Triamcin

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Indications for Drugs ::

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Drug Dose ::

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Contraindication ::

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Drug Precautions ::

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Drug Side Effects ::

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.

 

 Indications

PO/IM/IV administration: Replacement therapy in endocrine disorders; adjunctive therapy for short-term administration in rheumatic disorders; maintenance therapy or control of exacerbation of collagen diseases; treatment of dermatologic diseases; control of allergic states; management of allergic and inflammatory ophthalmic processes; treatment of respiratory diseases including pulmonary emphysema and diffuse interstitial pulmonary fibrosis; treatment of selected hematologic disorders; palliative management of selective neoplastic diseases; induction of diuresis in edematous states caused by nephrotic syndrome, refractory CHF and in ascites caused by cirrhosis of liver; control of exacerbation in selected GI diseases (eg, inflammatory bowel disease); control of exacerbation of multiple sclerosis; adjunctive treatment of tuberculous meningitis; treatment of trichinosis with neurologic or myocardial involvement; management of postoperative dental inflammatory reactions.

Intra-articular or soft tissue administration: Short-term adjunctive therapy in synovitis of osteoarthritis, rheumatoid arthritis, bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tenosynovitis, posttraumatic osteoarthritis.

Intralesional administration: Management of keloids; treatment of localized hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare, lichen simplex chronicus; treatment of discoid lupus erythematosus, necrobiosis lipoidica diabeticorum, alopecia areata, cystic tumors of aponeurosis or tendon.

Topical application: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inhalation: Control of bronchial asthma or corticosteroid-responsive bronchospastic states.

Intranasal administration: Relief of seasonal and perennial allergic rhinitis symptoms.

 

 Contraindications Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live virus vaccines; topical monotherapy in primary bacterial infections; topical use on face, groin, or axilla; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; intranasal administration in untreated localized infections involving nasal mucosa.

 

 Route/Dosage

Triamcinolone

Adults: PO 4 to 100 mg/day.

Children: PO 0.117 to 1.66 mg/kg/day.

Triamcinolone Acetonide

Adults and Children older than 12 yr: IM 2.5 to 60 mg/day. Intra-articular/intrasynovial/soft tissue 2.5 to 40 mg prn. Intradermal 1 mg/intradermal injection site. Inhalation 2 inhalations tid to qid (max, 16 inhalations/day). Intranasal Nasacort: Start with 220 mcg/day as 2 sprays (55 mcg/spray) in each nostril once daily. The dose may be increased to 440 mcg/day either as once-a-day dosage or divided up to qid (ie, bid [2 sprays/nostril] or qid [1 spray/nostril]). Some patients may be maintained with 1 spray/nostril once daily. Nasacort AQ: Recommended starting and maximum dose is 220 mcg/day as 2 sprays in each nostril once daily. When the maximum benefit is achieved and symptoms controlled at 220 mcg/day, decreasing the dose to 110 mcg/day (1 spray in each nostril/day) may be effective in maintaining control of allergic rhinitis symptoms.

Children 6 to 12 yr: IM 0.03 to 0.2 mg/kg q 1 to 7 days. Inhalation 1 to 2 inhalations tid to qid (max, 12 inhalations/day).

Children 6 to 11 yr: Intranasal Nasacort: Recommended starting dose is 220 mcg/day as 2 sprays in each nostril once daily. Once the maximum effect has been achieved, titrate to minimum effective dose. Nasacort AQ: Recommended starting dose is 110 mcg/day as 1 spray in each nostril once daily. Maximum recommended dose is 220 mcg/day as 2 sprays per nostril once daily. Once symptoms are controlled, pediatric patients may be maintained on 110 mcg/day (1 spray in each nostril/day).

Adults and Children: Topical Apply sparingly bid to qid.

Triamcinolone Diacetate

Adults: IM 40 mg/wk. Intra-articular/intrasynovial/soft tissue 2 to 40 mg prn. Intradermal 5 to 48 mg (no more than 12.5 mg per injection site) prn.

Triamcinolone Hexacetamide

Adults: Intra-articular 2 to 20 mg prn. Intradermal no more than 0.5 mg/square inch of affected area.

 

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis.

Barbiturates: May decrease pharmacologic effect of systemically administered triamcinolone.

Hydantoins, rifampin: May increase clearance and decrease efficacy of systemically administered triamcinolone.

Salicylates: Systemic administration may reduce serum levels and efficacy of salicylates.

Somatrem: May inhibit growth-promoting effects of somatrem.

Troleandomycin: May increase triamcinolone effects.

