Adjunctive treatment and for the temporary relief of symptoms associated with oral inflammatory lesions and ulcerative lesions resulting from trauma.
IM ( Kenalog-40 , Trivaris )
Control of severe or incapacitating allergic states (eg, asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions); treatment of dermatologic disease (eg, bullous dermatitis herpetiformis, exfoliative dermatitis, Stevens-Johnson syndrome, mycosis fungoides, pemphigus); replacement therapy for endocrine disorders (eg, primary or secondary adrenocortical insufficiency, congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis); control of GI diseases (eg, regional enteritis, ulcerative colitis); treatment of hematologic disorders (eg, acquired hemolytic anemia, Diamond-Blackfan anemia, selected cases of secondary thrombocytopenia, pure red cell aplasia); palliative management of neoplastic diseases (eg, leukemia, lymphoma); exacerbations of nervous system disorders (eg, multiple sclerosis, cerebral edema associated with primary or metastatic brain tumor, craniotomy, head injury); management of ophthalmic diseases (eg, sympathetic ophthalmia, temporal arteritis, uveitis); management of renal disease (induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or lupus erythematosus); treatment of respiratory disease (eg, berylliosis, fulminating or disseminated pulmonary tuberculosis [TB], idiopathic eosinophilic pneumonias, symptomatic sarcoidosis); adjunctive therapy in rheumatic disorders (eg, short-term administration in acute gouty arthritis, acute rheumatic carditis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis); treatment of dermatomyositis, polymyositis, and SLE; treatment of TB meningitis; treatment of trichinosis with neurologic or myocardial involvement.
Intra-articular ( Aristospan 20 mg/mL, Kenalog-10 , Kenalog-40 , Trivaris )
Adjunctive therapy for short-term administration in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, and synovitis of osteoarthritis.
Intralesional ( Aristospan 5 mg/mL, Kenalog-10 )
Management of alopecia areata; discoid lupus erythematosus; keloids; localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus, and psoriatic plaques; necrobiosis lipoidica diabeticorum; may be useful in cystic tumors of aponeurosis or tendon.
Treatment of seasonal and perennial allergic rhinitis symptoms.
Intravitreal ( Triesence , Trivaris )
Sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids; visualization during vitrectomy ( Triesence only).
Maintenance treatment of asthma as prophylactic therapy; use in asthma patients requiring systemic corticosteroid administration.
Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Individualize dose based on disease being treated and response of the patient.
Adults and Children: 2.5 to 5 mg for smaller joints and 5 to 15 mg for larger joints, depending on disease being treated.
Adults and Children: Dose per injection varies depending on the specific disease entity and lesion being treated. Multiple sites separated by at least 1 cm may be injected, keeping in mind that the greater the total volume used, the more drug that becomes available for systemic absorption and systemic effects. Injections may be repeated weekly or at less frequent intervals if needed.
Adults and Children:
Acute Exacerbations of Multiple Sclerosis: 160 mg daily for 1 wk followed by 64 mg every other day for 1 mo.
Hay Fever or Pollen Asthma: A single 40 to 100 mg injection may provide remission of symptoms lasting throughout the pollen season.
Adults: Recommended initial dose is 60 mg, injected deeply into gluteal muscle. Dose is adjusted from less than 40 to 80 mg, depending upon patient’s response and duration of relief.
Children: Initial dosage ranges from 0.11 to 1.6 mg/kg/day in 3 or 4 divided doses (3.2 to 48 mg/m2 BSA).
Adults and Children 12 y of age and older:
Nasacort AQ: Recommended starting dosage is 220 mcg/day as 2 sprays in each nostril once daily. When max benefit has been reached and symptoms controlled, reduce dosage to 110 mcg/day (as 1 spray in each nostril once daily).
Children 6 to 12 y of age:
Nasacort AQ: Recommended starting dosage is 110 mcg/day as 1 spray in each nostril once daily (max, 220 mcg/day as 2 sprays in each nostril once daily).
Children 2 to 5 y of age:
Nasacort AQ: Recommended and max dosage is 110 mcg/day as 1 spray in each nostril once daily.
Adults and Children:
Ophthalmic diseases other than visualization: Initial dose is 4 mg, with subsequent dosage as needed over the course of treatment.
Visualization: Recommended dose for visualization during vitrectomy is 1 to 4 mg ( Triesence ) or a 4 mg single dose ( Trivaris ) administered intravitreally.
Adults: Titrate to the lowest effective dose once asthma stability has been achieved.
Azmacort: 2 inhalations (150 mcg) 3 to 4 times daily or 4 inhalations (300 mcg) twice daily (max, 16 inhalations [1,200 mcg] daily). Higher initial doses (12 to 16 inhalations [900 to 1,200 mcg] daily) may be considered for more severe asthma.
