About all

Kenalog for allergies: Can Kenalog or Cortisone Shots Help My Hay Fever?

Содержание

Understanding How Allergy Shots Work

Q1. My doctor gave me a Kenalog shot for allergies. Is this a common remedy? Is there something better?

Kenalog, an injectable corticosteroid, is a medication that reduces inflammation in the body, including inflammation related to allergies. Whenever possible, it is better to use corticosteroid medications that only go where they are needed. Specifically, corticosteroids can be sprayed into the nose for nasal symptoms, or inhaled into the lungs for allergy-related asthma, rather than injected or taken in pill form. This is preferable, because much of your body is not affected by allergies, and there is usually no reason to give a whole-body medicine. In addition, the doses involved with injected or oral corticosteroids are much higher than the doses in sprays, and therefore the side effects are greater. See my earlier answer about the side effects of corticosteroid medications for more information on this subject.

Doctors will give someone a corticosteroid shot or pills to take by mouth for allergies when that person comes in with disabling symptoms (interfering with sleep or work performance) that have been going on for weeks. In this setting, injections or pills are sometimes the only treatment strong enough to work.

It is important to start medications for allergies as soon as symptoms appear, and if you know what time of year your symptoms are typically the worst, then medication can be started a week or two before. If you don’t know exactly when to expect your symptoms, it is best to have prescriptions on hand so that you can start the medicines quickly, when you need them. This approach works far better than waiting until the symptoms become severe and require a much stronger treatment.

Q2. I am taking allergy shots every week, one for cats and dogs and one for mold and weeds. I have gained 26 pounds since I started the shots six months ago. Could the shots cause me to gain weight?

— Carol, Ohio

No, allergy shots are not known to be associated with weight gain. On the other hand, some allergy medications are. If you are taking antihistamines on a regular basis, they may be contributing to your weight gain, as some of them are known to increase appetite. Perhaps you could talk to your doctor about using fewer antihistamines, and/or using steroid-containing nasal sprays instead. These don’t cause weight gain and are generally more effective, when used daily, for nasal allergy symptoms.

Another medication that definitely contributes to weight gain is oral steroids, which cause both water retention and actual weight gain. The doses used in pills are much higher than those in steroid inhalers and nasal sprays, which is why the pills have so many side effects while the inhalers and nasal sprays don’t. You didn’t mention steroids in your question, but check with your doctor to make sure they aren’t a factor for you.

Occasionally, I have a patient who feels very tired after his or her shots, which leads to a reduction in activity levels for a couple of days each week. This could also contribute to weight gain. I would suggest having a focused visit with the allergist who is treating you to think about what might be causing your weight gain. It is a significant amount, and I’m sure you are very frustrated. However, I wouldn’t advise just stopping the shots, because there is probably another reason. You would need to factor in any changes that occurred around the same time. For example, are you eating out more, exercising less, or did you change your job activities? Did you start any new prescription or over-the-counter medications?

Also, if you are just six months into the allergy shot process, you are not yet seeing all the improvement that the shots should provide. That’s why it’s worthwhile trying to sort out the cause of your weight gain and persist with the shots for at least two years so you can see their full effects.

Q3. While pregnant, I developed asthma, as well as polyps in my sinuses. I had sinus surgery to remove the polyps, but my problems persist with swollen nasal passageways and a chronic runny/stuffy nose. My ENT said my IgE level is over 400. He suggested allergy shots, but since I want to get pregnant again, he said I shouldn’t start the shots now. Why is that? Do you also suggest that women who are trying to get pregnant avoid allergy shots?

— Patty, Maryland

Allergy shots (or allergen immunotherapy) can be safely continued during pregnancy if a woman has not had any serious reactions to the shots previously, but it is not advised that women begin shots or increase the dose of their shots while pregnant. This is because allergic reactions to the shots, which are uncommon but can be dangerous, occur more often during the initial, buildup stage, when the dose is being increased. A severe allergic reaction could cause low blood pressure in the mother, and the baby might not get enough oxygen for a few minutes. In addition, the treatment for a severe allergic reaction — which is epinephrine — could temporarily reduce the blood supply to the baby. So rather than taking these risks, allergists avoid beginning or increasing allergy shots during pregnancy, an approach accepted by professional allergy and obstetrical societies. There is some preliminary evidence that mothers who get allergy shots while they are pregnant may lower their baby’s risk of being allergic, but more study is needed before this can be considered fact.

You mentioned that the allergy shots were suggested because you had developed nasal polyps. Nasal polyps are a difficult condition to treat, and most people end up having surgery to remove them at some point. After surgery, many patients’ polyps grow back within three years, unless something dramatic is done to prevent this. The approach at my center after surgery is to begin treatment with a combination of medications, including nasal steroid sprays (used at maximal dose absolutely every day), montelukast (Singulair), and sinus saline rinses once or twice a day. All these therapies have been taken safely by pregnant women, although you should always ask your doctor about the best treatment in your particular circumstances.

Q4. I am considering allergy shots for my daughter. If they work, will she be able to cut down on her allergy medications? Also, are the shots safe?

Also called immunotherapy, allergy shots are an extremely effective and safe way of manipulating the immune system so that a person becomes less allergic, sneezes less, has decreased itching of the nose and eyes and, in the best case scenario, is able to reduce or even prevent wheezing. With this approach, small doses of allergens are given to the patient by injection and gradually increased as the person’s immune system learns to tolerate them. Immunotherapy is especially effective for allergies to pollen, dust mites, animal dander and insect stings. It’s not recommend as a treatment for food allergies.

Allergy shots are effective in 85 percent of people who receive this method of treatment. However, they don’t cure allergies, so your daughter may still need some medication, depending on how effective the shots are for her.

Q5. Can you explain how allergy shots work? I have horrible hay fever and would like to be able to stop taking antihistamines, which make me groggy. How early would I have to start for them to be effective? Thanks.

— Diana, New Jersey

Allergy shots, or allergen immunotherapy, is a form of vaccination much like vaccines against tetanus or measles. However, this form of vaccination injects a solution containing the item that the person is allergic to, unlike vaccines against infections (which contain small, harmless pieces of a bacteria or virus, or viruses that have been altered so that they cannot cause infection). For example, if a person undergoes allergen immunotherapy for ragweed pollen, they are actually getting injected with ragweed pollen. This does not result in a dangerous allergic reaction because allergy vaccines are given in a gradual manner, over a long period of time. In the case of an allergy to ragweed pollen, the process would start with weekly injections of very tiny amounts of ragweed. Each week, the person would return for a bit more, and over time, they would be able to tolerate more and more. The process can be accomplished using several different schedules, although the end result is the same. After a period of time, usually a few months, the person can tolerate large doses of ragweed pollen. This ongoing exposure produces multiple changes in the immune system of the patient; their bodies no longer see ragweed pollen as a dangerous thing that needs to be attacked, but rather something that can safely be ignored.

Once the person can tolerate a strong dose of ragweed pollen, the shots can be reduced in number (but not strength) to once a month. Monthly shots should be continued for 3 to 5 years to reach the maximum benefit, but most people notice that their symptoms begin to improve within 6 to 9 months. By the second year, people usually notice a dramatic improvement.

The drawbacks to allergen immunotherapy are the following:

  • There is a risk of an allergic reaction to the shots, which can be severe
  • It can be inconvenient to make frequent visits to the allergist’s office
  • It can be expensive, although most insurance companies will cover the process, since it is cost-effective for members to be using less allergy medication

Most allergists will recommend allergen immunotherapy to patients who are not getting enough relief with combination medications (a nasal corticosteroid spray, an antihistamine, and antihistamine eyedrops if eye symptoms are prominent), or to patients who do not want to use medication.

Learn more in the Everyday Health Allergy Center.

Kenalog Injection: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Redness or pain at the injection site, stomach upset, headache, dizziness, trouble sleeping, or weight gain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

This medication may make your blood sugar rise, which can cause or worsen diabetes. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

This medication may lower your ability to fight infections. This may make you more likely to get a serious (rarely fatal) infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as sore throat that doesn’t go away, fever, chills, cough).

Tell your doctor right away if you have any serious side effects, including: weakness, puffy face, unusual weight gain, thinning skin, bone pain, menstrual period changes, mental/mood changes (such as depression, mood swings, agitation), easy bruising/bleeding, vision problems, swelling ankles/feet/hands, fast/slow/irregular heartbeat.

If you have received injection of this medication into the joint, temporary discomfort of the joint may occur. Tell your doctor right away if you have fever, increased/severe pain with swelling of the joint, weakness in the joint, or decreased range of motion in the joint.

Get medical help right away if you have any very serious side effects, including: symptoms of stomach/intestinal bleeding (such as stomach/abdominal pain, black/tarry stools, vomit that looks like coffee grounds).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Depot corticosteroid treatment for hay fever causing avascular necrosis of both hips

BMJ. 2001 Jun 30; 322(7302): 1589–1591.

Lesson of the week

, senior registrara and , consultantb

S M S Nasser

aDepartment of Medicine, University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge CB2 2QQ, bDepartment of Allergy and Clinical Immunology, Addenbrooke’s Hospital

P W Ewan

aDepartment of Medicine, University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge CB2 2QQ, bDepartment of Allergy and Clinical Immunology, Addenbrooke’s Hospital

aDepartment of Medicine, University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge CB2 2QQ, bDepartment of Allergy and Clinical Immunology, Addenbrooke’s Hospital

Contributed by

Contributors: PWE and SMSN both came up with the idea of writing the paper. SMSN undertook the literature review. The paper was written jointly by both authors. PWE will act as guarantor for the paper.

This article has been cited by other articles in PMC.

The prevalence of hay fever (seasonal allergic rhinitis) has increased dramatically over the past four decades in the United Kingdom, with a doubling from 10 per 1000 people in the 1970s to 20 per 1000 in the 1980s.1 The British Society for Allergy and Clinical Immunology has published guidelines on the management of rhinitis that recommend that, when measures for avoiding pollen are insufficient, treatment should be either oral or topical antihistamine, to be taken as required, or topical sodium cromoglycate, to be taken regularly.2 If these treatments are ineffective, intranasal corticosteroids should be taken regularly, with oral or topical antihistamines added if required. If this stepped programme is adhered to the vast majority of patients will respond, but if patients fail to respond systemic corticosteroids may be used.

Over the last few decades the practice of treating severe symptoms with depot corticosteroids has become common, mainly because the duration of treatment of 4-6 weeks is often sufficient to cover the whole season. If the season is exceptionally severe or the patient experiences prolonged symptoms as a result of multiple allergies (for example, a combination of tree and grass pollen allergy), more than one depot corticosteroid injection may be required. Oral corticosteroids are less commonly used, perhaps because of the inconvenience of taking daily medication for 6-8 weeks every year.

The United Kingdom is unusual in the developed world in that it has minimal provision of allergy services, hence only small numbers of patients with severe seasonal allergic rhinitis have access to immunotherapy despite the growing evidence for the efficacy of this treatment.3,4 We report a case of a man who developed avascular necrosis of both hip joints after depot corticosteroids were used to treat his severe hay fever.

Case report

A 42 year old man of Sri Lankan origin developed hay fever at 21 years of age, but his symptoms became severe and disabling only at the age of 27. Every year in mid-April he developed uvular swelling, palatal irritation, profuse rhinorrhoea, incessant sneezing, nasal obstruction, and conjunctivitis. Symptoms continued until the end of July, peaking in June, consistent with tree and grass pollen allergy. His symptoms were so severe that he was unable to work, and he had to sleep with a towel over his pillow. For the past eight years he had also developed seasonal asthma that started in early July and lasted for 2-3 weeks. He had used antihistamines and a number of topical nasal corticosteroids, including beclometasone, fluticasone, and budesonide, but without relief of symptoms; therefore his general practitioner resorted to depot corticosteroids. From 1987 to 1997 he was given 16 injections of depot corticosteroid: nine of Kenalog (triamcinolone; Bristol-Myers Squibb, Hounslow) 40 mg and seven of Depo-Medrone (methylprednisolone; Pharmacia & Upjohn, Milton Keynes) 80 mg. After each injection his symptoms were substantially relieved for up to six weeks. He had no history of atopy or asthma outside the grass pollen season. He was a non-smoker, did not drink alcohol, and had no history of substance abuse or previous musculoskeletal problems.

In August 1997 he developed a limp, with pain in his right hip, and a few months later developed similar symptoms in his left hip. Plain radiographs showed abnormalities in both hip joints (figure ). A magnetic resonance scan arranged by an orthopaedic surgeon showed avascular necrosis of the superior segment of the right femoral head, with early avascular necrosis of the left femoral head (figure ). It was thought that he would require bilateral total hip replacement at some stage in the future.

 Plain radiograph of the hip joints, showing severe avascular necrosis on the right, with collapse of the femoral head associated with underlying lysis and sclerosis. The acetabular joint surface is normal, confirming that this is not a degenerative (osteoarthritic) process. Mild avascular necrosis is seen on the left, with an area of lysis surrounded by a diffuse area of sclerosis

 Magnetic resonance image (T1 weighted) of the hips. The entire femoral head is reduced in signal on the right, indicating diffuse oedema around the necrotic segment. On the left, a line of low signal surrounds an area of normal signal, indicating a previous avascular insult. The normal signal within the lesion corresponds to normal fat and indicates that the marrow at this site is still viable

Comment

A man with severe hay fever was given at least one depot corticosteroid injection each year for 11 years, leading to avascular necrosis of both femoral heads. Depot corticosteroids are widely used in general practice for severe cases and at the patient’s request. Avascular necrosis, an uncommon though serious complication of corticosteroid treatment, has not previously been described in hay fever or with the use of depot corticosteroids.

