Kenalog®
The drug is not intended for intravenous, intradermal, intraocular, epidural or intrathecal use. Serious adverse events have been reported with epidural and intrathecal routes of administration.
To prevent tissue atrophy at the site of intramuscular injection, the drug should be administered deep into the gluteal muscle.
The drug has a therapeutic effect for a long period of time after administration, however, it is not intended for use in emergency situations.
When using the drug topically, it is necessary to evaluate its compatibility with simultaneously administered local anesthetics.
It is allowed to mix with an equal volume of solutions of local anesthetics (1% procaine solution or 1% lidocaine solution) in a syringe, but not in an ampoule.
Before and during GCS therapy, it is necessary to monitor a general blood count, glycemia, and the content of electrolytes in the blood plasma.
With long-term use of GCS, the risk of developing subcapsular cataracts and glaucoma increases, sometimes with damage to the optic nerve. The incidence of secondary eye infections may also increase.
It is necessary to study the synovial fluid in each joint to exclude a septic process. A significant increase in pain, accompanied by local swelling, further limitation of joint mobility, fever and malaise, suggests the development of septic arthritis. If sepsis is confirmed, appropriate antimicrobial therapy is necessary. When treating during intercurrent infections, septic conditions, tuberculosis, antibiotic treatment is carried out at the same time.
It should not be injected into “unstable” joints, in the area of the Achilles tendon (risk of rupture).
Vaccination with live viral vaccines is contraindicated during GCS therapy. Immunization with killed viral or bacterial vaccines during the use of GCS does not provide the expected increase in the number of antibodies and does not provide the expected protective effect. Therefore, such drugs should not be prescribed 8 weeks before and 2 weeks after vaccination.
In patients who have not had chickenpox and are receiving treatment with corticosteroids, the risk of developing chickenpox or herpetic infection increases due to accidental contact with infected persons. In such cases, passive immunization is recommended. Caution is necessary in patients after surgery and bone fractures, since glucocorticosteroids can slow down the healing of wounds and fractures due to increased excretion of calcium from the body.
The effect of GCS is enhanced in patients with liver cirrhosis or hypothyroidism.
The use of Kenalog may alter hypersensitivity tests.
GCS can mask some signs of existing infectious diseases, as well as the appearance of infection during treatment. When taking them, there may be a decrease in immunity and a weakening of the process of localizing the infection.
The use of GCS can provoke a worsening of the condition and increased migration of larvae in patients with strongyloidiasis, which can lead to severe enterocolitis and death due to gram-negative septicemia.
When using GCS (especially high and medium doses of hydrocortisone and cortisol), increased blood pressure, fluid and salt retention, and increased potassium excretion may be observed. Although these phenomena are less pronounced when prescribing synthetic corticosteroids (such as the drug Kenalog), however, limiting salt in food and additional intake of potassium supplements may be required. With long-term use of the drug, it is necessary to ensure sufficient consumption of protein foods necessary to maintain the nitrogen balance of the body.
If a patient has a gastric ulcer, its exacerbation during treatment with corticosteroids may be asymptomatic until the ulcer perforates or bleeding begins. Considering also the fact that long-term use of corticosteroids causes increased acidity of gastric juice, which can lead to the formation of gastric ulcers, an appropriate treatment regimen for peptic ulcer should be prescribed.
In children during the growth period, GCS should be used only according to absolute indications and under the particularly careful supervision of the attending physician.
When treating GCS, menstrual irregularities may occur. Due to the risk of developing severe allergic reactions (up to anaphylactic shock) during parenteral administration of GCS, special care should be taken when treating patients with a history of allergies.
This medicine contains benzyl alcohol, which can cause serious side effects (including death), especially in children. This should be taken into account when prescribing high doses of Kenalog and long courses of treatment to patients (especially children).
Kenalog – suspension
GCS inhibits the release of interleukin1, interleukin2, interferon gamma from lymphocytes and macrophages. It has anti-inflammatory, antiallergic, desensitizing, antishock, antitoxic and immunosuppressive effects.
Suppresses the release of ACTH and beta-lipotropin by the pituitary gland, but does not reduce the concentration of circulating beta-endorphin. Inhibits the secretion of TSH and FSH.
Increases the excitability of the central nervous system, reduces the number of lymphocytes and eosinophils, increases the number of red blood cells (stimulates the production of erythropoietins).
Interacts with specific cytoplasmic receptors and forms a complex that penetrates the cell nucleus and stimulates the synthesis of mRNA; the latter induces the formation of proteins, incl. lipocortin, mediating cellular effects. Lipocortin inhibits phospholipase A2, suppresses the formation of arachidonic acid and inhibits the synthesis of endoperoxides, Pg, leukotrienes, which contribute to inflammation, allergies, etc.
Protein metabolism: reduces the amount of protein in plasma (due to globulins) with an increase in the albumin/globulin ratio, increases the synthesis of albumins in the liver and kidneys; enhances protein catabolism in muscle tissue.
