CINGAL®

What Is Cingal®? A CE-marked HA + Corticosteroid Knee Injection

Cingal® is a single intra-articular injection developed by Anika Therapeutics for the treatment of pain associated with osteoarthritis of the knee. Each 4 mL prefilled syringe delivers 88 mg of cross-linked, non-avian sodium hyaluronate and 18 mg of triamcinolone hexacetonide, presented as a transparent gel in a sterile, single-use glass syringe. Because both actives are combined in the same syringe, one appointment covers what would otherwise be two separate intra-articular products.

The formulation is designed as a dual-mechanism product. The hyaluronic acid restores viscosity and cushioning inside the joint space, giving the knee a fluid environment closer to that of a healthy synovium. The triamcinolone hexacetonide, a long-acting corticosteroid selected for its poor water solubility and prolonged local residence time, dampens the inflammatory contribution to pain in the first weeks after administration. That sequencing, corticosteroid early and HA sustaining, is the practical clinical argument for the combination product.

Clinicians typically evaluate Cingal® against other orthopedic injections such as EUFLEXXA®, HYALGAN®, MONOVISC®, ORTHOVISC®, and SUPARTZ®. Each of those alternatives is a pure HA viscosupplement without a corticosteroid, which is why the decision is usually less about HA quality and more about whether the case calls for early anti-inflammatory action alongside lubrication.

Unlike EUFLEXXA®, HYALGAN®, MONOVISC®, ORTHOVISC®, and SUPARTZ®, which contain hyaluronic acid alone, Cingal® is a CE-marked intra-articular knee product that combines cross-linked sodium hyaluronate and triamcinolone hexacetonide in a single injection.

Cingal® Ingredients and Product Specification

Each 4 mL Cingal® syringe contains two active components. Sodium hyaluronate is present at 22 mg/mL (88 mg total), produced by bacterial fermentation and cross-linked using Anika’s proprietary viscosupplement platform. Because the HA source is non-avian, the product is often specified for patients with avian sensitivities or where the clinic prefers to avoid rooster-comb-derived HA on principle. Triamcinolone hexacetonide is present at 4.5 mg/mL for a total of 18 mg. It is a long-acting intra-articular corticosteroid chosen for local activity with limited systemic absorption at this dose.

The Cingal® 4 mL presentation is supplied ready to use and requires no reconstitution, mixing, or dilution. The syringe is single-use, sterile, and intended solely for intra-articular delivery. Anika’s Cingal® is the only combination product in the company’s viscosupplement lineup, sitting alongside the HA-only MONOVISC® and ORTHOVISC® ranges.

Full Cingal® Product Range

Based on currently available product information, Anika Therapeutics has not introduced additional Cingal® formulations, alternate syringe volumes, or multi-dose presentations. As product availability may change over time, healthcare professionals should verify the latest listings when sourcing Cingal® products.

• Cingal® 4 mL single-use prefilled syringe: Contains 88 mg of cross-linked sodium hyaluronate and 18 mg of triamcinolone hexacetonide in a 4 mL transparent gel supplied in a sterile, single-use glass syringe.

Administration, Protocol, and Post-Injection Guidance

Cingal® is administered as a single intra-articular injection into the affected knee. One injection completes a treatment cycle. Unlike three- to five-visit HA regimens, no series schedule is required, which benefits both the clinic calendar and patient adherence.

Before administration, the clinician should confirm the diagnosis, review the patient’s allergies and current medications, and rule out infection at or near the injection site. Where synovial effusion is present, aspiration before injection is generally appropriate. Ultrasound guidance can improve intra-articular placement accuracy in patients with substantial effusion, obesity, or difficult anatomy, though anatomical landmark technique remains acceptable in straightforward cases.

Inject the full 4 mL into the joint. Cingal® must not be placed into blood vessels, surrounding tissue, or an infected joint. After the procedure, patients should avoid physical activities such as jogging, heavy lifting, prolonged standing, and other high-impact loading for approximately 48 hours. Normal ambulation does not need to stop; activity can usually be resumed gradually as post-injection discomfort subsides. Retreatment is not on a fixed schedule and should be based on clinical reassessment, with treatment cycles typically separated by six months or longer per current product guidance.

Indications — Osteoarthritis of the Knee

Cingal® is authorized in its CE-marked markets for adults with pain associated with knee osteoarthritis. A Cingal® injection for knee pain is usually considered once conservative measures such as physiotherapy, activity modification, weight management, and oral analgesics have failed to give adequate control.

