Cingal (Hyaluronic Acid/Triamcinolone Hexacetonide) Injection

Cross-Linked Hyaluronic Acid+Triamcinolone Hexacetonide, Cingal
Description: Orthopedics

CSA NA – Not FDA Approved – REMS (N) – Cannot Ship To US

Hyaluronic acid is a naturally occurring glycosaminoglycan polysaccharide and is the chief component of the extracellular matrix. Hyaluronic acid and its derivatives are highly anionic and attract water which results in volume expansion and structural support of soft tissues essentially functioning as a tissue and joint lubricant improving the modulating interaction between adjacent tissues. When hyaluronic acid is used as an intra-articular injection increases the relative viscosity of synovial fluid in cartilage. When administered as an intra-articular injection, the hyaluronic acid is cleared within several hours with halflives ranging from 17 hours to 1.5 days. The half-life is longer for purified and synthesized hyaluronic acid preparations with larger molecular weight. Despite such as short half-life, the clinical benefit of hyaluronic acid in providing significant symptomatic pain can be long-lasting following an intra-articular hyaluronic acid injection.

Glucocorticoids exhibit an anti-inflammatory effect that is mediated by direct binding of the glucocorticoid/glucocorticoid receptor complex to glucocorticoid responsive elements in the promoter region of genes or by an interaction of this complex with other transcription factors. Glucocorticoids inhibit inflammatory-associated molecules such as cytokines, chemokines, arachidonic acid metabolites and adhesion molecules. When administered as an intra-articular injection, corticosteroids have been shown to decrease erythema, swelling, heat and tenderness of the inflamed joint while increasing the relative viscosity with an increase in hyaluronic acid concentration.

Intra-articular: Osteoarthritis

Do not use in patients with a known hypersensitivity to hyaluronic acid or any components of its formulation
Do not use in a pre-existing infection of the skin region of the intended injection site
Do not use in patients with a systemic bleeding disorder
Do not use in pregnant women, or women who might be pregnant
Should be used with caution in patients with impaired cardiac, renal, endocrine impairment
Should only be administered by a medical professional trained in accepted injection techniques

When administering by intra-articular injection, always refer to the manufacturer’s labelling for additional instructions on injection technique.
Injectable: According to the prescribed directions of a licensed medical doctor.
Cingal: Inject 88mg/18mg (4ml) once.

Cross-Linked Hyaluronic Acid and Triamcinolone Hexacetonide/Cingal Injection: Should be injected only into a joint and never extra-articular or into the synovial capsule or tissues. Do not use disinfectants containing ammonium salts for cleaning the injection site prior to administration. Should only be administered by a trained medical doctor.

Cross-Linked Hyaluronic Acid and Triamcinolone Hexacetonide/Cingal Should be Stored: Store this medication at 36°F to 77°F (2°C to 25°C) and away from heat, moisture, and light. Keep all medicine out of the reach of children. Throw away any unused medicine after the beyond use date. Do not flush unused medications or pour down a sink or drain.

The type of local reaction may vary from product to product and site to site:
>10%:
Central Nervous System: Headache (≤18%)
Dermatologic: Skin discoloration at injection site (4% to 78%), ecchymoses (≤14%), skin rash (≤14%)
Hematologic and Oncologic: Bruise (≤28%; more common in older patients)
Local: Swelling at injection site (3% to 98%), tenderness at injection site (17% to 95%), bruising at injection site (3% to 93%), erythema at injection site (≤93%), induration at injection site (6% to 92%), pain at injection site (≤92%), residual mass at injection site (3% to 90%), itching at injection site (7% to 47%), muscle rigidity at injection site (25%), hematoma at injection site (8% to 18%)
Neuromuscular and Skeletal: Arthralgia (1% to 25%), joint swelling (knee; ≤14%), joint effusion (≤11%)
Miscellaneous: Swelling (18% to 28%)