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Intermediate-acting corticosteroid Pregnancy: §4.6: triamcinolone does cross the placenta. Administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate, intra-uterine growth retardation and effects on brain growth and development. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities such as cleft palate/lip in man; however, when given for prolonged periods or repeatedly during pregnancy they may increase the risk of intra-uterine growth retardation. Hypoadrenalism may in theory occur in the neonate following prenatal exposure but usually resolves spontaneously. Corticosteroids should only be prescribed when the benefits to the mother and child outweigh the risks; when essential, patients with normal pregnancies may be treated as though they were in the non-gravid state. Breast-feeding: corticosteroids may pass into breast milk, although no data are available for triamcinolone; infants of mothers taking high doses for prolonged periods may have a degree of adrenal suppression.

Triamcinolone acetonide

Brand names: Adcortyl, Kenalog, Kenacort

Triamcinolone acetonide is a synthetic intermediate-acting corticosteroid available in injectable, topical, dental, and other formulations for suppressing inflammation in a range of musculoskeletal, dermatological, and allergic conditions.

Adult dose

Dose: Intra-articular (joint pain, swelling and stiffness in rheumatoid arthritis and osteoarthrosis with an inflammatory component; bursitis, epicondylitis, tenosynovitis): 5 mg to 10 mg (0.125-0.25 mL) for smaller joints and up to 40 mg (1.0 mL) for larger joints, depending on the disease entity. Intramuscular (where sustained systemic corticosteroid treatment is required): suggested initial dose 40 mg (1.0 mL) injected deeply into the upper outer quadrant of the gluteal muscle; subsequent dosage depends on response and period of relief. Asthma not responding to conventional therapy: a single dose of 40-100 mg when allergic symptoms appear.
Route: Intra-articular (including tendon sheaths and bursae) and deep intramuscular (gluteal) injection only
Frequency: Single injection; repeat when symptoms recur and not at set intervals (duration of effect is variable)
Indication and product match: the pinned product is Kenalog Intra-articular / Intramuscular Injection (eMC product 6748). Routes NOT covered by this card: topical and intraocular (the page lists IM / intra-articular / topical / intraocular); the SPC says Kenalog is for intra-articular/intramuscular injection ONLY, that safety and efficacy by other routes has yet to be established, and §4.3 lists intravenous, intrathecal, epidural or intraocular injection as contraindicated. No maximum single dose is printed; the SPC records that single injections into several sites for multiple joint involvement, up to a total of 80 mg, have been given without undue reactions (an observation, not a stated ceiling). For injection into the sheaths of short tendons the SPC recommends Adcortyl Injection (triamcinolone acetonide 10 mg/mL) rather than Kenalog; do not inject the Achilles tendon with depot corticosteroids. Strict aseptic precautions are required. Intramuscular injections must be deep into the gluteal site to avoid subcutaneous fat atrophy; the deltoid should not be used; alternate sides for subsequent injections. Withdrawal: in patients who have received more than physiological doses (more than one injection during a three week period), withdraw gradually, reducing the dose and increasing the interval until a dose of not more than 40 mg at an interval of at least three weeks is reached. A single dose not repeated within three weeks is unlikely to cause clinically relevant HPA-axis suppression in most patients. Elderly: plan treatment, particularly long-term, bearing in mind the more serious consequences of corticosteroid side effects in old age; close clinical supervision is required.

Paediatric dose

Dose: Children over 12 years: as adults - suggested initial intramuscular dose 40 mg (1.0 mL) injected deeply into the gluteal muscle. Children 6-12 years: the SPC's suggested initial dose is 40 mg (1.0 mL) deep gluteal injection, but it states this 'should be scaled according to the severity of symptoms and the age and weight of the child'; no scaled figure is printed here, so use a children's formulary. Not recommended under six years.
Route: Deep intramuscular (gluteal) injection
Frequency: Single injection; repeat when symptoms recur and not at set intervals
Printed in §4.2 of the Kenalog SPC for the intramuscular route only; no paediatric intra-articular dose is printed. Growth and development of children on prolonged corticosteroid therapy should be carefully observed, with caution in exposure to chickenpox, measles or other communicable diseases.

