CINGAL®

About Cingal® and Anika Therapeutics

Anika Therapeutics, a Massachusetts-based orthopedic specialist, is the Cingal® injection manufacturer and also produces the HA-only viscosupplements MONOVISC® and ORTHOVISC®. The company positions Cingal® as the first approved combination of cross-linked HA and a corticosteroid for symptomatic osteoarthritis of the knee in the international markets where it is registered. It carries CE marking and, according to Anika, is available in more than 45 countries, though it is not approved by the United States FDA.[2][3] Clinics that intend to buy Cingal® online should confirm that importation, prescribing, and administration are permitted under their local regulations before ordering.

Cingal® Injection Product Specifications

Cingal® is a transparent gel distributed in a single-use 4 mL prefilled glass syringe, formulated for intra-articular injection into the knee. The Cingal® injection contains cross-linked, non-avian sodium hyaluronate at 22 mg/mL and triamcinolone hexacetonide at 4.5 mg/mL, delivered together in the same syringe.

Before administration, practitioners should verify the LOT number, expiration date, syringe integrity, and cold-chain history of any Cingal® 4 ml unit received. Shipping conditions matter here. Temperature excursions during transit can affect viscosupplement stability, which is one reason clinics that buy Cingal® wholesale usually specify delivery arrangements up front.

Full Cingal® Product Range

The current commercial range comprises one presentation:

• Cingal® 4 mL Prefilled Syringe — 88 mg cross-linked sodium hyaluronate plus 18 mg triamcinolone hexacetonide, single-use, single injection.

Anika Therapeutics does not market alternative strengths, multi-injection packs, or corticosteroid-free Cingal® variants. Packaging, licensed indications, and Cingal® price may still vary between authorized markets, so clinics looking to buy Cingal® online alongside other orthopedic injections should confirm regional labeling and storage requirements before placing an order.

How the Cingal® Injection Works: Dual Mechanism in One 4 mL Syringe

Knee osteoarthritis is not just cartilage wear. Synovial fluid thins over time, cushioning drops, and intermittent inflammation drives much of the acute pain that patients present with. Cingal® is engineered to address both problems at once, which is why many of our clients ask about it: they want one appointment to address inflammation and lubrication together rather than staging two products across two visits.

Cingal® Hyaluronic Acid Component

The Cingal® hyaluronic acid component is a non-avian, cross-linked sodium hyaluronate produced by bacterial fermentation. It functions as a viscoelastic supplement, restoring some of the viscosity and shock-absorbing behavior of healthy synovial fluid so that joint surfaces glide with less mechanical friction. The cross-linking is intended to slow enzymatic degradation, letting the viscosupplement effect continue after the corticosteroid has moved past its most active window.

Triamcinolone Hexacetonide Component

Triamcinolone hexacetonide is a long-acting, poorly water-soluble corticosteroid that remains locally active inside the joint capsule with limited systemic absorption at the 18 mg dose delivered. Its role is early relief. Treatment starts producing measurable pain reduction within the first several days after administration, which is when a corticosteroid-free HA product typically has not yet reached its peak effect.

Administration and Post-Injection Protocol

Cingal® must be administered by a trained, licensed healthcare professional using strict aseptic technique. Before treatment, the clinician should confirm the diagnosis, examine the knee, review allergies and concurrent medications, and rule out infection at or near the injection site.

Where clinically appropriate, excess synovial fluid may be aspirated before administration. Ultrasound guidance can improve accuracy of intra-articular placement, particularly in patients with substantial effusion, difficult anatomy, obesity, or a history of technically challenging injections. The full 4 mL contents are injected into the affected knee. Cingal® must not be delivered into blood vessels, surrounding soft tissue, the synovial capsule, or an infected joint.

Patients should avoid physical activities such as jogging, heavy lifting, prolonged standing, and other high-impact loading for approximately 48 hours after the procedure. Normal ambulation does not need to stop entirely. Activity can usually be resumed gradually as post-injection discomfort settles.

Cingal® is designed as a single-injection treatment rather than a weekly series. Repeat administration should be based on individual clinical reassessment and current product labeling; Anika has published repeat-injection safety data, though the authorized interval between cycles varies by jurisdiction.[2]

Indications and Patient Selection

In its authorized international markets, Cingal® is indicated for pain associated with osteoarthritis of the knee. A Cingal® injection for knee pain is typically considered once conservative measures such as activity modification, weight management, physiotherapy, and oral analgesics have failed to produce adequate symptom relief.