Avascular necrosis of the hip is associated with corticosteroid therapy, but there is no direct relation with the total corticosteroid dosage.5 Avascular necrosis has been reported to develop after as little as two weeks of corticosteroid treatment,6,7 but susceptibility factors remain elusive. In our case it is difficult to know whether the pharmocokinetics of a depot preparation contributed to avascular necrosis of the femoral head. Avascular necrosis affects patients in their 30s or early 40s, corticosteroids being the leading cause, although alcohol and substance misuse have also been implicated. Patients who develop advanced stages of avascular necrosis of the femoral head at a young age must undergo total hip replacement, which carries a poor long term prognosis.

Specialist advice for hay fever

Hay fever is common and can be debilitating, as in this case, and we suggest that patients whose hay fever is poorly controlled despite treatment with topical corticosteroids and antihistamines should be referred at an early stage to an allergy centre for specialist advice. This patient was eventually referred at age 41 years, when allergy to grass and tree pollens was confirmed by skin tests, and an extremely high grass pollen specific IgE concentration (325 kU/l (normal: <0. 35 kU/l)) was found. He is currently undergoing grass pollen immunotherapy, which is showing clear benefit.

A recent article advised against the use of depot corticosteroids in hay fever and advised that corticosteroids could be given orally but only in special circumstances and only for short periods at the lowest effective dose.8 However, if conventional drug therapy fails, patients with hay fever should be referred to an allergist and considered for pollen immunotherapy. In seasonal allergic rhinitis (grass and birch pollen) the efficacy of immunotherapy has been confirmed in a number of carefully controlled studies.3,4,915 Immunotherapy consists of a series of injections with incremental doses of allergen extract and is a specific treatment for allergic disease that can alter the course of the allergy. A recent study showed that three years of grass pollen immunotherapy in carefully selected patients had benefit for at least three years after discontinuation. 4

Allergy services need improving

In 1986 the Committee on the Safety of Medicines expressed concerns about 25 deaths over 30 years from severe bronchospasm and anaphylaxis in patients receiving immunotherapy (desensitisation). These deaths were almost exclusively in patients with asthma. Furthermore, the injections were given in general practice by people without experience of immunotherapy or an understanding of the potential side effects and without monitoring of the patient. It is now recommended that allergen immunotherapy should be given only by experienced doctors and where facilities are available for resuscitation and monitoring of patients for at least one hour after the injection. In view of the safety issues, patients with multiple allergies, chronic asthma, or other serious medical diseases are excluded from this treatment.2,16 Seasonal asthma is not a contraindication, provided that the patient is asymptomatic outside the pollen season.

It was a failure in management that this patient was not referred to an allergist sooner. The lack of consultant allergists and good quality allergy services has led to the poor availability of immunotherapy in the United Kingdom (about 1000 patients are currently being treated). This is in sharp contrast to the rest of Europe, especially Scandinavia, and the United States, where immunotherapy is used widely. The newer vaccines, which are more potent (a higher content of the major allergen(s)) and biologically standardised, are particularly effective. Immunotherapy is never without risk, but the risks are low if treatment is undertaken in specialised allergy clinics by staff experienced in treating large numbers of patients. More allergists are urgently needed in the United Kingdom. Better provision of allergy services will be cost effective and save NHS funds, as exemplified by this patient.

Acknowledgments

We thank George Bentley of the Royal National Orthopaedic Hospital, Stanmore, London, for kind permission to use the plain radiographs and magnetic resonance images. We are grateful to Philip Bearcroft of the radiology department at Addenbrooke’s Hospital for his expert interpretation of these images.

Notes

Consider immunotherapy rather than depot corticosteroid treatment for hay fever

Footnotes

Competing interests: None declared.

References

2. British Society for Allergy and Clinical Immunology (BSACI) ENT Sub-committee. Rhinitis: management guidelines. 3rd ed. London: Martin Dunitz; 2000. [Google Scholar]3. Varney VA, Gaga M, Frew AJ, Aber VR, Kay AB, Durham SR. Usefulness of immunotherapy in patients with severe summer hayfever uncontrolled by antiallergic drugs. BMJ. 1991;302:265–269. [PMC free article] [PubMed] [Google Scholar]4. Durham SR, Walker SM, Varga E-M, Jacobson MR, O’Brien F, Noble W, et al. Long term efficacy of grass-pollen immunotherapy. N Engl J Med. 1999;341:468–475. [PubMed] [Google Scholar]5. Colwell CW, Robinson CA, Stevenson DD, Vint VC, Morris BA. Osteonecrosis of the femoral head in patients with inflammatory arthritis or asthma receiving corticosteroid therapy. Orthopedics. 1996;19:941–946. [PubMed] [Google Scholar]6. O’Brien TJ, Mack GR. Multifocal osteonecrosis after short-term high-dose corticosteroid therapy. A case report. Clin Orthop. 1992;279:176–179. [PubMed] [Google Scholar]7. Atkinson K, Cohen M, Biggs J. Avascular necrosis of the femoral head secondary to corticosteroid therapy for graft-versus-host disease after marrow transplantation: effective therapy with hip arthroplasty. Bone Marrow Transplant. 1987;2:421–426. [PubMed] [Google Scholar]8. Any place for depot triamcinolone in hay fever? Drug Ther Bull. 1999;37:17–18. [PubMed] [Google Scholar]9. Frankland AW, Augustin R. Prophylaxis of summer hay fever and asthma: a controlled trial comparing crude grass-pollen extracts with the isolated main protein component. Lancet. 1954;1:1055–1057. [PubMed] [Google Scholar]10. McAllen MK. Hyposensitisation in grass pollen hay fever. A double blind trial of alumn precipitated pollen extract and depot emulsion pollen extract compared with placebo injections. Acta Allergol. 1969;24:421–431. [PubMed] [Google Scholar]11. Bousquet J, Maasch HJ, Hejjaoui A, Skassa-Brociek W, Wahl R, Dhivert H, et al. Double-blind, placebo-controlled immunotherapy with mixed grass-pollen allergoids. III. Efficacy and safety of unfractionated and high-molecular-weight preparations in rhinoconjunctivitis and asthma. J Allergy Clin Immunol. 1989;84:546–556. [PubMed] [Google Scholar]12. Pastorello EA, Pravettoni V, Incorvaia C, Mambretti M, Franck E, Wahl R, et al. Clinical and immunological effects of immunotherapy with alum-absorbed grass allergoid in grass-pollen-induced hay fever. Allergy. 1992;47:281–290. [PubMed] [Google Scholar]13. Dolz I, Martinez-Cocera C, Bartolome JM, Cimarra MA. Double-blind, placebo-controlled study of immunotherapy with grass-pollen extract Alutard SQ during a 3-year period with initial rush immunotherapy. Allergy. 1996;51:489–500. [PubMed] [Google Scholar]14. Jacobsen L, Nuchel Petersen B, Wihl JA, Lownestein H, Ipsen H. Immunotherapy with partially purified and standardized tree pollen extracts. IV. Results from long-term (6 year) follow-up. Allergy. 1997;52:914–920. [PubMed] [Google Scholar]15. Walker SM, Varney VA, Gaga M, Jacobsen MR, Durham SR. Grass pollen immunotherapy: efficacy and safety during a 4-year follow-up study. Allergy. 1995;50:405–413. [PubMed] [Google Scholar]16. Position paper on allergen immunotherapy. Report of a BSACI working party. Clin Exp Allergy. 1993;23(suppl 3):1–44. [PubMed] [Google Scholar]

Your Good Health: Steroid shots not advised for allergy

Dear Dr. Roach: I have severe allergies to pollen every spring. I have been tested many times and get allergy injections once a week.


Dear Dr. Roach: I have severe allergies to pollen every spring. I have been tested many times and get allergy injections once a week. These seem to help, but what relieves all of my symptoms for the season is an 80-mg Kenalog injection once a year at the beginning of March. I question whether I can stop the allergy shots altogether and just get the Kenalog injection. I’ve asked my allergy doctor about this, and he indicates that I should stay on the regular allergy shots. Besides the complete allergy relief I get from the steroid shot, I get good side effects — increased energy, and it seems to relieve 75 per cent of my lower-back pain, at least for a couple of months. My second question is, how often can a person take this steroid injection without harm? I’m 63 and am in great shape.


L.F.


I don’t recommend steroid injections such as triamcinolone (Kenalog) at all for seasonal allergies. They certainly are effective, but the absorption is unpredictable.


The potential side effects are serious, and there is no way to get rid of the injected steroid if side effects occur. Serious side effects include elevations in blood pressure and blood sugar (occasionally converting borderline high blood sugars to overt diabetes), loss of bone strength and mental status changes, including acute psychosis.


You report good side effects, but you might be having significant side effects without knowing it.


A good response to systemic steroids, whether by injection or by oral steroids such as prednisone, predicts a good response to topical nasal steroids, which have far fewer side effects.


 


Dear Dr. Roach: I have taken a thyroid supplement since it was first prescribed for me, nearly 30 years ago. The dose has changed from time to time as the lab work would indicate. My dosage has been 75 micrograms for the past several years.


A year ago, my thyroid stimulating-hormone reading was 5.21 and my T4 free was 1.37. My physician at that time requested a second blood test before ordering a change in dosage. I had not taken my levothyroxine the morning of the first test, but did take it prior to the second test, which had results in the normal range. That physician has since left, and my new doctor recently ordered lab work. Prior to going for the blood draw, I did take levothyroxine. The readings were TSH 5.60 and 1.69 T4 free, both higher than the normal range. When I asked about them, the assistant said they were not high enough for the doctor to be concerned.


Would these latest readings cause you to order a retest or a change in medication? Those two items appeared alone on the last page of the report, and I am suspicious that the doctor may have missed looking at that page.


C.V.


TSH is a hormone produced by the pituitary gland that regulates the amount of thyroid hormone released. When the gland makes too much (as in Graves’ disease), TSH levels are low. If the gland can’t make enough (as in Hashimoto’s hypothyroidism), TSH is high. If TSH and thyroxine (T4) are high, it could be that the pituitary is making too much (usually from a tumour). However, your levels are very close to the normal range. I would recommend a recheck at your next visit. There are other causes, such as a recent change in thyroxine dose, but normal variation in hormone levels and in the lab is most likely.


Readers may email questions to [email protected] cornell.edu.

Kenalog-10, Kenalog-40 (triamcinolone acetonide injectable suspension) dosing, indications, interactions, adverse effects, and more

  • acarbose

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of acarbose by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • aceclofenac

    Monitor Closely (1)aceclofenac, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

  • acemetacin

    Monitor Closely (1)acemetacin, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

  • adenovirus types 4 and 7 live, oral

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of adenovirus types 4 and 7 live, oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Corticosteroids may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of corticosteroid therapy.

  • albiglutide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of albiglutide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully. .

  • aldesleukin

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of aldesleukin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid combination because corticosteroids can potentially diminish the antineoplastic effects of aldesleukin.

  • amobarbital

    Monitor Closely (1)amobarbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • amphotericin B cholesteryl sulfate

    Monitor Closely (1)triamcinolone acetonide injectable suspension and amphotericin B cholesteryl sulfate both decrease serum potassium. Use Caution/Monitor.

  • amphotericin B deoxycholate

    Monitor Closely (1)triamcinolone acetonide injectable suspension and amphotericin B deoxycholate both decrease serum potassium. Use Caution/Monitor.

  • amphotericin B liposomal

    Monitor Closely (1)triamcinolone acetonide injectable suspension and amphotericin B liposomal both decrease serum potassium. Use Caution/Monitor.

  • amphotericin B phospholipid complex

    Monitor Closely (1)triamcinolone acetonide injectable suspension and amphotericin B phospholipid complex both decrease serum potassium. Use Caution/Monitor.

  • anthrax vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of anthrax vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • antithrombin alfa

    Monitor Closely (1)triamcinolone acetonide injectable suspension, antithrombin alfa. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • antithrombin III

    Monitor Closely (1)triamcinolone acetonide injectable suspension, antithrombin III. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • aprepitant

    Monitor Closely (1)aprepitant will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • argatroban

    Monitor Closely (1)triamcinolone acetonide injectable suspension, argatroban. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • armodafinil

    Monitor Closely (1)armodafinil will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • artemether/lumefantrine

    Monitor Closely (1)artemether/lumefantrine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • aspirin

    Monitor Closely (1)aspirin, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Aspirin in conjunction with corticosteroids in hypoprothrombinemia should used with caution. Clearance of salicylates may increase with concurrent use of corticosteroids.Minor (1)triamcinolone acetonide injectable suspension decreases levels of aspirin by increasing renal clearance. Minor/Significance Unknown.

  • aspirin rectal

    Monitor Closely (1)aspirin rectal, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Aspirin in conjunction with corticosteroids in hypoprothrombinemia should used with caution. Clearance of salicylates may increase with concurrent use of corticosteroids.Minor (1)triamcinolone acetonide injectable suspension decreases levels of aspirin rectal by increasing renal clearance. Minor/Significance Unknown.

