Knieschmerzen - Was hilft bei Schmerzen im Knie wirklich?
For further information about unapproved drugs, click here. Each mL of the sterile aqueous suspension provides 40 mg triamcinolone acetonide, with 0. Sodium hydroxide or hydrochloric acid may be present to adjust pH to 5. At the time of manufacture, the air in the container is replaced by nitrogen. Its structural formula is:. Triamcinolone acetonide occurs as a white to cream-colored, crystalline powder having not more than a slight odor and is practically insoluble in water and very soluble in alcohol.
Glucocorticoids, naturally occurring and synthetic, are Kenalog Blockade im Kniegelenk steroids that are readily absorbed from the gastrointestinal tract. Naturally occurring glucocorticoids hydrocortisone and cortisonewhich also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states.
Synthetic analogs such as triamcinolone are primarily used for their anti-inflammatory effects in disorders of many organ systems. Kenalog Injection has an extended duration of effect which may be sustained over a period of several weeks. Studies indicate that following a single intramuscular dose of 60 mg to mg of triamcinolone acetonide, adrenal suppression occurs within 24 to 48 hours and then gradually returns to normal, usually in 30 to 40 days.
This finding correlates closely with the extended duration of Kenalog Blockade im Kniegelenk action achieved Kenalog Blockade im Kniegelenk the drug. Where oral therapy is not feasible, injectable corticosteroid therapy, including Kenalog Injection triamcinolone acetonide injectable suspension, USP is indicated for intramuscular use Kenalog Blockade im Kniegelenk follows:.
Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic Kenalog Blockade im Kniegelenk Bullous dermatitis herpetiformis, exfoliative erythroderma, Kenalog Blockade im Kniegelenk fungoides, pemphigus, severe erythema multiforme Stevens-Johnson Kenalog Blockade im Kniegelenk.
Endocrine disorders: Primary or secondary adrenocortical insufficiency hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importancecongenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis.
Gastrointestinal diseases: To tide the patient over a critical period of the disease in regional enteritis and ulcerative colitis. Hematologic disorders: Acquired autoimmune hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous: Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy.
Neoplastic diseases: For the palliative management of leukemias and lymphomas. Nervous system: Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic diseases: Sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids.
Renal diseases: To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic disorders: As adjunctive therapy Kenalog Blockade im Kniegelenk short-term administration to tide the patient over an acute episode or exacerbation in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis selected cases may require Kenalog Blockade im Kniegelenk maintenance therapy.
For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. The intra-articular or soft tissue administration of Kenalog Injection is indicated as adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation in acute gouty arthritis, acute and subacute bursitis, acute nonspecific Kenalog Blockade im Kniegelenk, epicondylitis, rheumatoid arthritis, synovitis, or osteoarthritis.
Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura. Exposure to excessive amounts of benzyl alcohol has been associated with toxicity hypotension, metabolic acidosisparticularly in neonates, and an increased incidence of kernicterus, particularly in small preterm infants.
There have been rare reports of deaths, primarily in preterm infants, associated with exposure to excessive amounts of benzyl alcohol. The amount of benzyl alcohol from medications is usually considered negligible compared to that received in flush solutions containing benzyl alcohol. Administration of high dosages of medications containing this preservative must take into account the total amount of benzyl alcohol administered. The amount of benzyl alcohol at which toxicity may occur is not known.
Cases of serious anaphylaxis, including death, have been reported in individuals receiving triamcinolone acetonide injection, regardless of the route of administration. Because Kenalog Injection triamcinolone acetonide injectable suspension, USP is a suspension, it should not be administered intravenously. Unless a deep intramuscular injection is given, local atrophy is likely to occur.
Due to the significantly higher Kenalog Blockade im Kniegelenk of local atrophy when the material is injected into the deltoid area, this injection site should be avoided in favor of the gluteal area. Increased dosage of rapidly acting corticosteroids is indicated in patients on corticosteroid therapy subjected to any unusual stress before, during, and after the stressful situation. Kenalog Injection is a long-acting preparation, and is not suitable for use in acute stress situations.
To avoid drug-induced adrenal insufficiency, supportive dosage may be required in times of stress such as trauma, Kenalog Blockade im Kniegelenk, or severe illness both during treatment with Kenalog Injection and for a year afterwards.
