Kenalog Intra-articular/Intramuscular

Triamcinolone acetonide is a type of medicine known as a corticosteroid. Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions on every organ system. Corticosteroids affect the strength of heart muscle and its response to natural chemicals affecting heart rate. They affect the water and salt balance in the body and also enable the body to cope with stress. Stress includes changes in temperature, pain, fear, anxiety and illness and can be hazardous if the body is not equiped to cope, due to low levels of corticosteroids. Corticosteroids allow us to respond to stress by increasing the rate and force of the heartbeat, increasing blood supply to essential tissues (muscle, heart, brain), increasing the body's supply of energy by raising blood sugar and by several other effects on body systems. Triamcinolone acetonide is a synthetic corticosteroid and is given by injection in many situations where a lasting corticosteroid effect is required. This includes replacement therapy in people whose adrenal glands are not producing enough natural steroids (adrenal insufficiency) and decreasing inflammation in certain disease states. Corticosteroids decrease inflammation by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses, resulting in inflammation. By decreasing the release of these chemicals in a particular area, inflammation is reduced. This can help control a wide number of disease states, characterised by excessive inflammation. They include severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis. The injection can be given as a single dose to people who suffer from hayfever and don't respond to conventional therapy. This can relieve symptoms over the entire hayfever period. Triamcinolone may also be given by injection directly into a joint to relieve inflammation and pain and increase mobility of the affected joint, in conditions such as arthritis. Triamcinolone also decreases the numbers of white blood cells circulating in the blood. This is useful for the treatment of certain types of leukaemia, where there is an abnormally large production of certain white blood cells. It is also used to treat some diseases which are caused by the immune system attacking the body's own tissues (auto immune diseases). Triamcinolone is used in much higher doses than the levels of corticosteroids produced naturally by the body, and as such, the usual actions of corticosteroids become exaggerated and can be observed as side effects of this medicine.

What is it used for?

- An attack of the body by its immune system resulting in the destruction of red blood cells (autoimmune haemolytic anaemia)
- Cancer of the lymph nodes
- Hayfever
- Inflammation of the bony projection at the end of a long bone e.g. humerus in the arm (epicondylitis)
- Inflammation of the envelope (bursa) found around parts of the body which are subject to friction e.g. joints, muscles and tendons (bursitis)
- Inflammation of the tissue surrounding a tendon (tenosynovitis)
- Inflammatory disorders e.g. asthma, arthritis, severe allergic reactions, Crohn's disease, systemic lupus erythematosus
- Insufficient production of natural steroid hormones by the adrenal glands (adrenal insufficiency)
- Joint injection in inflammatory disease of the joints (e.g. rheumatoid arthritis)
- Joint injection in osteoarthritis with associated inflammation
- Leukaemia

Warning!

- If you are taking a corticosteroid for longer than three weeks you will usually be given a steroid card with your medicine. The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as reminder that your medicine should not be stopped suddenly, and to provide information of your treatment in case of an accident. You should carry it with you at all times and show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist).
- If you are taking this medicine long-term, your doctor may need to temporarily increase your dose if you experience any any additional illness, trauma or surgery during treatment. Discuss this with your doctor.
- If you have never had chickenpox you should avoid close personal contact with people who have chickenpox or shingles (herpes zoster). If you are exposed you should your doctor urgently, as these diseases can be life-threatening in people who are taking long-term steroids and whose immune system is suppressed.
- This medicine may increase your susceptibility to infections and also mask the symptoms of these infections. Consult your doctor if you get an infection during treatment.
- Although oral and injected corticosteroids are banned by the international olympic committee, injections of corticosteroids into joints are not.
- Injections administered into joints are associated with a risk of infection. Any fluid present in the joint should be examined to exclude bacterial infection before starting treatment. These injections should only be given under sterile conditions.
- It is important not to overuse joints in which a benefit has been obtained by joint injection, as the inflammatory process may remain active.
- This medicine should not be stopped abruptly but tapered down, especially when more than one injection has been given in a 3 week period. The natural production of corticosteroids by the adrenal glands is suppressed by this medicine and the body therefore becomes reliant on it.
- During prolonged therapy with this medicine a high dietary protein intake is essential.

Use with caution in

- A type of cancer that has spread from its original site to somewhere else in the body (metastatic carcinoma)
- Abnormal muscle weakness
- Children
- Decreased kidney function
- Diabetes
- Dormant (currently inactive) tuberculosis infection
- Elderly people
- Epilepsy
- Family history of glaucoma
- Glaucoma
- Heart failure
- High blood pressure
- History of drug allergy
- History of or current mental disorder
- History of steroid induced mental disturbances
- Hypothyroidism
- Infection
- Inflammation of a vein associated with blood clot formation (thrombophlebitis)
- Inflammation of small sac-like structures which sometimes form in the walls of the intestine (diverticulitis)
- Inflammation of the blood vessels in a certain area of the kidney (glomerulonephritis)
- Liver cirrhosis
- Liver failure
- Long term inflammation of the kidney (chronic nephritis)
- Osteoporosis
- Peptic ulcer
- Post-menopausal women
- Previous muscle disease (myopathy) caused by steroids
- Psychotic illness
- Recent surgical procedure involving the joining together of ends of the intestine after a section has been removed (intestinal anastomosis)
- Skin rash occuring as a symptom of sudden viral or coccal disease e.g. measles (exanthematous disease)

Not to be used in

- Children under six years of age
- Infection of the joint or surrounding tissue (joint injection only)
- Infection throughout the body (systemic infection) unless treated with specific anti-infectives
- Injection into a vein (intravenous injection)
- Injection into tendons
- Injection into the achilles tendon
- Injection into the spinal cord (intrathecal injection)

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. Seek medical advice from your doctor.
- The safety of this medicine during breastfeeding has not been established. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Difficulty in sleeping (insomnia)
- Depression
- Thinning of the skin
- Increased pressure inside the eye (glaucoma)
- Irregular menstrual cycle
- Decreased functioning of the adrenal gland (adrenal suppression)
- Thinning of the bones (osteoporosis)
- Ulceration of the stomach or intestine
- Increased susceptibility to infections
- Acne
- An extreme allergic reaction (anaphylaxis)
- Increased risk of fractures of the bones
- Increased hair growth (hirsutism)
- Yeast infection of the moist areas of the body, especially the vagina (candidiasis)
- Muscle wasting and weakness

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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