  • aspirin/citric acid/sodium bicarbonate

    Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)triamcinolone acetonide injectable suspension decreases levels of aspirin/citric acid/sodium bicarbonate by increasing renal clearance. Minor/Significance Unknown.

  • atazanavir

    Monitor Closely (1)atazanavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • atracurium

    Monitor Closely (1)atracurium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • axicabtagene ciloleucel

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of axicabtagene ciloleucel by Other (see comment). Avoid or Use Alternate Drug.
    Comment: Avoid prophylactic use of systemic corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.

  • balsalazide

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.

  • BCG vaccine live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • belatacept

    Monitor Closely (1)belatacept and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor.

  • bemiparin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, bemiparin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • bendroflumethiazide

    Minor (1)triamcinolone acetonide injectable suspension, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • bivalirudin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, bivalirudin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • bosentan

    Monitor Closely (1)bosentan will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • budesonide

    Monitor Closely (1)budesonide will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • bumetanide

    Minor (1)triamcinolone acetonide injectable suspension, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • butabarbital

    Monitor Closely (1)butabarbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • butalbital

    Monitor Closely (1)butalbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • calcium acetate

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium acetate by increasing elimination. Minor/Significance Unknown.

  • calcium carbonate

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

  • calcium chloride

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium chloride by increasing elimination. Minor/Significance Unknown.

  • calcium citrate

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium citrate by increasing elimination. Minor/Significance Unknown.

  • calcium gluconate

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

  • carbamazepine

    Serious – Use Alternative (1)carbamazepine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • celecoxib

    Monitor Closely (1)celecoxib, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • chlorothiazide

    Minor (1)triamcinolone acetonide injectable suspension, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • chlorpropamide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of chlorpropamide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • chlorthalidone

    Minor (1)triamcinolone acetonide injectable suspension, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • cholera vaccine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of cholera vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine.

  • cholestyramine

    Monitor Closely (1)cholestyramine decreases levels of triamcinolone acetonide injectable suspension by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

  • choline magnesium trisalicylate

    Monitor Closely (1)choline magnesium trisalicylate, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .Minor (1)triamcinolone acetonide injectable suspension decreases levels of choline magnesium trisalicylate by increasing renal clearance. Minor/Significance Unknown.

  • chromium

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of chromium by increasing renal clearance. Minor/Significance Unknown.

  • cimetidine

    Serious – Use Alternative (1)cimetidine will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • ciprofloxacin

    Monitor Closely (1)triamcinolone acetonide injectable suspension and ciprofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

  • cisatracurium

    Monitor Closely (1)cisatracurium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • clarithromycin

    Serious – Use Alternative (1)clarithromycin will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • clopidogrel

    Monitor Closely (1)triamcinolone acetonide injectable suspension will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel

  • cobicistat

    Monitor Closely (1)cobicistat will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • colestipol

    Minor (1)colestipol decreases levels of triamcinolone acetonide injectable suspension by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

  • conivaptan

    Monitor Closely (1)conivaptan will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • cortisone

    Monitor Closely (1)cortisone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • cyclopenthiazide

    Minor (1)triamcinolone acetonide injectable suspension, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • cyclosporine

    Monitor Closely (2)cyclosporine will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

    triamcinolone acetonide injectable suspension, cyclosporine. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may increase or decrease cyclosporine concentrations. Also, cyclosporine may increase the plasma concentrations of the corticosteroids. Monitor for changes in cyclosporine concentrations and for toxicities of corticosteroids and/or cyclosporine.

  • dalteparin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, dalteparin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • danazol

    Minor (1)danazol, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • darifenacin

    Monitor Closely (1)darifenacin will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • darunavir

    Monitor Closely (1)darunavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • dasatinib

    Monitor Closely (1)dasatinib will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • deferasirox

    Monitor Closely (1)deferasirox will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • dengue vaccine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.

  • denosumab

    Monitor Closely (1)triamcinolone acetonide injectable suspension, denosumab. Other (see comment). Use Caution/Monitor.
    Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.

  • dexamethasone

    Monitor Closely (1)dexamethasone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • DHEA, herbal

    Monitor Closely (1)DHEA, herbal will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • dichlorphenamide

    Monitor Closely (1)dichlorphenamide and triamcinolone acetonide injectable suspension both decrease serum potassium. Use Caution/Monitor.

  • diclofenac

    Monitor Closely (1)diclofenac, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • diflunisal

    Monitor Closely (1)diflunisal, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .Minor (1)triamcinolone acetonide injectable suspension decreases levels of diflunisal by increasing renal clearance. Minor/Significance Unknown.

  • dihydroergotamine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • dihydroergotamine intranasal

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • diltiazem

    Monitor Closely (1)diltiazem will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • diphtheria & tetanus toxoids

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • diphtheria & tetanus toxoids/ acellular pertussis vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of diphtheria & tetanus toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • donepezil

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, donepezil. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • dronedarone

    Monitor Closely (1)dronedarone will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • efavirenz

    Monitor Closely (1)efavirenz will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • elvitegravir/cobicistat/emtricitabine/tenofovir DF

    Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • enoxaparin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, enoxaparin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • ergotamine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • erythromycin base

    Serious – Use Alternative (2)erythromycin base will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

    triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • erythromycin ethylsuccinate

    Serious – Use Alternative (2)erythromycin ethylsuccinate will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

    triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • erythromycin lactobionate

    Serious – Use Alternative (2)erythromycin lactobionate will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

    triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • erythromycin stearate

    Serious – Use Alternative (2)erythromycin stearate will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

    triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • eslicarbazepine acetate

    Minor (1)eslicarbazepine acetate will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

  • ethacrynic acid

    Minor (1)triamcinolone acetonide injectable suspension, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • etodolac

    Monitor Closely (1)etodolac, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • etravirine

    Monitor Closely (1)etravirine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • exenatide injectable solution

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of exenatide injectable solution by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully. .

  • exenatide injectable suspension

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of exenatide injectable suspension by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • fenoprofen

    Monitor Closely (1)fenoprofen, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • feverfew

    Minor (1)triamcinolone acetonide injectable suspension decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.

  • fingolimod

    Monitor Closely (1)triamcinolone acetonide injectable suspension increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .

  • fluconazole

    Monitor Closely (1)fluconazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • fludrocortisone

    Monitor Closely (1)fludrocortisone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • fluoxymesterone

    Minor (1)fluoxymesterone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • flurbiprofen

    Monitor Closely (1)flurbiprofen, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • fondaparinux

    Monitor Closely (1)triamcinolone acetonide injectable suspension, fondaparinux. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • fosamprenavir

    Monitor Closely (1)fosamprenavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • fosphenytoin

    Monitor Closely (1)fosphenytoin will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • furosemide

    Minor (1)triamcinolone acetonide injectable suspension, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • galantamine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, galantamine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • gemifloxacin

    Monitor Closely (1)triamcinolone acetonide injectable suspension and gemifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

  • glimepiride

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of glimepiride by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • glipizide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of glipizide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • glyburide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of glyburide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • glycerol phenylbutyrate

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of glycerol phenylbutyrate by Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may cause the breakdown of body protein and increase plasma ammonia levels; monitor ammonia levels closely when glycerol phenylbutyrate is coadministered with corticosteroids.

  • grapefruit

    Monitor Closely (1)grapefruit will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • griseofulvin

    Monitor Closely (1)griseofulvin will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • haemophilus influenzae type b vaccine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of haemophilus influenzae type b vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

  • hemin

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of hemin by pharmacodynamic antagonism. Use Caution/Monitor. Drugs that increase delta-aminolevulinic acid synthetase may decrease hemin effect.

  • heparin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, heparin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • hepatitis A vaccine inactivated

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of hepatitis A vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • hepatitis a/b vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of hepatitis a/b vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • hepatitis a/typhoid vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of hepatitis a/typhoid vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • hepatitis b vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of hepatitis b vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • human papillomavirus vaccine, nonavalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of human papillomavirus vaccine, nonavalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

  • human papillomavirus vaccine, quadrivalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of human papillomavirus vaccine, quadrivalent by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune responses to vaccines.

  • hydrochlorothiazide

    Minor (1)triamcinolone acetonide injectable suspension, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • hydrocortisone

    Monitor Closely (1)hydrocortisone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ibuprofen

    Monitor Closely (1)ibuprofen, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • ibuprofen IV

    Monitor Closely (1)ibuprofen IV, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • ibuprofen/famotidine

    Monitor Closely (1)ibuprofen/famotidine, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • indacaterol, inhaled

    Monitor Closely (1)triamcinolone acetonide injectable suspension, indacaterol, inhaled. serum potassium. Use Caution/Monitor. Combination may increase risk of hypokalemia.

  • indapamide

    Minor (1)triamcinolone acetonide injectable suspension, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • indinavir

    Monitor Closely (1)indinavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • indomethacin

    Monitor Closely (1)indomethacin, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • influenza A (H5N1) vaccine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of influenza A (H5N1) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids used in greater than physiologic doses may reduce immune response to H5N1 vaccine.

  • influenza virus vaccine (H5N1), adjuvanted

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine (H5N1), adjuvanted by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids used in greater than physiologic doses may reduce immune response to H5N1 vaccine.

  • influenza virus vaccine quadrivalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • influenza virus vaccine quadrivalent, adjuvanted

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

  • influenza virus vaccine quadrivalent, cell-cultured

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent, cell-cultured by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • influenza virus vaccine quadrivalent, intranasal

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • influenza virus vaccine quadrivalent, recombinant

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

  • influenza virus vaccine trivalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • influenza virus vaccine trivalent, adjuvanted

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.

  • influenza virus vaccine trivalent, recombinant

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine trivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.

  • insulin aspart

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin degludec

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin degludec by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin degludec/insulin aspart

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin detemir

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin detemir by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin glargine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin glargine by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin glulisine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin glulisine by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin inhaled

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin lispro

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin lispro by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin NPH

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin NPH by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • insulin regular human

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of insulin regular human by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • isavuconazonium sulfate

    Monitor Closely (1)triamcinolone acetonide injectable suspension and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.

  • isoniazid

    Monitor Closely (1)isoniazid will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)triamcinolone acetonide injectable suspension decreases effects of isoniazid by unknown mechanism. Minor/Significance Unknown.

  • itraconazole

    Serious – Use Alternative (1)itraconazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • Japanese encephalitis virus vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of Japanese encephalitis virus vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • ketoconazole

    Serious – Use Alternative (1)ketoconazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • ketoprofen

    Monitor Closely (1)ketoprofen, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • ketorolac

    Monitor Closely (1)ketorolac, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • ketorolac intranasal

    Monitor Closely (1)ketorolac intranasal, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • lapatinib

    Monitor Closely (1)lapatinib will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • levofloxacin

    Monitor Closely (1)triamcinolone acetonide injectable suspension and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

  • liraglutide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of liraglutide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully. .

  • lomustine

    Monitor Closely (1)lomustine and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.

  • lonapegsomatropin

    Monitor Closely (2)lonapegsomatropin decreases effects of triamcinolone acetonide injectable suspension by Other (see comment). Use Caution/Monitor.
    Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

    triamcinolone acetonide injectable suspension decreases effects of lonapegsomatropin by Other (see comment). Use Caution/Monitor.
    Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.

  • lornoxicam

    Monitor Closely (1)lornoxicam, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

  • lumefantrine

    Monitor Closely (1)lumefantrine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • macimorelin

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin. .

  • marijuana

    Monitor Closely (1)marijuana will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • measles (rubeola) vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • measles mumps and rubella vaccine, live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • measles, mumps, rubella and varicella vaccine, live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • meclofenamate

    Monitor Closely (1)meclofenamate, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • mefenamic acid

    Monitor Closely (1)mefenamic acid, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • meloxicam

    Monitor Closely (1)meloxicam, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • meningococcal A C Y and W-135 polysaccharide vaccine combined

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of meningococcal A C Y and W-135 polysaccharide vaccine combined by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • meningococcal group B vaccine

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.

  • mesalamine

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of mesalamine by increasing renal clearance. Minor/Significance Unknown.

  • mesterolone

    Minor (1)mesterolone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • metformin

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • methyclothiazide

    Minor (1)triamcinolone acetonide injectable suspension, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • methylprednisolone

    Monitor Closely (1)methylprednisolone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • methyltestosterone

    Minor (1)methyltestosterone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • metolazone

    Minor (1)triamcinolone acetonide injectable suspension, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • metronidazole

    Monitor Closely (1)metronidazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • metyrapone

    Minor (1)triamcinolone acetonide injectable suspension decreases effects of metyrapone by unspecified interaction mechanism. Minor/Significance Unknown.

  • miconazole vaginal

    Monitor Closely (1)miconazole vaginal will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • mifepristone

    Contraindicated (1)mifepristone, triamcinolone acetonide injectable suspension. Mechanism: unknown. Contraindicated. Mfr. states that mifepristone is contraindicated in pts. on long term corticosteroid Tx.