Results from one multicenter, randomized, placebo-controlled study with methylprednisolone hemisuccinate, an intravenous corticosteroid, showed an increase in early at 2 weeks and late at 6 months mortality in patients with cranial trauma who were determined not to have other clear indications for corticosteroid treatment. High doses of systemic corticosteroids, including Kenalog Injection, should not be used Kenalog Blockade im Kniegelenk the treatment of traumatic brain injury.
Average and large doses of corticosteroids can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic derivatives except when they are used in large doses. All corticosteroids increase calcium excretion. Literature reports suggest an apparent association between use of corticosteroids and left ventricular free wall rupture after a recent myocardial infarction; therefore, therapy with corticosteroids should be used with great caution in these patients.
Corticosteroids can produce reversible hypothalamic-pituitary-adrenal HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustment in dosage.
Patients who are on corticosteroids are more susceptible to infections than are healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used.
Infection with any pathogen viral, bacterial, fungal, protozoan, or helminthic in any location of the body Kenalog Blockade im Kniegelenk be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents. These infections may be mild to severe. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases.
Corticosteroids may also mask some signs of current infection. Corticosteroids may exacerbate systemic fungal infections and therefore should not be used in the presence of such infections unless they are needed to control drug reactions. Latent disease may be activated Kenalog Blockade im Kniegelenk there may be an exacerbation of intercurrent infections due to pathogens, including those caused by AmoebaCandidaCryptococcusMycobacteriumNocardiaPneumocystisor Toxoplasma.
It is recommended that latent amebiasis or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides threadworm infestation.
In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. The use of corticosteroids in patients with active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculosis regimen.
If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines cannot be predicted. Chicken pox and measles can have a more serious or even fatal course in pediatric and adult patients on corticosteroids.
In pediatric and adult patients who have not had these diseases, particular care should be taken to avoid exposure. If exposed to chicken pox, prophylaxis with varicella zoster Kenalog Blockade im Kniegelenk globulin VZIG may be indicated. If exposed to measles, prophylaxis with immunoglobulin IG may be indicated.
If chicken pox develops, treatment with antiviral agents should be considered. Epidural and intrathecal administration of this product is not recommended. Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic Kenalog Blockade im Kniegelenk, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.
The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should Kenalog Blockade im Kniegelenk be used in active ocular herpes simplex. Adequate studies to demonstrate the safety of Kenalog Injection use by intraturbinal, subconjunctival, sub-Tenons, retrobulbar, and intraocular intravitreal injections have not been performed.
Endophthalmitis, eye inflammation, increased intraocular pressure, and visual disturbances including vision loss have been reported with intravitreal administration. Administration of Kenalog Injection intraocularly or into the nasal turbinates is not recommended.
Intraocular injection of corticosteroid formulations containing benzyl alcohol, such as Kenalog Injection, is not recommended because of potential toxicity from the benzyl alcohol. This product, like many other steroid formulations, is sensitive to heat.
Therefore, it should not be autoclaved when it is desirable to sterilize the exterior of the vial. The lowest possible dose of corticosteroid should Kenalog Blockade im Kniegelenk used to control the condition under treatment.
When reduction in dosage is possible, the reduction should be gradual. Discontinuation of corticosteroids may result in clinical improvement. As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency.
Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation.
Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis.
If this complication occurs and the diagnosis of sepsis is confirmed, appropriate antimicrobial therapy should be instituted. Injection of a steroid into an infected site is to be avoided. Local injection of a steroid into a previously infected joint is not usually recommended. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation ie, decreasing absorption and increasing excretion and inhibition of osteoblast function.
This, together with a decrease in the protein matrix of Kenalog Blockade im Kniegelenk bone secondary to an increase in Kenalog Blockade im Kniegelenk catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age. Special consideration Kenalog Blockade im Kniegelenk be given to patients at increased risk of osteoporosis ie, postmenopausal women before initiating corticosteroid therapy.
Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that they affect the ultimate outcome or natural history of the disease.
The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission eg, myasthenia gravisor in patients receiving concomitant therapy with neuromuscular blocking drugs eg, pancuronium.