DOSAGE AND ADMINISTRATION
General
NOTE: CONTAINS BENZYL ALCOHOL (see PRECAUTIONS).
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therapy the drug is to be stopped, it is recommended that it be withdrawn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/m2bsa/day).
For the purpose of comparison, the following is the equivalent
milligram dosage of the various glucocorticoids:
Cortisone, 25
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Triamcinolone, 4
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Hydrocortisone, 20
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Paramethasone, 2
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Prednisolone, 5
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Betamethasone, 0.75
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Prednisone, 5
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Dexamethasone, 0.75
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Methylprednisolone,
4
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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.
Intra-Articular Administration
Dosage
The initial dose of Kenalog-10 Injection for intra-articular administration may vary from
2.5 mg to 5 mg for smaller joints and from 5 mg 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.
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.
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.
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.
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 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.
Intralesional
For treatment of dermal lesions, Kenalog-10 Injection 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 (23-25 gauge). Ethyl chloride
spray may be used to alleviate the discomfort of the injection.
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