Suitable candidates for a Cingal® shot may include adults with:

• Symptomatic, radiographically confirmed knee osteoarthritis
• Persistent pain, stiffness, or restricted range of motion
• An inflammatory component alongside cartilage degeneration
• Inadequate response to HA-only viscosupplementation
• A clinical preference for a single-injection protocol over a multi-visit HA course

Patient selection should weigh imaging findings, symptom severity, comorbidities such as diabetes where systemic corticosteroids are a concern, current medications, and prior response to intra-articular therapy. Clinics that use Cingal® injections routinely find the strongest fit is the patient who needs early inflammatory control and a sustained lubrication effect from the same appointment.

Regulatory Status: CE Mark, FDA, and Insurance Coverage

Cingal® received CE Mark approval in 2016 for pain associated with knee osteoarthritis and has since been registered across additional international markets.[3] Regarding Cingal® FDA approval, the product has not received United States FDA clearance. CE marking or authorization elsewhere should not be treated as equivalent to US approval. Practitioners must confirm local requirements before importing, promoting, supplying, or administering Cingal®.

Insurance coverage for Cingal® depends on the country, payer, indication, clinical protocol, and individual policy. In authorized markets, some public and private plans cover part or all of the Cingal® injection cost, while others treat it as self-pay or require prior authorization. Because Cingal® is not FDA-approved in the United States, it is generally not reimbursable through standard US insurance pathways. Clinics should verify coverage directly with the relevant insurer rather than offering patients a general guarantee.

Cingal® Compared With Other Viscosupplements

vs MONOVISC®

MONOVISC® is the closest sibling. It is manufactured by the same company, Anika Therapeutics, and shares the 88 mg cross-linked, non-avian HA platform in a 4 mL single-injection syringe. Both are single-shot products, which simplifies patient compliance compared with multi-injection HA regimens. The clinically meaningful difference is the added 18 mg of triamcinolone hexacetonide in Cingal®, which gives earlier inflammatory control. Patients who have already responded well to MONOVISC® may not need the corticosteroid layer at all. Patients presenting with a marked inflammatory component alongside cartilage change are the more natural fit for the Cingal® combination.

MONOVISC® also carries FDA approval for the US market; Cingal® does not. Practitioners choosing between the two in international markets are effectively deciding whether the case calls for a steroid.

vs ORTHOVISC®

ORTHOVISC® is another Anika HA product, supplied as 30 mg per 2 mL syringe and typically administered as three weekly injections. It suits clinicians and patients who prefer a staged HA-only course without corticosteroid exposure. Cingal® collapses that regimen into a single appointment and adds the anti-inflammatory component. ORTHOVISC® is FDA-approved for knee osteoarthritis in the United States.

vs EUFLEXXA®

EUFLEXXA® (Ferring/Bioventus) is a non-avian, highly purified sodium hyaluronate delivered as three weekly 2 mL injections at 20 mg per injection. Like Cingal®, it avoids an avian HA source, which is relevant for patients with avian sensitivity. It does not include a corticosteroid, so the early anti-inflammatory effect that triamcinolone hexacetonide contributes to Cingal® is not part of the profile. EUFLEXXA® is FDA-approved; Cingal® is not.

vs SUPARTZ®

SUPARTZ® (Bioventus) is a low-molecular-weight, rooster-comb-derived sodium hyaluronate at 25 mg per 2.5 mL syringe, administered across three to five injections. It remains an HA-only, avian-source, multi-visit protocol. Cingal® is single-shot, non-avian, and combined with a corticosteroid.

vs HYALGAN®

HYALGAN® (Fidia Pharma) is a rooster-comb-derived sodium hyaluronate at 20 mg per 2 mL syringe, given as three to five injections depending on the authorized protocol. It provides viscosupplementation only, with no corticosteroid element and an avian HA source. HYALGAN® is FDA-approved and CE-marked.

Effectiveness and Safety Evidence

The pivotal Cingal® 13-01 randomized, double-blind, placebo-controlled trial enrolled 368 adults with Kellgren-Lawrence Grade I to III knee osteoarthritis. Participants received a single injection of Cingal®, MONOVISC® as the HA-only comparator, or saline.[1]

Cingal® produced significantly greater pain reduction than HA alone at Weeks 1 and 3, reflecting the early contribution of triamcinolone hexacetonide. From Week 6 onward, the Cingal® and MONOVISC® arms performed comparably on pain outcomes, while Cingal® remained superior to saline through Week 26 across pain, stiffness, and physical-function measures.[1]

In practical research terms, this pattern supports a two-stage effect rather than a claim that the corticosteroid remains pharmacologically active for the full six months. The steroid drives the early relief; the cross-linked HA carries the longer viscosupplement benefit. Cingal® reviews and case-series reports from practitioners generally track with this profile, but they should not substitute for controlled evidence or individual patient assessment.

