Kenalog for Dogs & Cats - 10mg/ml-5 mL - [Pain Relief]

Kenalog -10 Injection (triamcinolone acetonide injectable suspension, USP) is a steroid veterinarians prescribe to treat allergic reactions such as inflammation, swelling, itching or other reactive conditions in dogs and cats. It can also be used to treat acute or chronic pain caused by trauma or injuries.

How it works

Triamcinolone is a corticosteroid that reduces swelling. It is used to treat many different conditions, including inflammation, and allergic and immune disorders.

Indications and Usage

The intra-articular or soft tissue administration of Kenalog-10 Injection (triamcinolone acetonideinjectable suspension, USP) is indicated as adjunctive therapy for short-term administration (to tide thepatient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acutenonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis.

The intralesional administration of Kenalog-10 Injection is indicated for alopecia areata; discoidlupus erythematosus; keloids; localized hypertrophic, infiltrated, inflammatory lesions of granulomaannulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; necrobiosislipoidica diabeticorum. Kenalog-10 Injection may also be useful in cystic tumors of an aponeurosis ortendon (ganglia).

The initial dose of Kenalog-10 Injection for intra-articular administration may vary from 2.5 mg to 5 mgfor smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entitybeing 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 specificdisease entity and lesion being treated. The site of injection and volume of injection should be carefullyconsidered due to the potential for cutaneous atrophy.

Multiple sites separated by one centimeter or more may be injected, keeping in mind that the greater thetotal volume employed the more corticosteroid becomes available for systemic absorption and systemiceffects. 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 desiredeffect when the corticosteroid is administered to provide a localized concentration. The site andvolume of the injection should be carefully considered when triamcinolone acetonide is administeredfor this purpose.

Administration

Strict Aceptic Technique is Mandatroy. The vial should be shaken before use toensure a uniform suspension. Prior to withdrawal, the suspension should be inspected for clumping orgranular appearance (agglomeration). An agglomerated product results from exposure to freezingtemperatures and should not be used. After withdrawal, inject without delay to prevent settling in thesyringe.

Injection Technique

For treatment of joints, the usual intra-articular injection technique should be followed. If an excessiveamount of synovial fluid is present in the joint, some, but not all, should be aspirated to aid in the reliefof pain and to prevent undue dilution of the steroid.

With intra-articular administration, prior use of a local anesthetic may often be desirable. Care shouldbe taken with this kind of injection, particularly in the deltoid region, to avoid injecting the suspensioninto 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 treatedby 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, i.e.,intradermally or subcutaneously. For accuracy of dosage measurement and ease of administration, it ispreferable to employ a tuberculin syringe and a small-bore needle (23-25 gauge). Ethyl chloride spraymay be used to alleviate the discomfort of the injection.

Contraindications

Kenalog-10 Injection is contraindicated in patients who are hypersensitive to any components of this product.

Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura.

Warnings

Serious Neurologic Adverse Reactions with Epidural Administration

Serious neurologic events, some resulting in death, have been reported with epidural injection ofcorticosteroids (see Warnings: Neurologic). Specific events reported include, but are not limitedto, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke. These seriousneurologic events have been reported with and without use of fluoroscopy. The safety andeffectiveness of epidural administration of corticosteroids have not been established, andcorticosteroids are not approved for this use.

Precautions

General

This product, like many other steroid formulations, is sensitive to heat. Therefore, it should not beautoclaved when it is desirable to sterilize the exterior of the vial.

The lowest possible dose of corticosteroid should be used to control the condition under treatment. When reduction in dosage is possible, the reduction should be gradual.

Since complications of treatment with glucocorticoids are dependent on the size of the dose and theduration of treatment, a risk/benefit decision must be made in each individual case as to dose andduration of treatment and as to whether daily or intermittent therapy should be used.

Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy, most oftenfor chronic conditions. Discontinuation of corticosteroids may result in clinical improvement.

Cardio-Renal

As sodium retention with resultant edema and potassium loss may occur in patients receivingcorticosteroids, these agents should be used with caution in patients with congestive heart failure,hypertension, or renal insufficiency.

Endocrine

Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction ofdosage. This type of relative insufficiency may persist for months after discontinuation of therapy;therefore, in any situation of stress occurring during that period, hormone therapy should bereinstituted. Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid shouldbe administered concurrently.

Gastrointestinal

Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinalanastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation.

Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroidsmay be minimal or absent.

There is an enhanced effect of corticosteroids in patients with cirrhosis.

Intra-Articular and Soft Tissue Administration

Intra-articularly injected corticosteroids may be systemically absorbed.

Appropriate examination of any joint fluid present is necessary to exclude a septic process.

A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, andmalaise are suggestive of septic arthritis. If this complication occurs and the diagnosis of sepsis isconfirmed, appropriate antimicrobial therapy should be instituted.

Injection of a steroid into an infected site is to be avoided. Local injection of a steroid into a previouslyinfected joint is not usually recommended.

Corticosteroid injection into unstable joints is generally not recommended.

Intra-articular injection may result in damage to joint tissues (see Adverse Reactions: Musculoskeletal).

Adverse Reactions

The following adverse reactions may be associated with corticosteroid therapy:

Allergic reactions: Anaphylaxis including death, angioedema.

Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatorycollapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy inpremature infants, myocardial rupture following recent myocardial infarction (see Warnings),pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis.

Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scaly skin,ecchymoses and petechiae, edema, erythema, hyperpigmentation, hypopigmentation, impaired woundhealing, increased sweating, lupus erythematosus-like lesions, purpura, rash, sterile abscess, striae,suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria.

Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state,glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agentsin diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, postmenopausal vaginalhemorrhage, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, asin trauma, surgery, or illness), suppression of growth in pediatric patients.

Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention,hypokalemic alkalosis, potassium loss, sodium retention.

Gastrointestinal: Abdominal distention, bowel/bladder dysfunction (after intrathecal administration [see Warnings: Neurologic]), elevation in serum liver enzyme levels (usually reversible upondiscontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possibleperforation and hemorrhage, perforation of the small and large intestine (particularly in patients withinflammatory bowel disease), ulcerative esophagitis.

Metabolic: Negative nitrogen balance due to protein catabolism.

Musculoskeletal: Aseptic necrosis of femoral and humeral heads, calcinosis (following intra-articular orintralesional use), Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis,pathologic fracture of long bones, post injection flare (following intra-articular use), steroid myopathy,tendon rupture, vertebral compression fractures.

Neurologic/Psychiatric: Convulsions, depression, emotional instability, euphoria, headache, increasedintracranial pressure with papilledema (pseudotumor cerebri) usually following discontinuation oftreatment, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, psychiatricdisorders, vertigo. Arachnoiditis, meningitis, paraparesis/paraplegia, and sensory disturbances haveoccurred after intrathecal administration. Spinal cord infarction, paraplegia, quadriplegia, corticalblindness, and stroke (including brainstem) have been reported after epidural administration ofcorticosteroids (see Warnings: Serious Neurologic Adverse Reactions with EpiduralAdministration and Warnings: Neurologic).

Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts,rare instances of blindness associated with periocular injections.

Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreasedmotility and number of spermatozoa, malaise, moon face, weight gain.

Overdosage

Treatment of acute overdosage is by supportive and symptomatic therapy. For chronic overdosage inthe face of severe disease requiring continuous steroid therapy, the dosage of the corticosteroid maybe reduced only temporarily, or alternate day treatment may be introduced.