Triamcinolone acetonide


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : Mouth Mouth ulceration As 0.1% triamcinolone acetonide paste: Press small amount (approx 0.6 cm) into the lesion without rubbing until a thin film develops. Apply at bedtime and, if necessary, 2 or 3 times/day. Re-evaluate after 7 days if recovery does not occur. IM Symptomatic control for hay fever As triamcinolone acetonide: 40-100 mg as a single dose. Suppression of allergic and inflammatory disorders As triamcinolone acetonide: Initial: 40 mg via deep inj into gluteal muscle, repeat if needed. Intra-articular Inflammatory joint diseases As triamcinolone acetonide: 5-10 mg (smaller joints); up to 40 mg (larger joints). Max total: 80 mg as a single inj into several sites for multiple joint involvement. As triamcinolone hexacetonide: 2-6 mg (smaller joints); 5-10 mg (medium-sized joints); 10-20 mg (larger joints). Administration into a single joint at 3-4 week intervals as needed. Periarticular Bursitis; Tendinitis 10-20 mg. Intradermal Inflammatory skin conditions As triamcinolone acetonide: 1-3 mg/site. Max: 5 mg/site. Max total: 30 mg if several sites of inj used. As triamcinolone diacetate: 5-25 mg in divided doses, injected as no more than 100 mcg/cm2 of skin surface area. As triamcinolone hexacetonide: Up to 500 mcg/in2 of affected skin. Topical Corticosteroid-responsive dermatoses As 0.025-0.5 triamcinolone acetonide cream/lotion/ointment: Apply to affected area 2-4 times/day. Nasal Treatment and prophylaxis of allergic rhinitis As triamcinolone acetonide: Initial: 2 sprays (110 mcg) into each nostril once daily, reduced to 1 spray (55 mcg) into each nostril once daily when under control. Intravitreal Inflammatory eye disorders As triamcinolone acetonide: Initial: 4 mg as a single dose. Visualisation during vitrectomy As triamcinolone acetonide: 1-4 mg.
Dosage Details
Intra-articular
Inflammatory joint diseases
Adult: As triamcinolone acetonide: 5-10 mg (smaller joints); up to 40 mg (larger joints). Max total: 80 mg as a single inj into several sites for multiple joint involvement. As triamcinolone hexacetonide: 2-6 mg (smaller joints); 5-10 mg (medium-sized joints); 10-20 mg (larger joints). Administration into a single joint at intervals of 3-4 weeks as needed.
Child: 3-12 years As triamcinolone hexacetonide: With juvenile idiopathic arthritis: 0.5 mg/kg (smaller joints); 1 mg/kg (larger joints). For hands and feet, 1-2 mg (metacarpophalangeal/metatarsophalangeal joints); 0.6-1 mg (proximal interphalangeal joints).

Intradermal
Inflammatory skin conditions
Adult: As triamcinolone acetonide: 1-3 mg/site. Max: 5 mg/site. Max total: 30 mg if several sites of inj used. As triamcinolone diacetate: 5-25 mg in divided doses, injected as no more than 100 mcg/cm2 of skin surface area. As triamcinolone hexacetonide: Up to 500 mcg/in2 (approx 80 mcg/cm2) of affected skin.

Intramuscular
Symptomatic control for hay fever
Adult: As triamcinolone acetonide: 40-100 mg as a single dose.

Intramuscular
Suppression of allergic and inflammatory disorders
Adult: As triamcinolone acetonide: Initially, 40 mg via deep inj into gluteal muscle, repeat if needed.
Child: 6-12 years Same as adult dose.

Intravitreal
Inflammatory eye disorders
Adult: As triamcinolone acetonide: Initially, 4 mg as a single dose, with subsequent doses as needed.

Intravitreal
Visualisation during vitrectomy
Adult: As triamcinolone acetonide: 1-4 mg.

Mouth/Throat
Mouth ulceration
Adult: As 0.1% triamcinolone acetonide paste: Press small amount (approx 0.6 cm) into the lesion without rubbing until a thin film develops, may require larger amount to cover some lesions. Apply at bedtime and, if necessary, 2 or 3 times daily, preferably after meals. Re-evaluate if recovery does not occur after 7 days of treatment.

Nasal
Treatment and prophylaxis of allergic rhinitis
Adult: As triamcinolone acetonide: Initially, 2 sprays (110 mcg) into each nostril once daily, reduced to 1 spray (55 mcg) into each nostril once daily when under control.
Child: As triamcinolone acetonide: 2-5 years Max: 1 spray (55 mcg) into each nostril once daily; 6-12 years 1 spray (55 mcg) into each nostril once daily, may increase to 2 sprays (110 mcg) into each nostril once daily for severe symptoms.

Periarticular
Bursitis, Tendinitis
Adult: As triamcinolone hexacetonide: 10-20 mg.