Suitable candidates typically include adults with:

• Symptomatic knee osteoarthritis confirmed on examination and imaging
• Persistent pain, stiffness, or reduced range of motion
• An inflammatory component alongside degenerative change
• Inadequate response to conservative care or to HA monotherapy
• A clinical preference for a single-injection protocol over a multi-visit HA course

Patient selection should factor in comorbidities, particularly where systemic corticosteroid exposure is a concern, such as poorly controlled diabetes, along with prior response to intra-articular therapy and the patient’s own treatment goals. The Cingal® shot is a single-administration protocol, but case selection determines whether the combination formulation is the right fit.

Regulatory Status: Is Cingal® FDA Approved?

Cingal® has not received United States FDA approval and is not available for clinical use in the US market. It received CE Mark approval in 2016 for pain associated with osteoarthritis of the knee and has since been registered in additional international markets, including Canada.[2] Anika has publicly indicated intent to pursue US approval, but until that changes, US-based clinicians should treat Cingal® as an international product they cannot prescribe, stock, or administer domestically.

This is a meaningful distinction from Anika’s other two viscosupplements, MONOVISC® and ORTHOVISC®, both of which are FDA-approved and legally available in the United States. Clinicians wondering about Cingal® insurance coverage should know it varies by country, payer, indication, and individual policy. Some CE-marked markets include viscosupplements under national or private schemes; others treat them as self-pay or require prior authorization, with the Cingal® injection cost varying accordingly. In the US, because Cingal® is not FDA-approved, it falls outside standard insurance reimbursement altogether.

Cingal® Compared to Other Knee Viscosupplements

Cingal® vs EUFLEXXA®

EUFLEXXA® from Ferring/Bioventus is a three-injection course of 1% non-animal, highly purified sodium hyaluronate at 20 mg per 2 mL injection. Like Cingal®, its HA is derived from bacterial fermentation, so there is no avian source consideration. Unlike Cingal®, it contains HA alone. The practical trade-off comes down to visits and market availability. EUFLEXXA® is FDA-approved and requires three appointments. Cingal® requires one, but is not available in the US.

Cingal® vs HYALGAN®

HYALGAN® (Fidia Pharma) uses rooster-comb-derived low-molecular-weight sodium hyaluronate at 20 mg per 2 mL and is delivered as three to five injections. Its avian source is often the first differentiator flagged for patients with bird-protein sensitivities. It is FDA-approved and CE-marked. Duration of relief typically runs three to six months per course, without an anti-inflammatory component to layer alongside the HA.

Cingal® vs MONOVISC®

MONOVISC®, also from Anika Therapeutics, is the closest in-house comparator to Cingal®. It matches the 88 mg cross-linked non-avian HA content in a single 4 mL syringe and is FDA-approved for knee OA in the United States. That shared HA platform is exactly the point: MONOVISC® is what Cingal® would be if you subtracted the corticosteroid. Clinics that have had good results with MONOVISC® on straightforward degenerative cases may not need the steroid layer at all. The typical rationale for switching to Cingal® is a presentation with a marked inflammatory element that the HA alone is not addressing quickly enough. MONOVISC® is available in the US market; Cingal® is not.

Cingal® vs ORTHOVISC®

ORTHOVISC® is Anika’s higher-molecular-weight, multi-injection HA product, dosed at 30 mg per 2 mL across three to four visits, and it holds FDA approval for knee OA. It suits practitioners who prefer a staged HA-only regimen with no corticosteroid exposure. Cingal® is the opposite trade: one visit, both mechanisms, no US availability.

Cingal® vs SUPARTZ®

SUPARTZ® (Bioventus) is a rooster-comb-derived, low-molecular-weight HA at 25 mg per 2.5 mL, given as three to five injections. FDA-approved and CE-marked, with the same avian-source flag as HYALGAN®. HA only, with a per-course duration commonly around six months.

Effectiveness, Safety, and Side Effects

The pivotal evidence base for Cingal® is a multicenter, randomized, double-blind, saline-controlled trial that compared Cingal® against HA alone (MONOVISC®) and against saline in patients with knee osteoarthritis. Cingal® produced significantly greater improvement from baseline than saline at both 12 and 26 weeks. It outperformed HA alone at the earliest timepoints, Weeks 1 and 3, with the two treatments converging from Week 6 onward.[1] Read as a whole, the corticosteroid drives the fast early relief, and the cross-linked HA carries the sustained effect through the following months, which is a more useful way to frame the data than treating it as a single “duration” number.

The broader Phase III program, including the Cingal® 13-01 and 16-02 trials and a 39-week extension study (17-02), tracked adverse event rates across the treatment population. The most commonly reported reactions across HA-plus-triamcinolone injections in this program were arthralgia, joint swelling, warmth, reduced range of motion, and injection-site pain, most of them transient. Rates of adverse events considered possibly, probably, or definitely related to the injection ran roughly 2 to 8 percent across the individual trials.[3]

Because the corticosteroid dose is delivered locally and in small quantity, systemic corticosteroid effects are minimal at the intra-articular dose. Cingal® reviews from published studies and post-approval use track with this profile, though individual patient experience always varies. Contraindications include active joint or skin infection at the injection site and known hypersensitivity to hyaluronic acid, corticosteroids, or product excipients. Practitioners should consult the current instructions for use for the complete warning profile.