  • miglitol

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of miglitol by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • modafinil

    Monitor Closely (1)modafinil will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • moxifloxacin

    Monitor Closely (1)triamcinolone acetonide injectable suspension and moxifloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

  • nabumetone

    Monitor Closely (1)nabumetone, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • naproxen

    Monitor Closely (1)naproxen, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • nateglinide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • nefazodone

    Serious – Use Alternative (1)nefazodone will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • nelfinavir

    Monitor Closely (1)nelfinavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • neostigmine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, neostigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • nevirapine

    Monitor Closely (1)nevirapine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • nifedipine

    Monitor Closely (1)nifedipine will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • nilotinib

    Monitor Closely (1)nilotinib will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ocrelizumab

    Monitor Closely (1)triamcinolone acetonide injectable suspension and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with high doses of corticosteroids is expected to increase the risk of immunosuppression.

  • ofatumumab SC

    Monitor Closely (1)ofatumumab SC, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.

  • ofloxacin

    Monitor Closely (1)triamcinolone acetonide injectable suspension and ofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

  • olodaterol inhaled

    Monitor Closely (1)triamcinolone acetonide injectable suspension and olodaterol inhaled both decrease serum potassium. Use Caution/Monitor.

  • oxaliplatin

    Monitor Closely (1)oxaliplatin and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Use of oxaliplatin with concomitant immunosuppressants or with impaired immune systems may increased risk for serious infections.

  • oxandrolone

    Minor (1)oxandrolone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • oxaprozin

    Monitor Closely (1)oxaprozin, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • oxcarbazepine

    Monitor Closely (1)oxcarbazepine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • oxymetholone

    Minor (1)oxymetholone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • ozanimod

    Monitor Closely (1)ozanimod, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.

  • pancuronium

    Monitor Closely (1)pancuronium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • parecoxib

    Monitor Closely (1)parecoxib, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

  • pentobarbital

    Monitor Closely (1)pentobarbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • phenindione

    Monitor Closely (1)triamcinolone acetonide injectable suspension, phenindione. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • phenobarbital

    Monitor Closely (1)phenobarbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • phenytoin

    Monitor Closely (1)phenytoin will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • physostigmine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, physostigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • pioglitazone

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of pioglitazone by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • piroxicam

    Monitor Closely (1)piroxicam, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • pneumococcal vaccine 13-valent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of pneumococcal vaccine 13-valent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • pneumococcal vaccine heptavalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of pneumococcal vaccine heptavalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • pneumococcal vaccine polyvalent

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of pneumococcal vaccine polyvalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • poliovirus vaccine inactivated

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of poliovirus vaccine inactivated by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Avoid vaccination during chemotherapy or radiation therapy if possible because antibody response might be suboptimal. Patients vaccinated within a 14-day period before starting or during immunosuppressive therapy should be revaccinated =3 months after therapy is discontinued if immune competence has been restored. .

  • ponesimod

    Monitor Closely (1)ponesimod and triamcinolone acetonide injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.

  • porfimer

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of porfimer by unspecified interaction mechanism. Minor/Significance Unknown.

  • posaconazole

    Monitor Closely (1)posaconazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • prednisone

    Monitor Closely (1)prednisone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • primidone

    Monitor Closely (1)primidone will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • protamine

    Monitor Closely (1)triamcinolone acetonide injectable suspension, protamine. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • pyridostigmine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, pyridostigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • quinupristin/dalfopristin

    Monitor Closely (1)quinupristin/dalfopristin will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • rabies vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of rabies vaccine by pharmacodynamic antagonism. Contraindicated. Immunosuppressants may interfere with development of active immunity.

  • rabies vaccine chick embryo cell derived

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of rabies vaccine chick embryo cell derived by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • ranolazine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • repaglinide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of repaglinide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • rifabutin

    Serious – Use Alternative (1)rifabutin will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • rifampin

    Serious – Use Alternative (1)rifampin will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • rifapentine

    Monitor Closely (1)rifapentine will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • ritonavir

    Monitor Closely (1)ritonavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • rivastigmine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, rivastigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

  • rocuronium

    Monitor Closely (1)rocuronium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • rosiglitazone

    Minor (1)triamcinolone acetonide injectable suspension decreases effects of rosiglitazone by pharmacodynamic antagonism. Minor/Significance Unknown.

  • rotavirus oral vaccine, live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of rotavirus oral vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • rubella vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of rubella vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • rufinamide

    Monitor Closely (1)rufinamide will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • salicylates (non-asa)

    Monitor Closely (1)salicylates (non-asa), triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)triamcinolone acetonide injectable suspension decreases levels of salicylates (non-asa) by increasing renal clearance. Minor/Significance Unknown.

  • salsalate

    Monitor Closely (1)salsalate, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .Minor (1)triamcinolone acetonide injectable suspension decreases levels of salsalate by increasing renal clearance. Minor/Significance Unknown.

  • saquinavir

    Monitor Closely (1)saquinavir will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • sargramostim

    Minor (1)triamcinolone acetonide injectable suspension increases effects of sargramostim by pharmacodynamic synergism. Minor/Significance Unknown.

  • saxagliptin

    Minor (1)triamcinolone acetonide injectable suspension decreases effects of saxagliptin by pharmacodynamic antagonism. Minor/Significance Unknown.

  • secobarbital

    Monitor Closely (1)secobarbital will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • silodosin

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • sipuleucel-T

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

  • sirolimus

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • sitagliptin

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of sitagliptin by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • smallpox (vaccinia) vaccine, live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of smallpox (vaccinia) vaccine, live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • sodium picosulfate/magnesium oxide/anhydrous citric acid

    Monitor Closely (1)triamcinolone acetonide injectable suspension, sodium picosulfate/magnesium oxide/anhydrous citric acid.
    Either increases toxicity of the other by Other (see comment). Use Caution/Monitor.
    Comment: May be associated with fluid and electrolyte imbalances such as hypokalemia.

  • sodium sulfate/?magnesium sulfate/potassium chloride

    Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of triamcinolone acetonide injectable suspension by Other (see comment). Use Caution/Monitor.
    Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

  • sodium sulfate/potassium sulfate/magnesium sulfate

    Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of triamcinolone acetonide injectable suspension by Other (see comment). Use Caution/Monitor.
    Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

  • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

    Monitor Closely (1)triamcinolone acetonide injectable suspension and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

  • somapacitan

    Monitor Closely (1)somapacitan decreases effects of triamcinolone acetonide injectable suspension by Other (see comment). Modify Therapy/Monitor Closely.
    Comment: Microsomal enzyme 11-beta-hydroxysteroid dehydrogenase type 1 (11-beta-HSD-1) required for cortisone conversion to its active metabolite, cortisol, in hepatic and adipose tissue. GH inhibits 11-beta-HSD-1. Patients treated with glucocorticoid for hypoadrenalism may require increased maintenance or stress doses after initiating somapacitan.

  • somatrem

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of somatrem by pharmacodynamic antagonism. Use Caution/Monitor.

  • somatropin

    Minor (1)triamcinolone acetonide injectable suspension decreases effects of somatropin by pharmacodynamic antagonism. Minor/Significance Unknown.

  • sorafenib

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases levels of sorafenib by increasing metabolism. Use Caution/Monitor.

  • squill

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension increases toxicity of squill by unspecified interaction mechanism. Avoid or Use Alternate Drug.

  • St John’s Wort

    Serious – Use Alternative (1)St John’s Wort will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • succinylcholine

    Monitor Closely (1)succinylcholine, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • sulfasalazine

    Monitor Closely (1)sulfasalazine, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)triamcinolone acetonide injectable suspension decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.

  • sulindac

    Monitor Closely (1)sulindac, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • tacrolimus

    Minor (1)triamcinolone acetonide injectable suspension, tacrolimus.
    Either increases levels of the other by decreasing metabolism. Minor/Significance Unknown.

  • testosterone

    Minor (1)testosterone, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • testosterone buccal system

    Minor (1)testosterone buccal system, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • testosterone intranasal

    Serious – Use Alternative (1)testosterone intranasal, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug.
    Comment: Coadministration increases risk for edema, particularly in patients with cardiac, renal, or hepatic disease.

  • testosterone topical

    Minor (1)testosterone topical, triamcinolone acetonide injectable suspension.
    Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May enhance edema formation.

  • tetanus toxoid adsorbed or fluid

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of tetanus toxoid adsorbed or fluid by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • tick-borne encephalitis vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of tick-borne encephalitis vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • tisagenlecleucel

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of tisagenlecleucel by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid using corticosteroids as premedication or during treatment with tisagenlecleucel, except for life-threatening emergence (eg, cytokine release syndrome).

  • tofacitinib

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension, tofacitinib.
    Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

  • tolazamide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • tolbutamide

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of tolbutamide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • tolfenamic acid

    Monitor Closely (1)tolfenamic acid, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

  • tolmetin

    Monitor Closely (1)tolmetin, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .

  • tolvaptan

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension will decrease the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

  • topiramate

    Monitor Closely (1)topiramate will decrease the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • torsemide

    Minor (1)triamcinolone acetonide injectable suspension, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypokalemia, especially with strong glucocorticoid activity.

  • trastuzumab

    Monitor Closely (1)trastuzumab, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

  • trastuzumab deruxtecan

    Monitor Closely (1)trastuzumab deruxtecan, triamcinolone acetonide injectable suspension.
    Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.

  • travelers diarrhea and cholera vaccine inactivated

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of travelers diarrhea and cholera vaccine inactivated by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • typhoid polysaccharide vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of typhoid polysaccharide vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • typhoid vaccine live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • varicella virus vaccine live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • vecuronium

    Monitor Closely (1)vecuronium, triamcinolone acetonide injectable suspension. Other (see comment). Use Caution/Monitor.
    Comment: Coadministration of corticosteroids and neuromuscular blockers may increase risk of developing acute myopathy.

  • verapamil

    Monitor Closely (1)verapamil will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • vildagliptin

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of vildagliptin by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

  • voriconazole

    Monitor Closely (1)voriconazole will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • warfarin

    Monitor Closely (1)triamcinolone acetonide injectable suspension, warfarin. Other (see comment). Use Caution/Monitor.
    Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

  • willow bark

    Minor (1)triamcinolone acetonide injectable suspension decreases levels of willow bark by increasing renal clearance. Minor/Significance Unknown.

  • xipamide

    Monitor Closely (1)xipamide, triamcinolone acetonide injectable suspension. pharmacodynamic synergism. Use Caution/Monitor. Risk of hypokalemia.

  • yellow fever vaccine

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of yellow fever vaccine by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • zafirlukast

    Monitor Closely (1)zafirlukast will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

  • zoster vaccine live

    Serious – Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of zoster vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

  • zoster vaccine recombinant

    Monitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.

  • what it is, benefits and risks

    If you’re plagued with severe sniffles, sneezing, watery eyes and an itchy throat as soon as warmer weather arrives – and medicines and nasal sprays don’t give you any reprieve – the hay fever injection could be the solution you’re looking for.

    As anyone who suffers from acute bouts of hay fever will tell you, this pesky pollen allergy can be all-consuming and make life extremely difficult. There’s no cure for the condition, also known as allergic rhinitis, so treatments are the only way to keep symptoms in check.

    To help you breathe easy this year, we spoke to Dr Seth Rankin, founder of London Doctors Clinic, and pharmacist Anshu Kaura of LloydsPharmacy, to explain how the hay fever injection works, reveal the risks associated with it, and share alternative treatment suggestions:

    What is hay fever?

    Hay fever is an allergic reaction to pollen. Around 10 to 15 per cent of Brits are afflicted at different stages of the year, depending on the type of pollen they’re allergic to. Tree pollen allergies are triggered between March and May, while grass pollen occurs between May and July, and weed pollen allergies are activated between June and September.

      Hay fever is the same as any other allergic response: your immune system identifies a foreign substance entering the body and attempts to remove it – initiating an inflammatory response. In the case of hay fever, the foreign body is pollen, which is harmless.

      Hay fever is the same as any allergy: your immune system identifies a foreign substance and attempts to remove it.

      While ‘defending’ your body from the pollen, your immune system triggers a cascade of cold-like symptoms that range from frequent sneezing and coughing to severe exhaustion and sickness. Other common hay fever symptoms include:

      • Runny or blocked nose
      • Red watery eyes
      • Itchy throat, mouth, nose, eyes or ears
      • Headaches
      • Wheezing
      • Tight chest
      • Loss of smell

        Antihistamine tablets, nasal sprays and eye drops are available on prescription and over the counter to treat the symptoms of hay fever. However, around two thirds of sufferers find their symptoms do not respond to these treatments, and this is where the hay fever injection comes in.

        Elena Shevchuk

        Can you get a hay fever injection?

        The hay fever injection, called Kenalog, is still officially licensed for the treatment of severe hay fever in the UK, but it’s only available in private clinics. It contains triamcinolone acetonide, which belongs to a group of medicines called corticosteroids (steroids). ‘Steroids are some of the most powerful anti-inflammatory medications available,’ says Dr Rankin. ‘They are used to treat a variety of conditions in which the body’s immune system gets out of control, including asthma and rheumatoid arthritis.’

        The NHS has determined that any potential benefits associated with administering a steroid injection for hay fever do not outweigh the risks. Steroid tablets (such as prednisolone) are occasionally prescribed for hay fever, but for no longer than 10 days. The longer you take them, the more likely it is you’ll experience side effects such as weight gain, difficulty sleeping, and mood changes such as anxiety and depression. Steroid nasal sprays or drops (containing betamethasone and fluticasone) are also available on prescription, but shouldn’t be used for more than four weeks.