Children 6 to 12 y of age:
Azmacort: Recommended dosage is 1 to 2 inhalations (75 to 150 mcg) 3 to 4 times a day or 2 to 4 inhalations (150 to 300 mcg) twice daily (max, 12 inhalations [900 mcg] daily).
Adults and Children:
0.025%: Apply thin film to affected area 2 to 4 times daily, depending on severity of the condition; rub in gently.
0.1% and 0.5%: Apply thin film to affected area 2 or 3 times daily; rub in gently. Occlusive dressing may be used for management of psoriasis or recalcitrant conditions.
Dental: Press a small dab (approximately ¼ inch) to the lesion until a thin film develops. May be necessary to apply 2 to 3 times a day after meals, depending on severity of symptoms.
Kenalog spray: 3 or 4 applications daily are generally adequate. Occlusive dressing may be used for management of psoriasis or recalcitrant conditions. Limit administration to children to the least amount compatible with an effective therapeutic regimen.
Lotion: Apply thin film to affected area 2 to 4 times daily. Occlusive dressing may be used for management of psoriasis or recalcitrant conditions.
Aristospan 20 mg/mL: Average dose of 2 to 20 mg, depending on the size of the joint, degree of inflammation, and amount of fluid present. In general, small joints, 2 to 6 mg; large joints, 10 to 20 mg. Usual frequency of injection is every 3 to 4 wk.
Intralesional or Sublesional:
Aristospan 5 mg/mL: 2 to 48 mg/day (up to 0.5 mg per square inch of skin) depending on disease entity being treated. Larger doses may be justified in certain overwhelming, acute, life-threatening conditions. Frequency determined by clinical response.
Aristospan 20 mg/mL: Initial dosage is 0.11 to 1.6 mg/kg/day in 3 or 4 divided doses.
Intralesional or Sublesional:
Aristospan 5 mg/mL: Initial dosage is 0.11 to 1.6 mg/kg/day in 3 or 4 divided doses.
|•||Must prime before using for the first time and if not used for more than 2 wk.|
|•||Shake well before use. Rinse mouth after inhalation.|
|•||Do not administer IV.|
|•||Each vial and injection needle should only be used for the treatment of a single eye.|
Anti-inflammatory effect by depressing formation, release, and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. It also modifies the body’s immune response.
Systemic fungal infections; IM use in idiopathic thrombocytopenic purpura; administration of live or live, attenuated virus vaccines; oral inhalation as primary treatment for status asthmaticus or other acute episodes of asthma; cerebral malaria; hypersensitivity to any component of the product.
CV: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, CHF, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture following recent MI, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis.
CNS: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema, insomnia, malaise, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, psychic disorder, sensory disturbances, vertigo.
IM, intra-articular, intralesional
Acne; allergic dermatitis; cutaneous and subcutaneous atrophy; dry scalp; dry, scaly skin; edema; erythema; facial erythema; hyper- or hypopigmentation; hypertrichosis; impaired wound healing; increased sweating; lupus erythematosus–like lesions; petechiae and ecchymosis; rash; sterile abscess; striae; suppressed reactions to skin tests; thin fragile skin; thinning scalp hair; urticaria.
Allergic contact dermatitis, burning, dryness, folliculitis, hypertrichosis, hypopigmentation, irritation, itching, maceration of the skin, miliaria, perioral dermatitis, secondary infection, skin atrophy, striae.
EENT: Abnormal sensation in the eye, anterior chamber cells, anterior chamber flare, blindness associated with periocular injections, cataract, cataract cortical, cataract nuclear, cataract subcapsular, conjunctival hemorrhage, dry mouth, epistaxis, exophthalmos, eye irritation, eye pain, eye pruritus, foreign body sensation in eyes, glaucoma, increased IOP, increased lacrimation, injection-site hemorrhage, nasal septal perforation, nasopharyngitis, otitis media, pharyngitis, posterior subcapsular cataracts, rhinitis, rhinorrhea, vitreous detachment, vitreous floaters.
ELECDIST: Hypokalemic alkalosis, potassium loss, sodium retention.
ENDO: Abnormal fat deposits, decreased carbohydrate tolerance, decreased glucose tolerance, development of Cushingoid state, glucosuria, hirsutism, hypertrichosis, manifestations of latent diabetes mellitus and increase in insulin and oral hypoglycemic requirements, moon face, secondary adrenocortical and pituitary unresponsiveness, suppression of growth in children.
GI: Abdominal distention, abdominal pain, bowel dysfunction (intrathecal), diarrhea, dyspepsia, hiccups, increased appetite, nausea, oral moniliasis, pancreatitis, peptic ulcer with perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), tooth disorder, toothache, ulcerative esophagitis, vomiting.
