment may require the addition of oral steroid tablets, or, if they have recently finished a course of Kenalog IA/IM injections, may need to start taking oral steroid tablets for a while. Mental health problems while taking Kenalog IA/IM injection Mental health problems can happen while taking steroids like Kenalog IA/IM Injection (see also section 4 Possible Side Effects).
• These illnesses can be serious.
• Usually they start within a few days or weeks of starting the medicine.
• They are more likely to happen at high doses.
• Most of these problems go away if the dose is lowered or the medicine is stopped. However, if problems do happen they might need treatment. Talk to a doctor if you (or someone taking this medicine), shows any signs of mental health problems. This is particularly important if you are depressed, or might be thinking about suicide. In a few cases, mental health problems have happened when doses are being lowered or stopped.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Serious effects: tell a doctor straight away Steroids including Kenalog IA/IM injection can cause serious mental health problems. These are uncommon in both adults and children.
• Mood changes, mental health disorders, feeling dependent on the medicine, trouble sleeping, fits or epilepsy, fainting and dizziness
• Feeling depressed, including thinking about suicide.
• Feeling high (euphoria and mania) or moods that go up and down.
• Feeling anxious/irritable, having problems sleeping, difficulty in thinking or being confused and losing your memory.
• Feeling, seeing or hearing things which do not exist. Having strange and frightening thoughts, changing how you act or having feelings of being alone. If you notice any of the following side effects talk to a doctor straight away. Serious cases of anaphylactic reactions (i.e. a serious allergic reaction) and anaphylactic shock including death have been reported. If you notice any of the following, contact your doctor immediately:
•Swelling of the face, lips or throat
•Breathing difficulties
•Skin itching, redness or a rash As these may be signs of an allergic reaction

Common: may affect up to 1 in 10 people
•Increased risk of infection
•Injection site reactions
•Headache
•Joint pain

Uncommon: may affect up to 1 in 100 people
•Changes in blood chemicals, which can cause fluid retention
•Heart failure or irregular heart beat
•Weak or fragile bones or muscles, poor healing of broken bones or destruction of the ends of bones, decrease in muscle mass, muscle or bone pain, muscular weakness/discomfort, bone fracture
•Loss of bone tissue (osteoporosis)
•Thin/fragile skin, rashes, stretch marks, bruising, sweating, flushing and increased hair growth, itchy bumps, loss/darkening of skin colour
•Indigestion, stomach pain, stomach ulcers and perforation, bloating, increased appetite and weight loss, inflammation of the pancreas/oesophagus, stomach bleeding
•Eye problems including inflammation, glaucoma and cataracts, blindness, bulging of the eye, damage to the cornea or white of eye
•Infection of the nose
•Irregular periods/ postmenopausal women may also experience vaginal bleeding
•Fungal or Viral eye infections
•Yeast infections e.g. thrush
•Tiredness and tingling, Increased pressure in the brain
•Increased appetite
•Weight loss
•Less tolerance to carbohydrates
•Mild form of diabetes with no obvious symptoms
•Inadequately controlled diabetes mellitus, high blood sugar
•Pain, swelling and worsening of the pain in the injected joint
•Impaired healing
•High body temperature
•Treatment with steroids can stop the body from producing some hormones and may slow or stop children’s growth.
•Hormone production by certain glands may be increased or decreased.
•Vertigo
•High/low blood pressure
•Abnormal blood clots
•Longstanding chronic infections such as tuberculosis could be made worse

Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine

How to Store Kenalog-40

Keep this medicine out of the sight and reach of children. Kenalog IA/IM injection will be kept in the pharmacy until it is given to you by your doctor or nurse. It should not be used after the expiry date shown on the outer packaging. It should not be stored above 25°C nor should it be allowed to freeze. The container should be kept in the outer carton.