Where to Buy Cingal® Wholesale Online

Medical Spa Rx supplies Cingal® to licensed orthopedic surgeons, rheumatologists, sports medicine practitioners, and clinic buyers in markets where the product is authorized. Clinics that want to buy Cingal® wholesale open a verified professional account, which our team completes in a 24-hour license verification window before the first order.

Ordering does not require a minimum quantity. Practitioners can buy Cingal® online for a single case load or place a larger request to order Cingal® wholesale against forecast demand, subject to stock and local regulations. Every order ships with LOT-verified authentic product, fully tracked international fulfillment, and access to a dedicated account manager who can coordinate specifics for temperature-sensitive intra-articular products. Volume-tiered wholesale pricing applies, and qualifying purchases are eligible for the Medical Spa Rx price-beat program.

Shipping is arranged with conditions suited to intra-articular products. Orders over $1,000 qualify for free shipping, and Medical Spa Rx offers a 14-day delivery guarantee, with many shipments arriving sooner where domestic routing applies. To purchase Cingal® online, verified customers can sign in to their account, confirm current availability, select the required quantity, and complete checkout.

Frequently Asked Questions

What is Cingal®?

Cingal® is a single-injection knee viscosupplement that combines 88 mg of cross-linked sodium hyaluronate with 18 mg of triamcinolone hexacetonide in one 4 mL prefilled syringe. It is manufactured by Anika Therapeutics, CE-marked in international markets, and not FDA-approved.

How is Cingal® administered?

One 4 mL injection into the affected knee joint completes a treatment cycle. Patients should avoid jogging, heavy lifting, and other strenuous activity for around 48 hours after the procedure, then resume normal activity as symptoms allow.

Is Cingal® FDA-approved?

No. Cingal® is CE-marked and has received regulatory approval in several international markets, including Canada, but it has not been approved by the US FDA. It is not available for clinical use in the United States.

Does Cingal® have insurance coverage?

Coverage varies by country, insurer, and reimbursement policy. In markets where viscosupplement treatments are reimbursed, Cingal® may be covered, although eligibility should always be confirmed with the relevant payer. In the United States, because Cingal® has not received FDA approval, it is not reimbursable under standard US health insurance programs.

What makes Cingal® unique among viscosupplements?

It is the only viscosupplement combining hyaluronic acid and a corticosteroid in a single injection. EUFLEXXA®, HYALGAN®, MONOVISC®, ORTHOVISC®, and SUPARTZ® are all HA-only products. Cingal® delivers viscoelastic supplement effect and anti-inflammatory pain relief together, in one intra-articular administration.

What are Cingal®’s side effects?

Transient injection-site pain, joint swelling, warmth, and reduced range of motion are the most commonly reported reactions. Post-injection flare is possible but uncommon. Systemic corticosteroid effects are minimal at the intra-articular dose. Treatment-related adverse events across the Phase III program ran roughly 2 to 8 percent per trial.[3]

Where can practitioners buy Cingal® online?

Licensed practitioners can buy Cingal® online through Medical Spa Rx once their professional credentials are verified. Ordering benefits include LOT-verified product, temperature-appropriate shipping, a price-beat program, free shipping above $1,000, and a 14-day delivery guarantee where routing allows.

The page and all of its displayed contents are for medical professionals, designed to inform only, and not as a replacement for medical advice.

Citations

[1] Hangody, Laszlo et al. “Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial.” Cartilage vol. 9,3 (2018): 276-283.

[2] Anika Therapeutics. Anika Therapeutics wins CE Mark approval for Cingal® for the treatment of pain associated with osteoarthritis of the knee. Anika Investor Relations, 2016. https://ir.anika.com/Anika-Therapeutics-Wins-CE-Mark-Approval-for-Cingal-R-for-the-Treatment-of-Pain-Associated-with-Osteoarthritis-of-the-Knee

[3] Anika Therapeutics, Inc. “Study of Cingal™ for the Relief of Knee Osteoarthritis Compared to Triamcinolone Hexacetonide.” ClinicalTrials.gov, U.S. National Library of Medicine, 24 Feb. 2022.

Related brands to CINGAL®

CRESPINE®

DUROLANE®

EUFLEXXA®

HYALGAN®

HYMOVIS®

Written and reviewed by the Medical Spa Rx Editorial Team 

All clinical and product claims on this page have been checked against peer-reviewed research, manufacturer data, and regulatory sources in accordance with our Editorial Policy .