 

 Lab Test Interferences Uptake of thyroid I¹³¹ may be decreased; false-negative results with nitroblue-tetrazolium test may occur; skin test reactions may be suppressed.

 

 Adverse Reactions

CARDIOVASCULAR: Edema; thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri; vertigo; headache; neuritis; paresthesias; psychosis. DERMATOLOGIC: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus-like lesions; SC fat atrophy; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation (injection); burning, itching, irritation, erythema, dryness, folliculitis, hypertrichosis, perioral dermatitis, allergic contact dermatitis, stinging, cracking, and tightening of skin, secondary infections, miliaria, telangiectasia (topical). EENT: Posterior subcapsular cataracts; increased IOP; glaucoma; exophthalmos; throat irritation, hoarseness, dysphonia, coughing, thrush, dry mouth (oral); nasal irritation, burning, stinging, dryness, epistaxis or bloody mucus, congestion, occasional sneezing attacks, rhinorrhea, anosmia, loss of sense of taste, throat discomfort (intranasal). GI: Pancreatitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; bowel perforation. HEMATOLOGIC: Leukocytosis. METABOLIC: Sodium and fluid retention; hypokalemia; hypokalemic metabolic alkalosis; hypocalcemia. RESPIRATORY: Wheezing (oral). OTHER: Musculoskeletal effects (eg, weakness, myopathy, muscle mass loss, osteoporosis, spontaneous fractures); endocrine abnormalities (eg, menstrual irregularities, cushingoid state, growth suppression in children, sweating, decreased carbohydrate tolerance or hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetic patients, hirsutism); anaphylactoid or hypersensitivity reactions; aggravation or masking of infections; osteonecrosis, tendon rupture, infection, skin atrophy, postinjection flare, hypersensitivity, facial flushing (intra-articular); may cause adverse effects similar to systemic use because of absorption (topical).

 

 Precautions

Pregnancy: Undetermined. Category C (Nasal/Topical). Lactation: Excreted in breast milk. CHILDREN: Children may be more susceptible to adverse effects from topical use. Monitor growth and development of infants and children on prolonged therapy. Intranasal form not recommended in children younger than 12 yr. Elderly: The elderly may require lower doses. Acute asthma: Oral inhalation is not indicated for rapid relief of bronchospasm. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with caution after recent MI. Hepatitis: Drug may be harmful in chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: Reactions including anaphylaxis may occur. Immunosuppression: Do not administer live virus vaccines while patient is on therapy. Infections: Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use drug with caution in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal function impairment: Use drug with caution. Repository injections: Do not inject SC. Avoid injection into deltoid muscle and repeated IM injection into same site. Route change: Particular caution is needed when transferring patient from systemically active corticosteroids to triamcinolone inhaler because deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic to aerosol corticosteroids. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during, and after stressful situations. Tartrazine sensitivity: Some oral dosage forms of these products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

PO

• Administer with meals or snacks.
• If drug is to be taken only once daily, administer early in morning.
• Administer multiple doses at evenly spaced intervals throughout day.
• When large doses are given, consider administering antacids between meals to help prevent peptic ulcers.
• Store at controlled room temperature (59° to 86°F).
• Avoid freezing of oral solution and suspension.
• Protect from light.

IM

• Shake vial well before withdrawing drug from vial.
• Inject deeply into well-developed muscle.
• Rotate injection sites.
• Avoid injection into deltoid muscle.
• Store at controlled room temperature (59° to 86°F).

Oral Inhalation

• Open inhaler so that medication canister is vertical and locked into position on built-in spacer.
• Thoroughly shake inhaler. Have patient take drink of water to moisten throat. Place adapter mouthpiece in mouth and gently seal with lips. Have patient tilt head back slightly, activate inhaler into spacer and take slow, deep breath for 3 to 5 sec while inhaler is activated. Have patient hold breath for 10 sec and breathe out slowly. Allow at least 1 min between inhalations. Have patient rinse mouth with water or mouthwash after each use.

Intranasal

• Clear nasal passages of secretions prior to use. If patient is congested, use topical, short-acting decongestant just before administration to ensure adequate penetration of spray.
• Shake canister, place nasal adapter into 1 nares, gently close other nares with finger. While inhaling from nostril, activate canister. Repeat process on other side.
• Do not blow nose immediately after administration.

Topical

• To increase drug penetration, wash or soak area before application.
• May use occlusive dressing such as plastic wrap to increase skin penetration. However, do not use occlusive dressings for more than 12 hr/day.
• Apply cream/ointment or lotion sparingly in light film; rub in gently.
• Do not place bandages, dressings, cosmetics, or other skin products over treated area unless directed by health care provider.
• Avoid contact with eyes.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain periodic electrolyte and renal function tests if systemic preparations are used long-term.
• In patients taking large doses, restrict sodium intake and monitor BP.
• In prolonged use with children, plot growth pattern. Notify health care provider if abnormalities are evident.
• Monitor weight monthly.