Reported side effects have been consistent with the class:

• Transient injection-site pain or tenderness
• Swelling or joint effusion
• Warmth or redness
• Short-term stiffness
• Bruising

Treatment-related events were uncommon in the pivotal study and included arthralgia, rash, and peripheral edema. No serious adverse events attributed to the study material were reported.[1][2] More serious complications of any intra-articular injection may include infection, hemarthrosis, hypersensitivity, or neurovascular injury. Cingal® should not be injected into an infected joint or through infected or damaged skin, and practitioners should consult the current instructions for use for the full warning and contraindication profile.

Where to Buy Cingal® Wholesale Online From Doctor Medica

Doctor Medica works with licensed orthopedic surgeons, rheumatologists, sports medicine practitioners, and clinic owners who need to buy Cingal® wholesale for regular practice use. Ordering is handled through a verified professional account, so before eligible customers can purchase Cingal® online, our team completes a 24-hour license verification.

Once verified, clinics can buy Cingal® online in the quantities that fit their case load, subject to stock and local regulations. There is no minimum order requirement. Every order includes LOT-verified authentic product, volume-tiered wholesale pricing, tracked international fulfillment, and access to a dedicated account manager who can coordinate specifics for temperature-sensitive intra-articular products. Qualifying purchases are also eligible for our price-beat program.

Shipping is handled with appropriate arrangements for intra-articular products, and orders above $1,000 qualify for free shipping. Doctor Medica offers a 14-day delivery guarantee, with many shipments arriving sooner, particularly within North America. Before placing an order, we recommend clinics confirm expiry dating, storage capacity, local authorization, and expected patient volume.

To order Cingal® wholesale for anticipated demand, sign in to your professional account, confirm current availability, select the required quantity, and complete checkout. Doctor Medica’s staff is available to assist with sourcing questions, documentation, and account setup.

Frequently Asked Questions

What is Cingal®?

Cingal® is a single-injection viscosupplement for pain associated with knee osteoarthritis. Each 4 mL prefilled syringe delivers 88 mg of cross-linked sodium hyaluronate plus 18 mg of triamcinolone hexacetonide.

What makes the Cingal® injection different from other viscosupplements?

It is the only combination product on the viscosupplement market that pairs an HA viscoelastic supplement with a corticosteroid in a single syringe. The corticosteroid provides earlier inflammatory relief while the cross-linked HA supports lubrication over the following weeks.

Who manufactures Cingal®?

Anika Therapeutics, based in the United States. Anika also produces MONOVISC® and ORTHOVISC®, both HA-only viscosupplements.

Is Cingal® FDA-approved?

No. Cingal® is not FDA-approved for the United States market. It holds CE Mark approval and is registered in more than 45 international markets according to Anika Therapeutics.

Is Cingal® covered by insurance?

Coverage depends on the country, insurer, indication, and individual policy. Because Cingal® is not FDA-approved, it is generally not reimbursable through standard US insurance pathways.

How is Cingal® administered?

A licensed healthcare professional injects the full 4 mL contents into the knee joint. Effusion may be aspirated where appropriate. Patients should generally avoid jogging, heavy lifting, and strenuous activity for about 48 hours.

How long may the effects last?

In the published Phase III study, improvements compared with saline were maintained through Week 26. Individual response and duration may vary. [1]

What are the possible Cingal® side effects?

Possible effects include temporary pain, swelling, warmth, stiffness, redness, bruising, or discomfort around the treated knee. Infection and significant inflammatory reactions are uncommon but require prompt medical attention.

Where can practitioners buy Cingal® wholesale?

Licensed practitioners can buy Cingal® wholesale through Doctor Medica, with professional verification, LOT-verified sourcing, wholesale pricing, tracked shipping, and account support.

Can practitioners buy Cingal® online without a minimum order?

Yes. Eligible professional customers can buy Cingal® online in quantities suited to current clinic requirements, subject to stock and local regulations.

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. doi:10.1177/1947603517703732

[2] Anika Therapeutics. For physicians: Cingal® clinical evidence. https://www.cingal.com/for-physicians/clinical-evidence/

[3] Anika Therapeutics. Anika Therapeutics wins CE Mark approval for Cingal® for the treatment of pain associated with osteoarthritis of the knee. Published March 28, 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

[4] Anika Therapeutics. Cingal® osteoarthritis knee injection. https://anika.com/medical/products/cingal/

[5] 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.

For licensed medical professionals only. This content is for informational purposes only and does not constitute medical advice.

Written by Doctor Medica’s Editorial team

The content on this page has been written and fact-checked in accordance with our Editorial Policy. Clinical claims are sourced from peer-reviewed literature, regulatory documentation, and manufacturer specifications. Where citations are provided, it is always in accordance to our editorial standards.

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