Topical/Cutaneous
Corticosteroid-responsive dermatoses
Adult: As 0.025-0.5% triamcinolone acetonide cream/lotion/ointment: Apply to affected area 2-4 times daily.
Incompatibility
Incompatible with solvents containing phenol, methylparaben, propylparaben.
Contraindications
Idiopathic thrombocytopenic purpura, cerebral malaria; untreated fungal, viral, or bacterial infections; acute psychosis, active TB, herpes simplex keratitis, systemic mycosis and parasitosis.
Special Precautions
Patient with glaucoma and/or cataracts, hypertension and/or heart failure, acute MI, diabetes mellitus, gastrointestinal diseases (intestinal anastomoses, diverticulitis, peptic ulcer, ulcerative colitis), cirrhosis, myasthenia gravis, osteoporosis, history of seizure disorder. Avoid abrupt withdrawal. Children. Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Adrenal suppression, immunosuppression (e.g. secondary infections, superinfections); kaposi sarcoma, myopathy, psychiatric disturbances including insomnia and depression (parenteral); local topical, nasal or ocular effects (e.g. sensitization, visual disturbances such as increased intraocular pressure, endophthalmitis).
Eye disorders: Cataract (ocular).
Gastrointestinal disorders: Dyspepsia, tooth disorder (nasal).
Injury, poisoning and procedural complications: Injection site reactions (e.g. blurring of vision for ocular, discomfort, pain, erythema, swelling, necrosis, abscess).
Investigations: Elevated blood pressure, weight gain (parenteral).
Metabolism and nutrition disorders: Increased appetite, fluid retention, glucose tolerance alteration (parenteral).
Musculoskeletal and connective tissue disorders: Arthralgia (parenteral).
Nervous system disorders: Headache.
Respiratory, thoracic and mediastinal disorders: Epistaxis (nasal).
Potentially Fatal: Rarely, anaphylaxis.
IM/Intra-articular/Intrabursal/Intradermal/Intralesional/Intrasynovial/Parenteral/SC/Topical: C; Intravitreal: D
MonitoringParameters
Monitor growth and development of child on prolonged therapy.
Drug Interactions
May antagonise effect of anticholinesterase agent. Additional increase of intraocular pressure with anticholinergics (e.g. atropine). May potentiate or reduce anticoagulant effect of oral anticoagulants. May increase hyperglycaemic effect of ceritinib. May diminish the therapeutic effect of antidiabetics (e.g. sulfonylurea derivatives) and insulin. May diminish arterial blood pressure reduction of antihypertensives (including diuretics). May reduce isoniazid serum concentrations. Increase in both ciclosporin and corticosteroids activity when used concomitantly. May increase toxicity of digitalis glycosides. Increased effects with ketoconazole. May alter the neuromuscular blocking action of non-depolarising muscle relaxants. May increase risk of gastrointestinal bleeding and ulceration associated with NSAIDs. Increased serum levels with oestrogen (including oral contraceptives). Neurological complications and diminished antibody response may occur on vaccinated patients. May develop hypokalaemia with K-depleting agents (e.g. amphotericin B inj, diuretics). May increase risk of QT prolongation or torsade de pointes with class Ia antiarrhythmics (e.g. disopyramide, quinidine, procainamide) or class II antiarrhythmics (e.g. amiodarone, sotalol, bepridil).
Lab Interference
May produce false-negative results with nitroblue tetrazolium test for bacterial infection. May produce a positive result in anti-doping test for athletes. May suppress reactions to skin tests.
Action
Description: Triamcinolone has mainly glucocorticoid activity. It suppresses the migration of polymorphonuclear leukocytes and reduces capillary permeability thereby decreasing inflammation. It also suppresses the immune system by reducing activity and volume of the lymphatic system.
Pharmacokinetics:
Absorption: Slowly absorbed from inj sites. Time to peak plasma concentration: 8-10 hours (IM).
Distribution: It crosses the placenta. Volume of distribution: 99.5 L. Plasma protein binding: Approx 68%.
Excretion: Via urine (approx 40%); faeces (approx 60%). Plasma half-life: Approx 2-5 hours.
Chemical Structure

Chemical Structure Image
Triamcinolone acetonide

Source: National Center for Biotechnology Information. PubChem Database. Triamcinolone acetonide, CID=6436, https://pubchem.ncbi.nlm.nih.gov/compound/Triamcinolone-acetonide (accessed on Jan. 23, 2020)

Storage
Store between 20-25°C. Do not freeze. Protect from light.
ATC Classification
D07AB09 - triamcinolone ; Belongs to the class of moderately potent (group II) corticosteroids. Used in the treatment of dermatological diseases.
S01BA05 - triamcinolone ; Belongs to the class of corticosteroids. Used in the treatment of inflammation of the eye.
R01AD11 - triamcinolone ; Belongs to the class of topical corticosteroids used for prophylaxis and treatment of allergic rhinitis.
D07XB02 - triamcinolone ; Belongs to the class of moderately potent (group II) corticosteroids in other combinations. Used in the treatment of dermatological diseases.
R03BA06 - triamcinolone ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, glucocorticoids.
References
Anon. Triamcinolone (Nasal). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/01/2016.

Anon. Triamcinolone (Ophthalmic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/01/2016.

Anon. Triamcinolone (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/01/2016.

Anon. Triamcinolone (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/01/2016.

Anon. Triamcinolone Acetonide (EENT). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/01/2016.

Anon. Triamcinolone Acetonide (Topical). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/01/2016.

Anon. Triamcinolone, Triamcinolone Acetonide, Triamcinolone Hexacetonide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/01/2016.

Buckingham R (ed). Triamcinolone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/01/2016.

Joint Formulary Committee. Triamcinolone Acetonide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/01/2016.

Joint Formulary Committee. Triamcinolone Hexacetonide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/01/2016.

Kenacort (Taisho Pharmaceutical). MIMS Indonesia. http://www.mims.com/indonesia. Accessed 10/07/2018.

Kenalog-10 Injection and Kenalog-40 Injection. U.S. FDA. https://www.fda.gov/. Accessed 05/01/2016.

Nasacort Aerosol, Metered (Aventis Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/01//2016.

Triamcinolone Acetonide Cream (Arbor Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/01//2016.

Triamcinolone Acetonide Injection, Suspension (Sandoz Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/01//2016.

Triesence Injection (Alcon Laboratories, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/01//2016.

Disclaimer: This information is independently developed by MIMS based on Triamcinolone acetonide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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