Dose adjustments

Renal

Not stated in the product information we used — check the full SPC.

Hepatic

Not stated in the product information we used — check the full SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to any of the ingredients
  • Systemic infections unless specific anti-infective therapy is employed
  • Administration by intravenous, intrathecal, epidural or intraocular injection

Side effects

  • Injection site reaction, headache, arthralgia and infection (common)
  • Injection site abscess (sterile), masked infection, tuberculosis, Candida infection (uncommon)
  • Anaphylactoid and anaphylactic reactions and shock (uncommon); serious anaphylaxis including death has been reported regardless of route
  • Cushingoid state, adrenal suppression, secondary adrenocortical insufficiency (uncommon); adrenal cortical atrophy during prolonged therapy may persist for years
  • Sodium and fluid retention, hypokalaemic alkalosis, hyperglycaemia, poor diabetic control (uncommon)
  • Psychiatric reactions including depression, euphoria, mood swings, psychosis and suicidal ideation (uncommon)
  • Skin atrophy and fragility, hypo/hyperpigmentation (uncommon) - subcutaneous fat atrophy if not injected deeply into the gluteal muscle
  • Osteoporosis, osteonecrosis, pathological fracture, myopathy, muscle atrophy, growth retardation (uncommon); severe joint destruction with bone necrosis and tendon rupture with repeated intra-articular or tendon injection
  • Cataract, glaucoma and visual disturbances (uncommon); blindness after injection into nasal turbinates or intralesional injection about the head
  • Peptic ulcer with perforation or haemorrhage, pancreatitis (uncommon)

Interactions

  • Live vaccines should not be administered during corticosteroid therapy; antibody response to vaccines is reduced
  • Pharmacokinetic interactions that increase the risk of corticosteroid side effects are referred to in §4.5 (the fetched text does not include the full §4.5 list)

Monitoring

  • Frequent patient review to titrate the dose against disease activity; use the lowest effective dose for the minimum period
  • Adrenal suppression: withdrawal after prolonged therapy must be gradual, tapered over weeks or months; intercurrent illness, trauma or surgery during prolonged therapy needs a temporary increase in dosage
  • Signs of infection, which may be masked (septicaemia, tuberculosis); chickenpox and measles exposure is of particular concern in non-immune patients (VZIG within 3 days of exposure and not later than 10 days)
  • Psychiatric symptoms, especially depressed mood or suicidal ideation, which usually emerge within days or weeks of starting
  • Growth and development of children on prolonged corticosteroid therapy
  • Patients should carry steroid treatment cards; warn patients to avoid over-use of joints in which symptomatic benefit has been obtained

Clinical monograph

How it works

As a glucocorticoid it binds intracellular receptors to modulate gene transcription, reducing inflammatory mediator production and immune cell activity.

Prescribing in practice

  • Systemic or repeated administration can suppress the hypothalamic-pituitary-adrenal axis, so courses should not be stopped abruptly and the lowest effective exposure should be used.
  • Avoid or use cautiously where there is active untreated infection, as corticosteroids mask signs and impair the immune response.
  • Prolonged exposure may cause hyperglycaemia, fluid retention, osteoporosis, and skin or soft-tissue atrophy at injection or application sites.

Monitoring

Monitor for glycaemic disturbance, signs of infection, blood pressure changes, and local or systemic steroid adverse effects according to dose and duration.

Counselling the patient

  • Do not stop the medicine suddenly if you have been using it regularly.
  • Tell your healthcare team about any infection or feeling unwell.
  • Carry a steroid treatment card if you are on prolonged or repeated treatment.

Evidence & guidelines

Corticosteroid efficacy in inflammatory and allergic conditions is long established and reflected in the SPC and current prescribing references.

Reference: NICE; BSR; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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