Kenalog - instructions for use, reviews, analogs and forms of release (injections in ampoules for injections in a suspension of 40 mg / ml, tablets 4 mg) of a hormonal drug for the treatment of psoriasis and bronchial asthma in adults, children and pregnancy

In this article you can get acquainted with the instructions for the use of a hormonal drug Kenalog. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Kenalog in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Kenalog in the presence of existing structural analogues.Use for the treatment of psoriasis and bronchial asthma in adults, children, as well as during pregnancy and lactation.

Kenalog - Glucocorticosteroid (GCS). Suppresses the function of white blood cells and tissue macrophages. Limits the migration of leukocytes to the area of ​​inflammation. Violates the ability of macrophages to phagocytosis, as well as to the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ​​inflammation. Reduces the permeability of capillaries due to the release of histamine. Suppresses the activity of fibroblasts and the formation of collagen.

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 contributes to a decrease in 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; suppresses the formation of antibodies.

Suppresses pituitary release of ACTH and beta-lipotropin, but does not reduce the level of circulating beta-endorphin. Oppresses the secretion of TSH and FSH.

Composition

Triamcinolone acetonide + auxiliary substances.

Pharmacokinetics

In systemic use, it is metabolized mainly in the liver and partially in the kidneys. The main pathway of metabolism is 6-beta hydroxylation. It is excreted by the kidneys.

Indications

Systemic application (intramuscular administration)

• hay fever;
• chronic obstructive airways diseases (eg, bronchial asthma, chronic spastic bronchitis), severe forms and negative results of local treatment;
• skin diseases and contact dermatitis characterized by itching, scaling or blistering, for example, contact dermatitis, pemphigoid, psoriasis, herpetiform dermatitis, atopic, exfoliative and eczematoid dermatitis.

Local application

Intra-articular administration:

• after systemic administration, 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;
• when dropsy of joints;
• when blocking the shoulder joint as a result of wrinkling of the joint 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 bag, inflammation of the periosteum, as well as exostoses (cyst formations near the joints);
• for certain skin diseases, for example, with isolated psoriatic plaques, chronic simple lichen (limited neurodermatitis), ring-shaped granuloma, flat lichen, alopecia areata, discoid lupus erythematosus, and also in kelloids.

Forms of release

Suspension for injection (injections in ampoules) 40 mg / ml.

Tablets 4 mg.

Medicinal form in the form of an ointment or cream does not exist.

Instructions for use and treatment regimen

Before use, shake the contents of the ampoule. The Kenalog 40 mg / ml is a suspension, so it should not be administered intravenously. Care should also be taken with regard to unintentional intravascular injections, especially to the left side of the face, the scalp, and also to the buttock.

Systemic application (intramuscularly)

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

In systemic treatment of adults and adolescents over 16 years of age, 1 ml of the drug (= 40 mg) is injected slowly through a deep intragenic injection. Do not administer intravenously and subcutaneously. In severe cases, doses of up to 80 mg may be required. With deep intra-annual injection, the possible development of tissue atrophy should be avoided. After the injection, it should be tightly pressed for 1-2 minutes with a sterile napkin to the site of injection.

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

If several injections are necessary, the interval between injections should be at least 4 weeks.

Local application

With intraarticular 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 the following doses of the drug are used:

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

Joints of medium size (for example, brachial, elbow) - 20 mg.

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

If several joints are affected, the total dose of the drug can be up to 80 mg. If you need to use smaller doses, you should use Kenalog 10 mg / ml. To ensure faster relief of symptoms, 40 mg / ml Kenalog 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 the creation of a drug depot in the subcutaneous adipose tissue. When injecting, the conditions of the strictest aseptic should be observed. Before the intra-articular injection, the skin area is prepared, as before the surgical operations. Re-apply the drug should not be earlier than 2 weeks.

When intramuscular introduction for small lesions: inflammation of the mucosa (bursitis), inflammation of the periosteum and exostoses, adults and children over the age of 12 years, depending on the size and localization of the treated lesions, administer up to 10 mg of the drug and, with large lesions, 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 diluted with saline solution of sodium chloride and fan-shaped enter into the area characterized by the greatest pain. You should avoid creating large depots of the drug. A canal of 40 mg / ml can also be mixed with a local anesthetic. In the treatment of exostosis, Kenalog 40 mg / ml is injected with a thick cannula after aspiration directly into the cyst space.

Repeat the drug should not be earlier than 2 weeks.

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 is mixed in a syringe. Injection is carried out horizontally into the area between the skin and the subcutaneous layer to ensure anesthesia of the infiltrate. As an indicative dose, 1 mg of the drug per 1 cm2 of skin surface is recommended. When treating several lesions in one dose, the daily dose of the drug to adults should not exceed 30 mg, and children - 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 directly introduced into the tissue of the rumen without dilution; do not enter s / k.Re-apply the drug should not be earlier than 2 weeks.