GU: Alteration in motility and number of spermatozoa, bladder dysfunction (intrathecal), cystitis, menstrual irregularities, UTI, vaginal moniliasis.
HEPA: Elevated serum liver enzymes, hepatomegaly.
M/N: Negative nitrogen balance, weight gain.
MUSC: Aseptic necrosis of femoral and humeral heads, back pain, bursitis, calcinosis, charcot-like arthropathy, loss of muscle mass, muscle weakness, myalgia, osteoporosis, pathologic fracture of long bones, postinjection flare (intra-articular), steroid myopathy, tendon rupture, tenosynovitis, vertebral compression fractures (intra-articular/intralesional).
RESP: Asthma, bronchitis, chest congestion, cough, pharyngolaryngeal pain, sinusitis, voice alteration.
OTHER: Abnormal fat deposits, anaphylactoid reactions, anaphylaxis, angioedema, decreased resistance to infection, excoriation, facial edema, flu syndrome, fluid retention, immunosuppression, impaired wound healing, moon face, pain, photosensitivity.
May lead to loss of corticosteroid-induced adrenal suppression.
Amphotericin B, potassium-sparing diuretics
Risk of hypokalemia may be increased.
May antagonize anticholinesterase effects in myasthenia gravis.
Because triamcinolone may increase blood sugar levels, dosage adjustments of antidiabetic agents may be needed.
May increase triamcinolone Cl.
Cyclosporine and triamcinolone activity may be increased. Seizures have been reported.
CYP3A4 inducers (eg, barbiturates, carbamazepine, hydantoins [eg, phenytoin], rifampin)
May decrease efficacy of systemically administered triamcinolone.
CYP3A4 inhibitors (eg, azole antifungal agents [eg, ketoconazole], macrolide antibiotics [eg, clarithromycin])
May elevate triamcinolone plasma levels, increasing the pharmacologic effects and the risk of adverse reactions.
Risk of arrhythmia due to hypokalemia may be increased.
Estrogens, hormonal contraceptives
Triamcinolone plasma levels may be elevated, increasing therapeutic effects and the risk of adverse reactions.
The pharmacologic effects of interleukin-2 may be decreased.
Serum levels may be reduced by triamcinolone, decreasing efficacy.
Concurrent use with triamcinolone is contraindicated during long-term corticosteroid therapy.
NSAIDs, salicylates (eg, aspirin)
Risk of GI adverse reactions is increased.
Triamcinolone plasma concentrations and pharmacologic effects may be increased.
Quinolones (eg, ciprofloxacin)
The risk of quinolone-induced tendon rupture may be increased.
Maternal pulmonary edema is a possibility when coadministered with triamcinolone.
Systemic administration may reduce serum levels and efficacy of salicylates.
Toxoids and live or inactivated vaccines
Because of inhibition of antibody response, patients on prolonged triamcinolone therapy may exhibit a diminished response to toxoids, live or inactivated vaccines, or skin tests. Replication of some organisms contained in live, attenuated vaccines may be potentiated. Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of triamcinolone.
Variable effects on warfarin; monitor anticoagulant parameters.
Therapeutic Classification: corticosteroids
Pharmacologic Classification: corticosteroids
Absorption: Following single intravitreal administration, the peak aqueous humor concentrations range from 2,151 to 7,202 ng/mL. Mean Cmax is approximately 0.5 ng/mL and Tmax is 1.5 h postdose (intranasal). When injected intra-articularly, intralesionally, or sublesionally, triamcinolone can be expected to be absorbed slowly from the injection site.
Distribution: Based on IV data, Vd is 99.5 to 103.4 L; binding to plasma proteins is approximately 68%.
Metabolism: Metabolized primarily in the liver. Metabolites are substantially less active than the parent compound.
Excretion: Based on IV data, mean half-life is 88 min and Cl is 45.2 L/h. After intranasal administration, average terminal half-life is 3.1 h. Urinary and fecal excretion accounted for 40% and 60%, respectively. Some of the topical corticosteroids and their metabolites are also excreted in the bile.
Following single intravitreal administration, the mean elimination half-life is approximately 19 days in nonvitrectomized eyes and approximately 3 days in patients who have undergone vitrectomy.
|INHALATION||WITHIN 24 HOUR||1-4 WEEKS**||UNKNOWN|
|ORAL||UNKNOWN||1-2 HOUR||2.25 DAYS|
|INTRAMUSCULAR||24-48 HOUR||UNKNOWN||1-6 WEEKS|
|TOPICAL||MIN TO HOURS||HOURS TO DAYS||DAYS|
INHALATION PEAK ** Improvement in pulmonary function; decreased airway responsiveness may take longer