Kenalog (KENACORT) ampoules 40mg/ml 1ml №3

Trade name
KENALOG 40 (KENALOG 40)

International name
TRIAMCINOLONUM

Latin name
KENALOG 40

General Characteristics
Triamcinolone acetonide ... .. 40 mg / ml
Other ingredients: carboxymethylcellulose sodium salt, sodium chloride, benzyl alcohol, polysorbate, water for injection.

Form release
Valium. d /. 40 mg / ml amp. 1 ml, № 5

Farmgruppa
Corticosteroids for systemic use. H02A B08

Pharmacological properties
triamcinolone acetonide aqueous suspension with a duration of action, designed for systemic and topical application. Triamcinolone - a synthetic corticosteroids with marked antiinflammatory, antiallergic, antipruritic and immunosuppressive activity. Does not cause retention of sodium and water in the body, its diabetogenic effect is 2-3 times less pronounced than that of dexamethasone. The inhibitory effect of triamcinolone on the pituitary function is somewhat less than other corticosteroids. Kenalog 40 has a prolonged effect that may persist for several weeks. After a single i / m injection at a dose of 80-100 mg observed inhibition of the function of the adrenal cortex during 24-48 h, which gradually disappear within 20-40 days.

Pharmacokinetics
After intraarticular injection 58-67% triamcinolone resorbed during 3 days. Metabolized in the liver. Less than 15% are allocated unchanged in the urine.

Indications for Use
rheumatoid arthritis (intra-articular administration), extraarticular manifestations of rheumatism (bursitis, fibrositis, myositis), allergic diseases, diseases of the skin (bullous dermatosis, psoriasis, especially in psoriatic arthropathy).

Dosing and Administration
In the intravenous NOT! Dosing of the individual.
Adults / m is usually administered at an initial dose of 40 mg, and then at a dose of 40-80 mg every 2-4 weeks, depending on the clinical situation. If necessary, increase the dose to 120 mg per injection.
Children aged 6-12 / m administered 0,03-0,2 mg / kg with a 7-day intervals.
With the introduction of intra-articular use of 10-40 mg. The total dose when administered in several joints at the same time should not exceed 80 mg.
Further intraarticular injections are given every 3-4 weeks, depending on the clinical situation.
With the addition of lesion dose is 10-40 mg.

Side Effects
triamcinolone acetonide side effects are similar to those of other corticosteroids.
Skin: striae, acne, petechia, ecchymosis, telangiectasia, pigmentation, delayed wound healing.
Musculoskeletal system: weakness and muscle atrophy, osteoporosis with increased risk of fractures, aseptic necrosis of bone, inhibition of growth in children and adolescents.
The organ of vision: glaucoma, cataracts.
Digestive tract and liver: dyspeptic symptoms, nausea, anorexia, steroid ulcer, pancreatitis.
Endocrine system: suppression of the adrenal cortex, Cushing syndrome, steroid diabetes, impaired secretion of sex hormones (dysmenorrhea, impotence, hirsutism), increased body weight.
Immune System: immunosuppression with an increased risk of infection, masking of symptoms of infection has developed, rarely allergic reactions.
Blood system: the increased tendency to thrombosis.
Cardiovascular system: hypertension.
CNS: dizziness, headache, increased intracranial pressure, psychosis, depression.

Contraindications
Hypersensitivity to triamcinolone or to other components of the drug, peptic ulcer, duodenal ulcer or anastomoses, diverticulitis, glaucoma, diabetes, 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 infection (without adequate antibiotic therapy), amoebiasis, Cushing's syndrome, severe injuries and surgeries, thrombosis and thromboembolism, the age of 6 years.

Interaction with other drugs
reduces the effect of anticoagulants, high concentrations of salicylate and increases plasma glucose (requires correction dose of insulin or oral hypoglycemic agents). The simultaneous use of triamcinolone and diuretics may increase the excretion of potassium (hypokalemia in patients with increased sensitivity to cardiac glycosides). Co-administration of beta-adrenergic blockers increase the risk of hypokalemia. Estrogens may decrease the metabolism of corticosteroids. Co-administration of barbiturates, phenytoin or rifampicin reduces the effectiveness of triamcinolone. Triamcinolone, used in conjunction with NSAIDs increases the risk of gastrointestinal bleeding. GCS reduce the effectiveness of antihypertensive drugs.

Overdose
exceeding the recommended doses for a few weeks of development may cause Cushing's syndrome, depression of the function of the adrenal cortex, muscle weakness, osteoporosis and erosive gastroduodenopatiyu. Treatment is symptomatic. A single overdose does not cause clinically significant toxicity. Hemodialysis is ineffective.

Features of
prolonged use of triamcinolone inhibits the endogenous secretion of adrenal hormones, so treatment should stop gradually. Inhibition of adrenal function may take several months after stopping treatment.
Patients with a history of tuberculosis should be kept under close supervision, since there is a risk of reactivation of the process for the treatment of GCS, it also applies to patients with peptic ulcer.
In severe infections, triamcinolone can be used only in combination with antimicrobial therapy.
There is also an increased risk of viral infection through contact with patients (such as chickenpox or herpes). With carefully administered to patients with severe diseases of the muscles.
Triamcinolone in children is used only when absolutely necessary, because it can inhibit the growth and development.
GCS should be used with caution in patients with hypertension, severe chronic heart failure, epilepsy and severe hepatic impairment.
SCS may affect the results of allergy tests, and increase the risk of hypokalemia.
Safety of corticosteroids during pregnancy has not been established, their use is shown only in extreme cases, when the potential benefits for the expectant mother outweighs the potential risk to the fetus. During the treatment should stop breastfeeding. Newborns whose mothers received corticosteroids during pregnancy should be kept under medical supervision to identify the possible failure of the adrenal cortex.

Conditions and terms of
in a dark place at a temperature of 8-25

Manufacturer's name and address
KRKA