The duration of the drug depends on the nature and severity of the disease and is determined by the doctor. It varies from a single intravenous administration of hay fever to a course that lasts for several years, for example, in severe forms of bronchial asthma. If after 3-5 local injections (intra-articular, intramuscular injections, injections into the area of ​​subcutaneous lesions) there is no satisfactory response, the drug should be withdrawn and another form of treatment should be prescribed.

Side effect

• reactions of hypersensitivity (redness (hot flashes), the formation of skin blisters, violation of cardiac activity and circulation, due, inter alia, to the presence of benzyl alcohol in the preparation);
• aseptic necrosis of bone tissue (head of the hip and humerus);
• thinning of the skin;
• expansion of small dermal vessels;
• steroid acne;
• skin blisters;
• increased hair growth;
• inflammation of hair follicles;
• change in pigmentation and inflammation of the skin around the mouth;
• Cushing's syndrome;
• muscle weakness;
• atrophy of muscle tissue;
• atrophy of bone tissue;
• decreased glucose tolerance;
• diabetes mellitus (impairment of compensation for existing diabetes mellitus or activation of latent diabetes mellitus);
• violation of the secretion of sex hormones (violation of the menstrual cycle, increased hair growth, impotence);
• bleeding on the skin and mucous membranes (petechien, ekchymosen);
• functional suppression or atrophy of the adrenal glands;
• inflammatory processes in the vessels (vasculitis, withdrawal syndrome after prolonged therapy);
• ulcerative inflammation of the gastrointestinal mucosa;
• stomach ulcer;
• suppression of immunity and increased risk of infection;
• slowing healing of wounds and bone fractures;
• ruptures of tendons;
• growth disorders in children;
• headache;
• increased sweating;
• dizziness;
• increased intracranial pressure, accompanied by a symptom of the stagnant nipple of the optic nerve;
• glaucoma;
• cataract;
• mental disorders;
• increased risk of thrombosis.

Contraindications

For topical application:

• chickenpox;
• after immunization;
• skin lesions of a tuberculous or syphilitic nature;
• fungal diseases;
• bacterial skin lesions;
• inflammation of the skin around the mouth (rosacea);
• kenalog 40 mg / ml not to enter intraarticularly if there is an infection nearby.

When systemic or repeated topical application of the drug should take into account the following contraindications for the systemic use of glucocorticoids.

Absolute contraindications:

• stomach ulcer and duodenal ulcer;
• severe condition of bone atrophy;
• mental illness in the medical history;
• viral diseases, for example herpetic pemphigus (herpes simplex), shingles (herpes zoster, viremic phase), chicken pox;
• infections caused by amoebas;
• fungal infections of internal organs;
• poliomyelitis of childhood, with the exception of the bulbar-encephalitis form;
• depending on the specific situation, within 8 weeks before the vaccination, up to 2 weeks after vaccination;
• glaucoma.

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

Relative contraindications:

• ulcer of the stomach and duodenum in the history of the disease;
• with severe muscle disease;
• diverticulitis;
• fresh intestinal anastomoses;
• with a tendency to thrombosis and embolism;
• with carcinomas with a tendency to metastasis;
• with diabetes mellitus;
• with acute glomerulonephritis;
• with chronic nephritis;
• when the lymph nodes swell during the post-BCG immunization period.

In the treatment of corticosteroids, activation of the tuberculosis process can occur.

Application in pregnancy and lactation

Do not use Kenalog during the first 5 months of pregnancy, because animal studies indicate a teratogenic effect (the appearance of fetal anomalies), and there are no safety data for the drug during pregnancy. With prolonged use of the drug can not exclude the violation of fetal growth inside the uterus. When using the drug at the end of pregnancy, there is a risk of atrophy of the adrenal glands of the fetus.

Glucocorticoids pass into breast milk, so breast-feeding during treatment with the drug should be discontinued.

Use in children

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

special instructions

At systemic treatment by a preparation it is recommended to appoint or nominate the diet enriched with fibers and vitamins.

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

When re-applying the drug, the intervals between injections should be observed and, if necessary, the intervals between injections should be increased.

Drug Interactions

In 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, there may be an intensification of their action; when combined with saluretics, the release of potassium from the body may increase.

Simultaneous use with non-steroidal anti-inflammatory drugs (NSAIDs) or antirheumatic drugs may contribute to the development of gastrointestinal bleeding.

With simultaneous administration with rifampicin, the corticoid effect of the drug may be weakened.

Analogues of the drug Kenalog

Structural analogs for the active substance:

• Azmacort;
• Berlikort;
• Kenakorth;
• Kenalog 40;
• Polcortolone;
• Polcortolone 40;
• Triacort;
• Triamsinolone;
• Triamcinolone;
• Triamcinolone acetonide;
• Fluorocort.

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