OVERDOSAGE: SIGNS & SYMPTOMS   Excessive or long-term use : Moonface, central obesity, striae, hirsutism, acne, ecchymoses, hypertension, osteoporosis, myopathy, sexual dysfunction, hyperglycemia, hyperlipidemia, peptic ulcer, electrolyte and fluid imbalance

 

 Patient/Family Education

• Advise patient to follow dosage guidelines carefully. Do not discontinue or change dose unless directed by health care provider.
• Instruct patient on long-term steroid therapy to carry identification (eg, Medi-Alert ) indicating condition and drug therapy.
• Advise patient to notify health care provider of stressful events/illnesses that may make dose adjustments necessary.
• Remind patient to use caution when exercising joints that have been recently medicated.
• Inform patient that nasal inhaler is for preventive therapy only and should be used on a daily basis.
• Recommend that patient have eyes examined periodically.
• Stress that oral inhalation is for preventive therapy only, should be used on a daily basis, and should not be used to abort acute asthmatic attack. Instruct patient to notify health care provider if sore throat or mouth occur.
• Inform diabetic patient that sugar level in blood will probably be increased during systemic use of steroid and to monitor blood sugar more frequently.
• Remind patient that disease symptoms may reappear even after medication has been discontinued.
• Advise patient to notify health care provider promptly of signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, vomiting, dizziness, fainting, diarrhea, low blood sugar).
• Instruct patient to report the following symptoms to health care provider: unusual weight gain, swelling of lower extremities, muscle weakness, black tarry stools, vomiting of blood, puffing of face, menstrual irregularities, prolonged sore throat, fever, cold, infection.

Drug Mode of Action ::  

(TRY-am-SIN-oh-lone)

Triamcinolone

Aristocort

Tablets: 4 mg

Tablets: 8 mg

Atolone

Tablets: 4 mg

Kenacort

Tablets: 4 mg

Tablets: 8 mg

Syrup: 4 mg (as diacetate)/5 mL

Triamcinolone Acetonide

Aristocort

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Aristocort A

Ointment: 0.1%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Azmacort

Aerosol: 100 mcg/actuation (Inhaler contains 60 mg)

Delta-Tritex

Cream: 0.1%

Ointment: 0.1%

Flutex

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Kenaject-40

Injection: 40 mg/mL suspension

Kenalog

Ointment: 0.025%

Ointment: 0.1%

Ointment: 0.5%

Cream: 0.025%

Cream: 0.1%

Cream: 0.5%

Lotion: 0.025%

Lotion: 0.1%

Aerosol: 2 sec. Spray

Kenalog-10

Injection: 10 mg/mL suspension

Kenalog-40

Injection: 40 mg/mL suspension

Kenalog-H

Cream: 0.1%

Kenalog in Orabase

Paste: 0.1%

Kenonel

Cream: 0.1%

Nasacort

Inhaler: 55 mcg/actuation

Nasacort AQ

Spray: 55 mcg/actuation

Oralone Dental

Paste: 0.1%

Tac-3

Injection: 3 mg/mL suspension

Tac-40

Injection: 40 mg/mL suspension

Tri-Kort

Injection: 40 mg/mL suspension

Triacet

Cream: 0.1%

Triam-A

Injection: 40 mg/mL suspension

Triamonide 40

Injection: 40 mg/mL suspension

Triderm

Cream: 0.1%

Trilog

Injection: 40 mg/mL suspension Aristocort Acetonide Topicals, Kenalog-10, Kenalog-40, Kenalog in Orabase

Oracort, Scheinpharm Triamcine-A

Triaderm

Triamcinolone Diacetate

Amcort

Injection: 40 mg/mL suspension

Aristocort Forte

Injection: 40 mg/mL suspension

Aristocort Intralesional

Injection: 25 mg/mL suspension

Cinacort

Injection: 40 mg/mL suspension

Triam Forte

Injection: 40 mg/mL suspension

Trilone

Injection: 40 mg/mL suspension

Tristoject

Injection: 40 mg/mL suspension

Aristocort Parenteral

Aristocort Syrup

Triamcinolone Hexacetonide

Aristospan Intra-articular

Injection: 20 mg/mL suspension

Aristospan Intralesional

Injection: 5 mg/mL suspension

Class: Corticosteroid

 

 Action Anti-inflammatory effect by depressing formation, release and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body’s immune response.