        Does the hay fever injection work?

        There is scientific evidence that the hay fever injection is effective. In a randomised, double-blind, placebo-controlled trial from 1972, the hay fever injection was administered to 97 people with severe symptoms of hay fever. After 10 days, symptoms had improved or resolved in 94 per cent of the patients.

        ‘A single dose is likely to relieve hay fever symptoms,’ a Drug and Therapeutics Bulletin (DTB) concluded in 1999, ‘but it is unclear for how long any benefit is likely to last, what unwanted effects might develop and how it compares with standard therapy’. The bulletin recommended against the hay fever injection ‘until there is clear evidence of its advantages over other hay fever treatments’.

        A single dose of the hay fever injection is likely to relieve symptoms, but it is unclear how long any benefit is likely to last.

        In 2019, a fresh review of the hay fever injection was prepared by the UK Medicines Information. ‘Despite the likelihood that a single injection of Kenalog will relieve hay fever symptoms, there remains uncertainly about the efficacy and safety of repeated administration,’ the authors wrote. ‘There is a paucity of comparative studies and no new data on Kenalog have been published to change the conclusions of the DTB review in 1999 that this product should not be used.’

        Getty Images

        How does the hay fever injection work?

        The hay fever injection works by temporarily suppressing your body’s immune response for long enough to relieve symptoms. The steroids are injected into the buttock – known as an IntraMuscular (IM) injection – depositing a low dose directly into the muscle. They slowly leak into the bloodstream over the course of three weeks.

        How long does the hay fever injection take to work?

        Once the injection is administered, the effects last for a minimum of three weeks, with many people experiencing relief from symptoms that lasts the entire season. Usually one dose of the hay fever\ injection, equivalent to 40mg triamcinolone acetonide, is enough. It’s not recommended that anyone have more than two injections per hay fever season.

        How much does the hay fever injection cost?

        The hay fever injection isn’t available on the NHS, and it certainly isn’t cheap. Generally, each 40mg dose will set you back upwards of £75, though it varies from clinic to clinic. Often the price covers the consultation too, but it’s worth checking before you book.



        Hay fever injection risks

        Before you look to the hay fever injection as a remedy for severe hay fever symptoms, it’s worth familiarising yourself with the risks and potential side effects:

        • Hay fever injection side effects

        Taking steroid medication is not without risks. It’s possible to experience short- and long-term side effects from the hay fever injection, such as swelling, breathing difficulties, itchy skin, abdominal pain, raised blood pressure and raised blood sugar, among others. ‘Before anyone agrees to a steroid treatment, they should be made explicitly aware of the potential side effects, but it’s also good to remember that they are relatively rare,’ says Dr Rankin.

        • Hay fever injection persistent side effects

        While the hay fever injection is more convenient than taking tablets, if you’re unlucky enough to suffer side effects, you’ll be stuck with them for longer, says Dr Rankin. ‘Once you’ve had the injection, there’s nothing that anyone can do to stop the steroids leaking into your bloodstream,’ he says. ‘If you do suffer any side effects, they may last for up to three weeks.’ Your immune system will also be suppressed during this time, leaving you more at risk of infection.

        • Hay fever injection and underlying medical conditions

        Steroids, such as the hay fever injection, can exacerbate existing medical conditions – such as diabetes, stomach ulcers, and infections – and interact with certain medications, like aspirin and ibuprofen. It can also interfere with certain lab tests to produce false results. If you’re thinking about getting the hay fever injection, speak to your GP or a qualified medical professional first – they’ll help you make an informed decision.



        Hay fever injection benefits

        It’s not all doom and gloom. There are some potential benefits associated with the hay fever injection:

        ✔️ The hay fever injection is convenient

        No one can deny the appeal of quelling hay fever symptoms with a one-off shot. ‘Hay fever sufferers generally only require one injection to reduce symptoms for the entire season,’ says Dr Rankin. ‘Compared to taking tablets every day, that’s very convenient.’

        ✔️ The hay fever injection is less potent than steroid tablets

        Theoretically, a lower dose means a reduction in the severity of potential side effects. ‘Each injection is roughly equal to the steroid dose from taking a 5mg tablet of Prednisolone every day for around three weeks,’ says Dr Rankin. ‘It does not have to go through the liver or the digestive system, so you can administer a slightly lower dose than the tablet form.’

        ✔️ The hay fever injection can be effective

        Some people report significant improvements in their symptoms after having the hay fever injection. ‘For severe sufferers, life can be seriously disrupted by hay fever,’ says Dr Rankin. ‘Untreated, hay fever has been shown to reduce students’ exam results by between five and 10 per cent. Patients report feeling unwell or exhausted for several months at a time.’



        Can you permanently get rid of hay fever?

        Unfortunately, there’s no cure for hay fever. The only way to control the condition is to limit your exposure to pollen and treat symptoms with topical and oral antihistamines, nasal steroids and eye drops. Those who experience severe hay fever each year may be a candidate for immunotherapy, which involves being exposed to small amounts of pollen to help build up immunity.

        ‘This form of therapy is a long-term treatment option that helps prevent allergy symptoms from occurring in the first place or at least reduce the severity of the symptoms,’ says Kaura. ‘The best time to start hay fever immunotherapy is ahead of the peak pollen season, which typically takes place March until July. Patients receive small doses of treatment, over the course of three to four months, helping gradually build up immunity.’

        Those who experience severe hay fever each year may be a candidate for immunotherapy to help build up immunity.

        Immunotherapy can be administered in the form of an injection, known as systemic injection immunotherapy (SIT), or as a tablet that dissolves under your tongue, known as sublingual immunotherapy (SLIT). Over time, it reduces the severity of your immune system reaction, which results in milder symptoms. Immunotherapy is a slow process – to achieve long-term pollen desensitisation, usually three years of treatment is required.

          ‘Immunotherapy isn’t always safe for everyone, which is why it’s important to seek advice from your GP first and if you do decided to proceed, seek the treatment from somewhere safe and reputable,’ says Kaura. ‘For people who can’t seem to shake symptoms despite trying lifestyle changes and over-the-counter medicine – their GP may refer them for immunotherapy, if suitable.’

          Does hay fever improve with age?

          In much the same way that allergies like hay fever can develop in adulthood, they can also dwindle as you age. Many people find their hay fever symptoms become less severe as they get older – around half of people report improvements in symptoms, and a lucky 10-20 per cent find their symptoms vanish entirely. A study by University Hospital in Sweden concluded that hay fever was most likely to disappear when people reach their fifties.



            Last updated: 21-04-2021

            This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

            Steroid Shots For Allergies – Side Effects, How They Work, More

            There’s no sugarcoating the fact that allergies are an absolute pain in the you-know-what. And when warmer temps roll around, allergy sufferers have to deal with weeks and weeks of red, itchy eyes and plenty of sneezing.

            And it seems like allergy season just keeps getting worse, right?! Well, the severity of allergy season depends on weather patterns, the amount of rain, and the temperature, says Kara Wada, MD, allergist/immunologist at the Ohio State University Wexner Medical Center. Unfortunately, climate change has had an effect on all of these—and that’s the case for the 2020 allergy season, too. “Each year of the last several years, we have seen increases in the pollen counts and pollen seasons are lasting longer. This has been attributed to climate change.” Spring has sprung earlier than usual, about three to four weeks, than the long-term average, according to the National Phenology Network.

            Early spring also means this year’s pollen season has already started, as low levels of pollen have already been measured says Tricia Lee, MD, allergist/immunologist at Hudson Allergy, who has already received calls from symptomatic patients.

            Okay, an early and worse allergy season may sound like a nightmare—which may make you consider a strong remedy for relief, like a steroid shot. But you do have options, and they don’t only include steroid shots, which do come with a ton of side effects (more on that ahead).

            This content is imported from {embed-name}. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

            If you aren’t sure what route you should take to relieve your allergy symptoms, consult an allergist-immunologist for advice tailored to you. In the meantime, here’s what you should know about steroid shots for allergies.

            What’s up with steroid shots for allergies?

            First, a quick lesson on allergy basics: You get allergies when your body overreacts to a substance (like pollen or cat dander) in an attempt to protect you from it. (Cue the congestion and watery eyes.)

            A steroid shot is an aggressive remedy used to calm that response, says Purvi Parikh, MD, an allergy and immunology clinical assistant professor at NYU Langone Health. But while these steroid shots are extremely effective, they should only be administered “when all else fails,” says Dr. Parikh.

            That’s because there are long-term side effects of overuse—and overdoing it is when you exceed two shots in the same year and continue that practice every year. Side effects include: weight gain, diabetes, bone deterioration, and cataracts (to name a few), says Dr. Parikh.

            So, over-the-counter preventative medications should always be your first move, she says. But if you develop breathing problems, start wheezing, or contract a virus as a result of your allergies, then a steroid shot might be right for you. Still, don’t make it a regular thing.

            What is it like getting a steroid shot for allergies?

            The steroid shot is administered by an allergist and injected into a muscle, usually in the arm. The steroid shot takes six hours to go into effect, and there’s no going back once it starts working. That means, if you have a bad reaction to the shot, you’ll need to deal with it until the shot wears off in a few weeks or months, says Dr. Parikh.

            Thankfully, there’s a much less intense route: steroid-free immunotherapy shots. “That’s the best long-term solution,” says Dr. Parikh, who adds that these shots work by introducing small amounts of the allergen to your body, in an effort to help you slowly acclimate to it. “Over time, your body stops reacting,” she says.

            Generally, a patient will start with low concentrations and build up to a monthly maintenance shot, Dr. Lee explains. “These shots help the patient so that next time the body is exposed to the allergen, it is less reactive.”

            So basically, steroid shots work on the symptoms of your allergies, while immunotherapy shots work to lessen your body’s defenses. The downside: Immunotherapy shots can take a year or longer before they provide relief.

            If you’re a bit wary of needles, though, there’s another option still: nasal corticosteroids. While, yes, these contain steroids, “the steroid nasal sprays are very safe because very little of that steroid goes in your body,” says Dr. Parikh. Like the steroid shots, steroid nasal sprays also work to reduce inflammation.

            Are there any side effects of steroid shots that I should know about?

            There is a risk of having an adverse reaction to a steroid shot, and Dr. Wada says she typically doesn’t use steroid shots in her practice. “Although they can be incredibly helpful when someone is very sick, they have significant potential for harm especially if used regularly,” she says. “These side effects include high blood pressure, high blood sugar, weight gain, mood swings, loss of bone and eye disease.”

            Dr. Lee also says that she doesn’t usually recommend steroid shots because absorption is unpredictable, and there is an inability to adjust the dosage if side effects do occur.

            Over-the-counter preventative medications should always be your first move, says Dr. Parikh.

            If you do have a need for this treatment, Dr. Wada suggests scheduling an appointment with a board certified allergist-immunologist to develop an individualized treatment plan with both safety and efficacy in mind.

            There is still a risk of side effects when using steroid-free immunotherapy shots, but reactions are typically a lot more minor. “We commonly see minor reactions such as redness, itching and swelling at the injection site,” Dr. Lee says about steroid-free allergy shots. “Though in rare cases, more serious reactions can occur, including difficulty breathing, itchy rashes and anaphylaxis, a severe and potentially life-threatening allergic reaction.”

            Should I give steroid shots a try?

            The sad truth: You can’t get rid of allergies. All you can really do is suppress them or slowly acclimate to them (via immunotherapy shots), says Dr. Parikh.

            The best route is to start using steroid nasal sprays or oral allergy relief medicines before allergy season starts—at least two weeks in advance, says Dr. Parikh. If you don’t feel relief from that, then it might be time to consider immunotherapy shots.

            If none of those options work for you, then (and only then) should you turn to steroid shots. And if that’s what you decide to do, make sure you limit them to one or two shots max, per year.

            The bottom line: Steroid shots work, but they should be your last resort for allergy relief. It’s best to try OTC medicines, steroid nasal sprays, or immunotherapy shots first.

            Aryelle Siclait
            Associate Editor
            Aryelle Siclait is the associate editor at Women’s Health where she writes and edits articles about relationships, sexual health, pop culture, and fashion for verticals across WomensHealthMag.com and the print magazine.

            Jasmine Gomez
            Associate Lifestyle editor
            Jasmine Gomez is the associate lifestyle editor at Women’s Health and covers health, fitness, sex, culture and cool products.

            This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

            Kenalog instructions for use: indications, contraindications, side effects – description of Kenalog tab. 4 mg: 50 pcs. (380)

            💊 Composition of the preparation Kenalog

            ✅ Application of the drug Kenalog

            Save

            Share with friends

            Please fill in the fields of e-mail addresses and make sure they are correct

            Description of the active components of the drug

            Kenalog
            (Kenalog)

            The scientific information provided is generalized and cannot be used to make
            decisions about the possibility of using a particular drug.

            Update date: 2020.05.29

            Marketing authorization holder:

            ATX code:

            H02AB08

            (Triamcinolone)

            Dosage form

            Kenalog

            Tab.4 mg: 50 pcs.

            reg. No .: P N012381 / 01
            from 12.10.10
            – Unlimited

            Release form, packaging and composition
            drug Kenalog

            Tablets 1 tab.
            Triamcinolone 4 mg

            50 pcs.- dark glass bottles (1) – cardboard packs.