Lipid metabolism: increases the synthesis of higher fatty acids and TG, redistributes fat (fat accumulation mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.
Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase, leading to an increase in the flow of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, leading to the activation of gluconeogenesis.
Water-electrolyte metabolism: retains Na+ and water in the body, stimulates the excretion of K+ (MCS activity), reduces the absorption of Ca2+ from the gastrointestinal tract, “washes out” Ca2+ from the bones, increases the excretion of Ca2+ by the kidneys.
The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils; inducing the formation of lipocortin and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes and organelle membranes (especially lysosomal ones).
The antiallergic effect develops as a result of suppression of the synthesis and secretion of allergic mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, suppression of the development of lymphoid and connective tissue, a decrease in the number of T- and B-lymphocytes, mast cells, reducing the sensitivity of effector cells to allergy mediators, inhibiting antibody formation, changing the body's immune response.
In COPD, the action is based mainly on inhibition of inflammatory processes, inhibition of development or prevention of swelling of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of the bronchial epithelium, deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucous membrane. Increases the sensitivity of beta-adrenergic receptors of small and medium-caliber bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by inhibiting or reducing its production.
Antishock and antitoxic effects are associated with an increase in blood pressure (due to an increase in the concentration of circulating catecholamines and restoration of the sensitivity of adrenergic receptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane protective properties, and activation of liver enzymes involved in the metabolism of endo- and xenobiotics.
The immunosuppressive effect is due to inhibition of the release of cytokines (interleukin1, interleukin2; interferon gamma) from lymphocytes and macrophages.
Suppresses the synthesis and secretion of ACTH and, secondarily, the synthesis of endogenous corticosteroids. Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.
In terms of anti-inflammatory activity, triamcinolone is close to hydrocortisone; triamcinolone acetonide is 6 times more active. There is virtually no activity on the ISS.
After intramuscular administration, the maximum effect is observed after 24-48 hours, the duration of action with intramuscular administration is 1-6 weeks, in the joint cavity - several weeks.
Interactions of the drug Kenalog
Weakens the effect of anticoagulants, reduces the concentration of salicylates and increases the level of glucose in the blood plasma (dosage adjustment of insulin or oral hypoglycemic drugs is necessary). Concomitant use of triamcinolone and diuretics may increase potassium excretion (in patients with hypokalemia, sensitivity to cardiac glycosides increases). Co-administration of beta-adrenergic blockers increases the risk of hypokalemia. Estrogens can reduce the metabolism of GCS. Concomitant administration of barbiturates, phenytoin or rifampicin reduces the effectiveness of triamcinolone. Triamcinolone used concomitantly with NSAIDs increases the risk of gastrointestinal bleeding. GCS reduce the effectiveness of antihypertensive drugs.
Use of the drug Kenalog
The dose and duration of treatment are determined individually. The drug is prescribed once a day (preferably in the morning) or in several doses, especially if the total dose exceeds 16 mg. The usual daily dose for adults is 4–32 mg. If side effects develop, the dose is gradually reduced (by 4 mg every 2–3 days) until an adequate dose is reached (usually 4 mg/day). Children whose body weight exceeds 25 kg are prescribed at the dose recommended for adults. Children weighing up to 25 kg are prescribed an initial dose of 12 mg/day, then the dose is selected taking into account the nature of the disease and tolerability of the drug.
Contraindications to the use of the drug Kenalog
Hypersensitivity to triamcinolone or to other components of the drug, peptic ulcer of the stomach, duodenum or anastomosis, diverticulitis, glaucoma, diabetes mellitus, osteoporosis, psychosis, lymphadenitis after BCG vaccination, a period of 2 months after vaccination with live viral vaccines, myasthenia gravis, tuberculosis, viral infections , systemic mycosis, bacterial infections (without adequate antibiotic therapy), amebiasis, Cushing's syndrome, severe injuries and surgical interventions, vascular thrombosis and thromboembolism.
Side effects of the drug Kenalog
Side effects of triamcinolone are similar to those of other corticosteroids. Skin: stretch marks, acne, petechiae, ecchymoses, telangiectasia, pigmentation, delayed wound healing. Musculoskeletal system: muscle weakness and atrophy, osteoporosis with an increased risk of fractures, aseptic bone necrosis, growth inhibition in children and adolescents. Organ of vision: glaucoma, cataract. Digestive tract and liver: dyspeptic symptoms, nausea, anorexia, steroid gastric ulcer, pancreatitis. Endocrine system: suppression of the adrenal cortex, Cushing's syndrome, steroid diabetes, impaired secretion of sex hormones (dysmenorrhea, impotence, hirsutism), weight gain. Immune system: immunosuppression with an increased risk of developing infections, masking the symptoms of a developed infection, rarely allergic reactions. Blood system: increased tendency to thrombosis. Cardiovascular system: hypertension (arterial hypertension) . CNS: dizziness, headache, increased intracranial pressure, psychosis, depression.