            Pharmacological action

            GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of ​​inflammation. Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ​​inflammation.Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

            Inhibits the activity of phospholipase A 2 , which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

            Decreases 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; inhibits the formation of antibodies.

            Triamcinolone inhibits the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.

            When applied directly to the vessels, it has a vasoconstrictor effect.

            Triamcinolone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, triamcinolone enhances the storage of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism.An increase in blood glucose activates the release of insulin.

            Triamcinolone inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which contributes to the accumulation of fat.

            Has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue.

            Osteoporosis and Itsenko-Cushing’s syndrome are the main factors limiting long-term GCS therapy.As a result of the catabolic effect, it is possible to suppress growth in children.

            In high doses, triamcinolone can increase the excitability of brain tissue and helps to lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

            With systemic use, the therapeutic activity of triamcinolone is due to anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

            When applied topically and locally, the therapeutic activity of triamcinolone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) action.

            When used by inhalation, it has an anti-inflammatory effect on the bronchial mucosa in patients with bronchial asthma. With constant use, it reduces the number of mast cells, macrophages, T-lymphocytes and eosinophils in the epithelium and submucous layer of the bronchi, suppresses airway hyperresponsiveness.

            In terms of anti-inflammatory activity, triamcinolone is close to hydrocortisone, and triamcinolone acetonide is 6 times more active. Mineralocorticoid activity in triamcinolone and triamcinolone acetonide is practically absent.

            Pharmacokinetics

            Metabolized mainly in the liver and partly in the kidneys. The main metabolic pathway is 6-beta hydroxylation. T 1/2 – 3.5 h. Excreted by the kidneys.

            Indications of the active substances of the drug

            Kenalog

            For oral administration: rheumatism, rheumatoid arthritis, systemic lupus erythematosus and other collagenoses, acute allergic reactions, allergic skin diseases, severe forms of bronchial asthma, erythema multiforme, hemorrhagic diathesis, hemolytic anemia, lymphomas, leukemias.

            For parenteral use: rheumatoid arthritis, connective tissue diseases, systemic lupus erythematosus, dermatoses, pulmonary emphysema and pulmonary fibrosis, lymphosarcoma, lymphogranulomatosis, lymphatic leukemia, nephrotic syndrome, sprue.

            For inhalation use: bronchial asthma in the acute phase. Insufficient effectiveness of bronchodilators and / or stabilizers of mast cell membranes in the treatment of bronchial asthma. Hormone-dependent bronchial asthma (in order to reduce the dose of oral corticosteroids).Allergic rhinitis.

            For external use: eczema, psoriasis, neurodermatitis, various types of dermatitis and other inflammatory and allergic skin diseases of non-microbial etiology (as part of complex therapy).

            Dosing regimen

            Method of application and dosage regimen of a particular drug depends on its form of release and other factors.The optimal dosage regimen is determined by the doctor. It is necessary to strictly observe the compliance of the used dosage form of a particular drug with the indications for use and the dosage regimen.

            Inside for adults – 4-20 mg per day in 2-3 doses. After improvement of the condition, the daily dose is gradually reduced by 1-2 mg every 2-3 days to the minimum maintenance dose of 1 mg and the complete cancellation of therapy.

            V / m at the beginning of treatment – 40 mg 1 time in 4 weeks.Then, depending on the indications and the patient’s response to treatment, 40-80 mg can be administered every 2-4 weeks. If necessary, a single dose can be increased to 100 mg. To avoid subcutaneous atrophy, it is injected deep into the muscle.

            When administered intra-articularly, as well as when administered in the area of ​​the lesion, the dose is 10-40 mg. The interval between injections is at least 1 week.

            For inhalation use, the dose depends on the dosage form used and the age of the patient.

            Applied externally 1-3 times / day. The duration of treatment is determined individually and is usually 5-10 days. With a persistent course of the disease, the course of treatment can be extended up to 25 days. Application for more than 4 weeks is not recommended.

            Side effects

            From the endocrine system: redistribution of adipose tissue, menstrual irregularities, increased blood glucose levels, suppression of adrenal function, “moon face”, striae, hirsutism, acne.

            From the metabolic side: edema, electrolyte imbalance, negative nitrogen balance, growth retardation in children.

            From the digestive system: steroid stomach ulcer, erosive and ulcerative lesions of the gastrointestinal tract, acute pancreatitis.

            From the side of the central nervous system: convulsions, sleep disturbances, mental disorders, headaches and dizziness, weakness.

            From the musculoskeletal system: myopathy, osteoporosis.

            From the cardiovascular system: arterial hypertension.

            From the side of the blood coagulation system: thromboembolism.

            From the side of the organ of vision: visual impairment, posterior subcapsular cataract, increased intraocular pressure or exophthalmos, anaphylactic reactions.

            Reactions due to immunosuppressive action: exacerbation of infectious diseases.

            With intra-articular administration: possible joint pain, irritation at the injection site, depigmentation, sterile abscess, skin atrophy, when administered in doses of more than 40 mg, resorptive side effects are possible.

            Inhalation: possible headache, sneezing, cough, dryness of the mucous membrane of the mouth or nose, irritation in the nose, hoarseness, rarely – fungal infection of the nasopharynx caused by Candida albicans.

            For external use: may itch, skin irritation, late reactions such as eczema, steroid acne, purpura. With prolonged use of the ointment, the development of secondary infectious lesions and atrophic skin changes is possible.

            Contraindications to use

            Acute psychoses in history, active form of tuberculosis, myasthenia gravis, neoplasms with metastases, diverticulitis, gastric ulcer and duodenal ulcer, arterial hypertension, Itsenko-Cushing syndrome, renal failure, thrombosis and embolism in history, diabetes mellitus, latent infections, diabetes mellitus, latent infections amyloidosis, syphilis, fungal diseases, viral infections (incl.including caused by Herpes simplex and Varicella zoster), amoebic infections, poliomyelitis (with the exception of bulbar-encephalitis form), gonococcal or tuberculous arthritis, vaccination period, lymphadenitis after BCG vaccination, glaucoma, infected skin lesions.

            Use during pregnancy and lactation

            If it is necessary to use it during pregnancy (especially in the first trimester) and during lactation, the intended benefits for the mother and the risk of side effects in the fetus or child should be assessed.

            Application for impaired renal function

            Contraindicated: renal failure.

            Use in children

            Parenteral use in children under 6 years of age is not recommended; at the age of 6-12 years – according to strict indications.

            Avoid long-term external use in children, regardless of age.

            Special instructions

            Not intended for intravenous administration.

            With caution and under strict medical supervision, it is used for edema, obesity, mental illness and gastrointestinal diseases. During the treatment period, it is recommended to take vitamin D and eat foods rich in calcium.

            After a single intramuscular injection at a dose of 60-100 mg for 24-48 hours, suppression of adrenal function can be observed, which is usually restored after 30-40 days.

            When applied externally to prevent local infectious complications, it is recommended to use it in combination with antimicrobial agents.

            Parenteral administration in children under 6 years of age is not recommended; at the age of 6-12 years – according to strict indications.

            Avoid long-term external use in children, regardless of age.

            Drug interactions

            When used simultaneously with anabolic steroids, androgens, the risk of developing peripheral edema and acne increases.

            With simultaneous use with antithyroid drugs and thyroid hormones, the function of the thyroid gland may change.

            When used simultaneously with blockers of histamine H 1 -receptors, the effect of triamcinolone decreases; with hormonal contraceptives – the action of triamcinolone is potentiated.

            Hypocalcemia associated with the use of triamcinolone can lead to an increase in the duration of neuromuscular blockade caused by the action of depolarizing muscle relaxants when used simultaneously.

            When used simultaneously with immunosuppressants, the risk of developing bacterial and viral infections increases.

            With simultaneous use with potassium-sparing diuretics hypokalemia is possible.

            With simultaneous use, it is possible to reduce the effectiveness of indirect anticoagulants, heparin, streptokinase, urokinase, increase the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract.

            With simultaneous use with NSAIDs (including acetylsalicylic acid), the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract increases.

            With simultaneous use, the effect of oral hypoglycemic agents, insulin, is weakened; with laxatives – hypokalemia is possible; with cardiac glycosides – the risk of developing cardiac arrhythmias and other toxic effects of glycosides increases.

            With simultaneous use with tricyclic antidepressants, it is possible to increase mental disorders associated with taking triamcinolone.

            When used simultaneously with m-anticholinergics (incl.including atropine) may increase intraocular pressure.

            With simultaneous use with amphotericin B, carbonic anhydrase inhibitors, there is a risk of hypokalemia, left ventricular myocardial hypertrophy and circulatory failure.

            With simultaneous use with isoniazid, it is possible to reduce the concentration of isoniazid in the blood plasma, mainly in persons with rapid acetylation.

            With simultaneous use, it is possible to accelerate biotransformation and reduce the concentration of mexiletine in blood plasma.

            With simultaneous use with paracetamol, the risk of developing hypernatremia, peripheral edema, increased calcium excretion, hypocalcemia, osteoporosis, hepatotoxicity of paracetamol increases.

            When used simultaneously with rifampicin, phenytoin, carbamazepine, barbiturates, the metabolism of triamcinolone is accelerated due to the induction of microsomal liver enzymes, its effect is reduced.

            When used simultaneously with ephedrine, the metabolism of triamcinolone is accelerated.

            Save

            Share with friends

            Please fill in the fields of e-mail addresses and make sure they are correct

            instructions for use, analogs, composition, indications

            Like all medicines, this medicine can cause side effects, although not everybody gets them.
            Side effects mainly occur during long-term treatment with high doses of Kenalog® 40 and are similar to those of other corticosteroids.

            Frequent (affects 1 in 10):
            – hoarseness, irritated dry pharynx (after using oral corticosteroid inhalers),
            – dryness of the oral mucosa,
            – acne, hematomas, skin capillary bleeding, facial redness, thinning and decreased skin elasticity, increased hair growth, prolonged wound healing, increased sweating, stretch marks on the skin (striae), the appearance of small blood vessels on the skin surface, skin discoloration,
            – muscle weakness and wasting, loss of bone tissue (osteoporosis), destruction and death of bone tissue (osteonecrosis),
            – sodium retention in the blood, followed by a decrease in the level of potassium in the blood, suppression of adrenal function, Cushing’s syndrome (“moon face” and hunchbacked upper back), stunted growth in children and adolescents, diabetes, low blood sugar, menstrual irregularities, and hot flashes (vasomotor symptoms), the likelihood of vaginal bleeding in postmenopausal women, the absence of a menstrual cycle (amenorrhea).

            Uncommon side effects (affects 1 in 100):
            – elevated blood lipids (triglycerides, cholesterol),
            – headache, increased intracranial pressure (benign intracranial hypertension or false brain tumor),
            – clouding of the lens of the eye (cataract), increased pressure inside the eye (glaucoma), damage to the optic nerve (due to increased intracranial pressure),
            – duodenal ulcer (including gastrointestinal bleeding), fungal infection of the mouth and pharynx,
            – lethargy (sedation), depression, insomnia, personality changes, manic syndrome.

            Rare (may affect up to 1 in 1000 people):
            – increased or decreased levels of certain blood cells (granulocytosis, lymphopenia, monocytopenia),
            – exacerbation of pulmonary tuberculosis,
            – porphyria (hemoglobin metabolic disorders),
            – seeing or hearing non-existent things (hallucinations), psychosis.

            Very rare (may affect up to 1 in 10,000 people) and frequency unknown (frequency cannot be estimated from available data):
            – deterioration of cardiac activity,
            – inflammation of the skin (dermatitis), tissue death due to infection, tissue death due to other causes, local changes in the skin (discoloration of the skin, thinning of the skin),
            – allergic (hypersensitive) reactions (including skin rash, hives, swelling, airway spasm, respiratory arrest and severe anaphylactic reaction)
            – tendon damage when applied topically.

            Frequency unknown (frequency cannot be estimated from available data):
            – blurred vision,
            – hiccups.

            Adverse reaction report
            If you experience any adverse reactions, consult your doctor. This recommendation applies to any potential adverse reactions, including those not listed in this package insert. By reporting adverse reactions, you can help provide more information on the safety of this medicine.

            20 reviews, instructions for use

            GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of ​​inflammation. Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ​​inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

            Inhibits the activity of phospholipase A 2 , which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

            Decreases 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; inhibits the formation of antibodies.

            Triamcinolone inhibits the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin.Inhibits the secretion of TSH and FSH.

            When applied directly to the vessels, it has a vasoconstrictor effect.

            Triamcinolone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, triamcinolone enhances the storage of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism.An increase in blood glucose activates the release of insulin.

            Triamcinolone inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which contributes to the accumulation of fat.

            Has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue.

            Osteoporosis and Itsenko-Cushing’s syndrome are the main factors limiting long-term GCS therapy.As a result of the catabolic effect, it is possible to suppress growth in children.

            In high doses, triamcinolone can increase the excitability of brain tissue and helps to lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

            With systemic use, the therapeutic activity of triamcinolone is due to anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

            When applied topically and locally, the therapeutic activity of triamcinolone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) action.

            When used by inhalation, it has an anti-inflammatory effect on the bronchial mucosa in patients with bronchial asthma. With constant use, it reduces the number of mast cells, macrophages, T-lymphocytes and eosinophils in the epithelium and submucous layer of the bronchi, suppresses airway hyperresponsiveness.

            In terms of anti-inflammatory activity, triamcinolone is close to hydrocortisone, and triamcinolone acetonide is 6 times more active. Mineralocorticoid activity in triamcinolone and triamcinolone acetonide is practically absent.

            Pharmacokinetics

            Metabolized mainly in the liver and partly in the kidneys. The main metabolic pathway is 6-beta hydroxylation. T 1/2 – 3.5 h. Excreted by the kidneys.

            Kenalog instruction, price in pharmacies in Ukraine

            Composition and form of release

            Ingredients:

            1ml suspension for injection contains:

            • triamcinolone acetate – 40mg;
            • Excipients.

            1 tablet contains:

            • triamcinolone – 4 mg;
            • excipients, including lactose.

            Form of issue:

            Kenalog – 4mg tablets of active ingredient, 50 tablets per pack.

            Kenalog 40 – suspension for injection, 1 ml in ampoules, 5 ampoules in a cardboard box.

            Pharmacies

            A synthetic drug of the group of glucocorticosteroids for systemic use.The active ingredient of the drug – triamcinolone – has a pronounced anti-inflammatory, antiallergic and immunosuppressive effect. In comparison with other systemic glucocorticosteroids, triamcinolone inhibits the production of corticotropin in the pituitary gland to a much lesser extent. In addition, when using triamcinolone, the water-salt balance practically does not change, there is no sodium and fluid retention in the body. The diabetogenic effect of the drug is insignificant.

            The drug has an anti-inflammatory effect by reducing the amount of proteolytic enzymes at the site of inflammation, inhibiting the release of cyclooxygenase, and reducing the amount of prostaglandins.Triamcinolone reduces the number of T- and B-lymphocytes, other immune agents, suppresses the formation of antibodies. Reduces the secretion and release of allergy mediators.

            The drug is available in several dosage forms, which allows you to choose the ideal form of treatment for each patient.

            After intramuscular administration of triamcinolone at a dose of 80-100mg, inhibition of adrenal function is observed within 24-48 hours, complete recovery of adrenal function after a single injection is observed after 20-40 days.

            After intra-articular administration, about 60% of the drug is released into the systemic circulation within 3 days.

            After oral administration, the drug is rapidly absorbed into the systemic circulation. The maximum concentration of the drug is reached within 8-12 hours.

            The metabolism of the drug occurs mainly in the liver and to some extent in the kidneys. It is excreted in the urine, both unchanged and in the form of metabolites.

            Readings

            The drug is prescribed for conditions that require glucocorticosteroid therapy.Forms of the drug for systemic use (tablets, suspension for injection, intramuscular administration) are prescribed for patients who suffer from the following diseases:

            • Hay fever.
            • Chronic airway disease with obstruction when local therapy is ineffective. Including obstructive chronic bronchitis, bronchial asthma.
            • Allergic diseases and skin diseases, including allergic dermatitis, allergic rhinitis, conjunctivitis and urticaria, neurodermatitis, psoriasis, atopic and eczematoid dermatitis.
            • Lack of adrenal function.
            • Oncological diseases of the blood and prostate gland.

            The preparation in the form of a suspension for injection is also used for intra-articular administration for the following joint diseases:

            • Arthrosis, arthritis, including exudative arthritis.
            • Dropsy of the joints, blockage of the joints due to dysfunction of the joint capsule.

            Dosage

            Doses of the drug and the course of treatment are determined by the attending physician.

            Pills:

            The drug is taken orally, preferably in the morning. If the daily dose does not exceed 16 mg, then it is recommended to take it once a day, however, if the dose exceeds 16 mg, then it must be divided into several doses.

            Adults are usually prescribed 4-32 mg at the beginning of therapy with Kenalog, depending on the severity and nature of the disease. In patients with chronic leukemia, the dose may be increased to 75 mg per day. In the event of side effects and / or the achievement of the required therapeutic effect, the dose is gradually reduced every 3 days, decreasing by 1-2 mg until the required maintenance dose is reached.If it is necessary to discontinue the drug, the dose is also reduced gradually; abrupt cancellation of the drug is not recommended.

            For children over 6 years old, the drug is prescribed taking into account body weight at the rate of 0.1-0.5 mg / kg of body weight per day. The calculated dose of the drug is taken in one or more doses. The maximum daily dose for children is 14 mg.

            Suspension for injection:

            The drug is not used for intravenous administration. With intramuscular injection, it is necessary to make sure that the needle does not enter the vessel, and only after that, inject the drug.

            Intramuscularly:

            The drug is injected slowly deep into the buttock, it is not recommended to exceed the dose of 40 mg (1 ml), however, in severe cases, 80 mg (2 ml) of the drug can be prescribed. The drug in the treatment of children under 12 years of age is dosed according to body weight. Usually it is prescribed at 0.03-0.2 mg / kg of body weight.

            For the treatment of seasonal allergic diseases, adults and children over 12 years of age are usually prescribed 40 mg (1 ml) once a year. The injection is usually given before the onset of the pollen season.

            If it is necessary to re-use the drug, it is necessary to observe a break between injections of 2-4 weeks.

            Intra-articular:

            Usually the dose is 10-40mg per 1 injection; when using the drug for injections into different joints, the total dose should not exceed 80mg. Repeated injections are usually carried out no earlier than 3-4 weeks later.

            When using the drug, it is necessary to monitor the conditions of asepsis. The injection site is treated in the same way as before the surgery.

            After the injection, it is necessary to close the injection site with a sterile napkin for several minutes.

            Side effects

            When using the drug, patients may experience the following side effects:

            From the gastrointestinal tract: nausea, vomiting, digestive disorders, flatulence, ulcerative lesions of the stomach and duodenum, appetite disorders, dysfunction of the pancreas.

            From the side of the cardiovascular system: arterial hypertension, cardiac arrhythmias, increased blood clotting, increased thrombus formation.

            From the side of the central and peripheral nervous systems: depressive conditions, disturbed sleep and wakefulness, headache, dizziness. Nervous disorders, including manic-depressive psychosis, paranoia, anxiety, increased irritability. Convulsions, tremors of the extremities, increased intracranial pressure, disorientation in space.

            On the part of the skin: stretch marks, acne, age spots, impaired wound healing, petechiae.

            From the endocrine system: decreased glucose tolerance, increased body weight, delayed sexual development in children, inhibition of the secretion of endogenous hormones by the adrenal glands, Itsenko-Cushing’s syndrome.

            From the senses: changes in the cornea, cataracts, increased intraocular pressure.

            On the part of metabolic processes: an increase in sodium levels and a decrease in calcium and potassium levels in the blood.

            On the part of the musculoskeletal system: muscle atrophy, impaired growth in children, osteoporosis, bone necrosis.

            Others: the development of local allergic reactions is possible, as well as urticaria, itchy skin. In addition, it is possible to change laboratory parameters.

            The drug is characterized by the development of a withdrawal syndrome.

            When using the drug in the form of a solution for injection, side effects such as pain, burning, numbness, scarring at the injection site are possible.

            Contraindications

            • Increased individual sensitivity to the components of the drug;
            • children under 6 years of age;
            • period of pregnancy and lactation;
            • ulcerative lesions of the stomach and duodenum;
            • bone disease;
            • the period after severe injuries, surgical interventions;
            • glaucoma.
            • diabetes;
            • an increased tendency to thrombosis and bleeding, including as a result of taking anticoagulants;
            • Itsenko-Cushing’s syndrome;
            • the drug is prescribed with caution to elderly patients and / or suffering from impaired liver function, hypo- or hyperthyroidism, as well as in immunodeficiency states, hyperlipidemia, impaired heart function, obesity, epilepsy.

            Pregnancy:

            The drug is contraindicated for use during pregnancy, as it can cause fetal malformations.Kenalog during pregnancy is prescribed only for health reasons. Newborns whose mothers have taken glucocorticosteroids during pregnancy should be under close medical supervision, as they have an increased risk of developing adrenal insufficiency.

            The drug passes into breast milk and is not recommended for use during lactation.

            Interaction

            The drug, when used simultaneously with anticoagulants, weakens their effect.

            Kenalog enhances the excretion of potassium by diuretics. Increases sensitivity to cardiac glycosides.

            The simultaneous use of the drug with high doses of beta-blockers increases the risk of hypokalemia.

            Barbiturates, phenytoin, rifampicin reduce the effectiveness of Kenalog.

            Estrogens alter the metabolic rate of triamcinolone.

            Preparations of the group of non-steroidal anti-inflammatory drugs, when taken simultaneously with Kenalog, increase the risk of side effects from the gastrointestinal tract.

            Overdose

            In case of an overdose of the drug, patients experience symptoms such as nausea, vomiting, feelings of euphoria and excitement, and sleep disturbances.

            In case of chronic overdose, resulting from taking overestimated doses of the drug for several weeks or more, patients have fluid retention in the body, muscle weakness, arterial hypertension, Itsenko-Cushing’s syndrome, suppression of hormone production by the adrenal cortex.

            Hemodialysis is ineffective.

            A gradual decrease in the dose of the drug is shown up to its complete cancellation.

            Treatment of an overdose is symptomatic, there is no specific antidote.

            After an overdose of the drug, characteristic conditions can be observed for several weeks after the last intake of an overdose.

            Storage conditions

            The drug is recommended to be stored in a dry place protected from direct sunlight at a temperature not exceeding 25 degrees Celsius.

            The shelf life of the tablets is 5 years.

            The shelf life of the suspension for injection is 3 years.

            Pay attention!

            Description of the drug Kenalog on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use. Before purchasing or using the drug, you should consult your doctor and familiarize yourself with the original manufacturer’s instructions (attached to each package of the drug).

            Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the doses and methods of its use.

            Kenalog suspension for injection 40mg / ml 1ml 5 pcs.

            Short description

            Anti-inflammatory, anti-allergic, membrane stabilizing agent. Inside. Treatment begins with high doses, with a gradual transition to lower maintenance doses.

            Roster

            1 ml suspension for injection contains:
            Active ingredient:
            Triamcinolone acetonide 40.00 mg
            Excipients:
            Carmellose sodium 6.30 mg,
            sodium chloride 6.60 mg,
            benzyl alcohol 9.90 mg ,
            polysorbate – 80 0.40 mg,
            water for injection up to 1.00 ml.

            GKS. Suppresses the function of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of ​​inflammation.Violates the ability of macrophages to phagocytosis, as well as the formation of interleukin-1. Promotes the stabilization of lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of ​​inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.
            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 helps to reduce the production of prostaglandins.
            Decreases 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; inhibits the formation of antibodies.
            Suppresses the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.
            When applied directly to the vessels, it has a vasoconstrictor effect.
            Has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats.Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys, and increases the activity of gluconeogenesis enzymes. In the liver, it enhances the storage of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism. An increase in blood glucose activates the release of insulin.
            Suppresses the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which contributes to the accumulation of fat.
            Has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue.
            Osteoporosis and Itsenko-Cushing’s syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic effect, it is possible to suppress growth in children.
            In high doses, it can increase the excitability of brain tissue and helps to lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.
            With systemic use, the therapeutic activity is due to anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.
            When applied topically and locally, the therapeutic activity of triamcinolone acetonide is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) action.
            In terms of the anti-inflammatory activity of triamcinolone, acetonide is 6 times more active than hydrocortisone. Mineralocorticoid activity in triamcinolone acetonide is practically absent.

            • For systemic use: bronchial asthma, chronic bronchitis with broncho-obstructive syndrome, pemphigoid, psoriasis, dermatitis.
            • Intra-articular administration: chronic inflammatory diseases of the joints, exudative arthritis, gout, dropsy of the joints, blockade of the shoulder joint, chronic inflammation of the inner layer of the joint capsule.
            • For external use: eczema, psoriasis, neurodermatitis, various types of dermatitis and other inflammatory and allergic skin diseases of non-microbial etiology (as part of complex therapy).

            Individual, depending on the indications and the dosage form used.

            • From the endocrine system: redistribution of adipose tissue, menstrual irregularities, increased blood glucose, suppression of adrenal function, “moon face”, striae, hirsutism, acne.
            • From the metabolic side: edema, electrolyte imbalance, negative nitrogen balance, growth retardation in children.
            • From the digestive system: steroid gastric ulcer, erosive and ulcerative lesions of the gastrointestinal tract, acute pancreatitis.
            • From the side of the central nervous system: convulsions, sleep disturbances, mental disorders, headaches and dizziness, weakness.
            • From the musculoskeletal system: myopathy, osteoporosis.
            • From the cardiovascular system: arterial hypertension.
            • From the side of the blood coagulation system: thromboembolism.
            • On the part of the organ of vision: visual impairment, posterior subcapsular cataract, increased intraocular pressure or exophthalmos, anaphylactic reactions.
            • Reactions due to immunosuppressive action: exacerbation of infectious diseases.
            • With intra-articular administration: possible joint pain, irritation at the injection site of the needle, depigmentation, sterile abscess, skin atrophy, when administered in doses of more than 40 mg, resorptive side effects are possible.
            • For external use: may itching, skin irritation, late reactions such as eczema, steroid acne, purpura. With prolonged use of the ointment, the development of secondary infectious lesions and atrophic skin changes is possible.
            • history of acute psychoses,
            • active tuberculosis,
            • myasthenia gravis,
            • neoplasms with metastases,
            • diverticulitis, gastric ulcer and duodenal ulcer,
            • arterial hypertension,
            • Itsenko-Cushing’s syndrome,
            • renal failure,
            • history of thrombosis and embolism,
            • osteoporosis,
            • diabetes mellitus, hidden foci of infection, amyloidosis,
            • syphilis, fungal diseases, viral infections (incl.including caused by Herpes simplex and Varicella zoster), amoebic infections, poliomyelitis (except for the bulbar-encephalitis form),
            • gonococcal or tuberculous arthritis, vaccination period,
            • lymphadenitis after BCG vaccination, glaucoma,
            • infected skin lesions.

            Not intended for intravenous administration.
            With caution and under strict medical supervision, it is used for edematous syndrome, obesity, mental illness and gastrointestinal diseases.During the treatment period, it is recommended to take vitamin D and eat foods rich in calcium.
            When applied externally to prevent local infectious complications, it is recommended to use it in combination with antimicrobial agents.
            Parenteral use in children under 6 years of age is not recommended; at the age of 6-12 years – according to strict indications.
            Avoid long-term external use in children, regardless of age.

            When used simultaneously with anabolic steroids, androgens, the risk of developing peripheral edema and acne increases.
            With simultaneous use with antithyroid drugs and thyroid hormones, the function of the thyroid gland may change.
            When used simultaneously with histamine h2-receptor blockers, the effect of triamcinolone decreases; with hormonal contraceptives – the action of triamcinolone is potentiated.
            Hypocalcemia associated with the use of triamcinolone can lead to an increase in the duration of neuromuscular blockade caused by the action of depolarizing muscle relaxants when used simultaneously.
            When used simultaneously with immunosuppressants, the risk of developing bacterial and viral infections increases.
            With simultaneous use with potassium-sparing diuretics hypokalemia is possible.
            With simultaneous use, it is possible to reduce the effectiveness of indirect anticoagulants, heparin, streptokinase, urokinase, increase the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract.
            With simultaneous use with NSAIDs (including acetylsalicylic acid), the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract increases.
            With simultaneous use, the effect of oral hypoglycemic agents, insulin is weakened; with laxatives – hypokalemia is possible; with cardiac glycosides – the risk of developing cardiac arrhythmias and other toxic effects of glycosides increases.
            With simultaneous use with tricyclic antidepressants, it is possible to increase mental disorders associated with taking triamcinolone.

            class = “h4-mobile”>

            Where did Diprospan disappear from the pharmacy counters?

            Anapchans who suffer from allergies ask this question.

            For some, the warming in Anapa after winter is a real joy. But there are people who perceive the arrival of spring (and, accordingly, everything blooming and smelling), in the literal sense, is painful.

            Anapa.life was contacted by a citizen who said that the sharp warming caused a serious reaction among allergy sufferers. For example, it is hard for him to breathe.

            But the main problem is that the only effective remedy in the fight against the disease is the drug “Diprospan”. True, the medicine disappeared from the pharmacy counters in Anapa.He is not in Krasnodar either.

            Whether the problem is urgent for the resort town, we decided to ask the townspeople through social networks. At least a dozen people responded to our cry. The information was confirmed.

            So, for example, a local resident Elena Yeronina told our editorial office that she knows about allergies firsthand. And the drug really disappeared.

            “I drip and spray endlessly with” Vibrocil “, then with” Afrin “. And nothing else. During the day it is still bearable. I somehow manage to cope without drops, but I don’t go to bed without a spray, ”the girl said.

            Elena added that there is a drug “Kenalog”, which has similar properties. But for some reason, doctors do not prescribe him.

            Is it difficult to get the medicine? And most importantly, where? A local resident, Irina Nemirova, answered our question shortly: “This year I ordered it in Moscow. There is nowhere in the region ”.

            This drug is a glucocorticosteroid. It has a high insignificant mineralocorticoid activity and has anti-inflammatory, anti-allergic and immunosuppressive effects.

            It is used for diseases of the musculoskeletal system and soft tissues, allergic and dermatological diseases.

            We contacted several city pharmacies, where we also said that the medicine was not available. When it will be possible to purchase it, and whether it is worth the wait is unknown. The fact is that the process of import substitution is in full swing, and “our” medicine will not appear on sale soon.

            What exactly should allergy sufferers do in such a situation remains a question. Perhaps the most effective option is to consult with doctors and try to find at least some kind of replacement.

            Some Anapchans became desperate and began to use “grandmother’s methods”.

            Allergy sufferers resort to medicinal nettle. They say they checked it on their own experience – it helps. Nevertheless, doctors always advise not to self-medicate, and to coordinate all your actions with specialists. But without fish, as they say …


            Vladimir

            It has been three months since the imported Diprospan disappeared! And the one that is being sold does not stand up to criticism! A logical question – if the manufacturer is the one that is painted on the package, why is the text far from in the manufacturer’s language ?! This is the first thing..! Secondly, I would like to take a look at the packaging barcode! and thirdly, I asked these questions in one of the most prestigious pharmacies (Gaevsky’s pharmacy), to which I received an exhaustive answer – raw materials from the manufacturer, and they are packed in ampoules in Ukraine …! All clear??!! So, in our beloved country, the pharmacological mafia is fantastically inventive! From personal experience, more than half of the ampoules contain cheap analogs of the Flosterone type, which causes terrible side effects, up to the formation of a 12-fold ulcer, etc.And they sell at the price of Diprospan … The difference is doubly …! The size of the broth is not hard to imagine! At the same time, Diprospan in a syringe, which is difficult to forge, (and even risky, because it is easier to examine the contents of a syringe in a laboratory than from an ampoule) has disappeared completely! This means that when you become psychologically tired of fakes in ampoules, you will be offered syringes with original drug, but three times more expensive than the purchase price! Be healthy!

            Vladimir

            It has been three months since the imported Diprospan disappeared! And the one that is being sold does not stand up to criticism! A logical question – if the manufacturer is the one that is painted on the package, why is the text far from in the manufacturer’s language ?! This is the first thing..! Secondly, I would like to take a look at the packaging barcode! and thirdly, I asked these questions in one of the most prestigious pharmacies (Gaevsky’s pharmacy), to which I received an exhaustive answer – raw materials from the manufacturer, and they are packed in ampoules in Ukraine …! All clear??!! So, in our beloved country, the pharmacological mafia is fantastically inventive! From personal experience, more than half of the ampoules contain cheap analogs of the Flosterone type, which causes terrible side effects, up to the formation of a 12-fold ulcer, etc.And they sell at the price of Diprospan … The difference is doubly …! The size of the broth is not hard to imagine! At the same time, Diprospan in a syringe, which is difficult to forge, (and even risky, because it is easier to examine the contents of a syringe in a laboratory than from an ampoule) has disappeared completely! This means that when you become psychologically tired of fakes in ampoules, you will be offered syringes with original drug, but three times more expensive than the purchase price! Be healthy!

            Gali

            You first remove deprospan from production, make an analogue to it, and so it makes sense to remove it if there is nothing to replace it with, but for allergies I have been using it for almost 15 years, and there is someone who told me about it for more than 35-40 years; my nose, even when I didn’t want to smoke, smoked
            and I don’t smoke for 6 years, so if you remove the deprospan, I’ll smoke again.

            Dexamethasone versus Kenalog for allergies and allergic diseases: differences and side effects

            Are Dexamethasone and Kenalog the same thing?

            Dexamethasone and Kenalog (triamcinolone acetonide) are corticosteroids.

            Dexamethasone is used for allergic conditions and allergic reactions, dermatological diseases, endocrine disorders, gastrointestinal diseases, hematological disorders, tumor diseases, the nervous system, ophthalmic diseases, kidney diseases, rheumatic diseases and respiratory diseases.

            Kenalog is injected into the joint space to treat inflammation of the joints or tendons, to treat arthritis, bursitis or epicondylitis (tennis elbow). Kenalog is also injected into the soft tissues of the body to treat certain skin conditions caused by autoimmune diseases such as lupus, psoriasis, lichen planus, and others.

            Dexamethasone brand names include Ozurdex and DexPak 6 Day or 13 Day.

            What are the possible side effects of dexamethasone?

            Common side effects of dexamethasone include:

            what is Watson 853 tablet

            • vision changes,
            • swelling,
            • rapid weight gain,
            • sleep problems (insomnia),
            • mood changes,
            • acne,
            • dry skin,
            • thinning skin,
            • or discoloration ,

            • slow wound healing,
            • increased sweating,
            • Headache,
            • dizziness,
            • sensation of rotation,
            • nausea,
            • abdominal pain,
            • bloating
            • changes or the location of body fat (especially on the arms, legs, face, neck, chest, and waist).

            Rare cases of severe allergic reactions (anaphylaxis) have been observed in patients treated with corticosteroids such as dexamethasone.

            What are the possible side effects of Kenalog?

            Common Kenalog side effects include:

            • allergic reactions,
            • sleep problems (insomnia),
            • mood swings,
            • Headache,
            • euphoria,
            • spinning sensation (dizziness),
            • nausea,
            • bloating
            • change in appetite,
            • abdominal or flank pain,
            • indigestion,
            • acne,
            • peeling or other skin changes,
            • wound that is slowly healing
            • ,
            • bruising or swelling,
            • sweating more than usual,
            • irregular periods,
            • redness or pain at the injection site, or
            • weight gain.

            What is dexamethasone?

            Dexamethasone is a corticosteroid indicated for allergic conditions, dermatological diseases, endocrine disorders, gastrointestinal diseases, hematological disorders, tumor diseases, the nervous system, ophthalmic diseases, kidney diseases, respiratory diseases and rheumatic diseases. Dexamethasone is available as a generic drug.

            What is Kenalog?

            Kenalog-40 (triamcinolone acetonide) is a corticosteroid intended for intramuscular or intraarticular use only for allergic conditions, dermatological diseases, endocrine disorders, gastrointestinal diseases, hematological disorders, kidney diseases, respiratory diseases and rheumatic disorders in which oral therapy is inappropriate.Kenalog-40 is available as a generic drug.

            What medications interact with dexamethasone?

            Dexamethasone may interact with aspirin (taken daily or in high doses), insulin or oral diabetes medications, anticoagulants, cyclosporine, rifampicin, or seizure medications.

            Dexamethasone can also interact with diuretics (water pills) or ketoconazole.

            What drugs interact with Kenalog?

            Kenalog may interact with aspirin (taken daily or in high doses), insulin or oral diabetes medications, anticoagulants, cyclosporine, rifampicin, or seizure medications.

            Kenalog may also interact with aminoglutethimide, birth control pills, hormone replacement therapy, digoxin, isoniazid, antibiotics, or nonsteroidal anti-inflammatory drugs (NSAIDs).

            How should I take dexamethasone?

            Dexamethasone tablets are available in doses of 0.5, 0.75, 1, 1.5, 2, 4 and 6 mg. The starting dosage of dexamethasone ranges from 0.75 to 9 mg per day, depending on the condition being treated. Infants born to mothers who have received significant doses of corticosteroids during pregnancy should be monitored closely for signs of hypoadrenalism.Because of the potential for serious adverse reactions to corticosteroids in infants, a decision should be made to discontinue breastfeeding or to discontinue the drug, taking into account the importance of the drug to the mother. In pediatric patients, it is advisable to consult a pediatrician.

            How should the kenalog be taken?

            The usual recommended starting dose of Kenalog-40 is 60 mg, injected deep into the gluteus maximus. The dosage is usually adjusted in the range of 40 mg to 80 mg, depending on the patient’s response and the duration of relief.However, some patients can be well controlled with doses up to 20 mg or less. Many doses depend on the patient’s response to the medication and may vary.

            Disclaimer

            All drug information presented on RxList.com is obtained directly from drug monographs published by the US Food and Drug Administration (FDA).

            Any drug information published on RxList.com regarding general drug information, drug side effects, drug use, dosage, etc.From the original drug documentation contained in his FDA drug monograph.

            The drug information contained in drug comparisons published on RxList.com is primarily derived from FDA drug information. The drug comparison information contained in this article does not include data from human or animal clinical trials conducted by any of the drug comparison drug manufacturers.

            The drug comparison information provided does not cover all potential uses, warnings, drug interactions, side effects, side effects, or allergic reactions.RxList.com is not responsible for the medical care provided to a person based on the information posted on this site.

            Because drug information can and will change at any time, RxList.com makes every effort to update its drug information. Due to the fact that medication information is time-dependent, RxList.com makes no guarantees that the information provided is the most up-to-date.

            medicine to stop vomiting

            The absence of drug warnings or information does not in any way guarantee the safety, efficacy, or side effects of any medication.The medication information provided is for reference only and cannot be used as a substitute for medical advice.

            If you have specific questions about drug safety, side effects, uses, warnings, etc., you should ask your doctor or pharmacist or consult the FDA website for specific drug details. gov or RxList.com for more information. …

            You can also report negative side effects of prescription drugs to the FDA by visiting the FDA MedWatch website or by calling 1-800-FDA-1088.