triamcinolone diacetate

triamcinolone diacetate

Kenacort

Pharmacologic class: Synthetic corticosteroid

Therapeutic class: Anti-inflammatory (steroidal)

Pregnancy risk category C

Action

Unknown. Thought to decrease inflammation mainly by inhibiting activities of mast cells, macrophages, and other mediators of allergic reactions. Also suppresses immune system by depressing lymphatic activity.

Availability

triamcinolone

Tablets: 1 mg, 2 mg, 4 mg, 8 mg

triamcinolone acetonide

Cream: 0.025%, 0.1%, 0.5%

Inhalation aerosol (intranasal): 55 mcg/inhalation (metered spray) in 20-g canister (240 metered inhalations)

Inhalation aerosol (oral): 100 mcg/inhalation (metered spray)

Injectable suspension: 3 mg/ml, 10 mg/ml, 40 mg/ml

Lotion: 0.025%, 0.1%

Ointment: 0.025%, 0.1%, 0.5%

Solution: 50 mcg/metered spray

Suspension: 55 mcg/metered spray

triamcinolone diacetate

Injectable suspension: 25 mg/ml, 40 mg/ml

triamcinolone hexacetonide

Injectable suspension: 5 mg/ml, 20 mg/ml

⊘Indications and dosages

➣ Allergic rhinitis

Adults and children older than age 12: 8 to 12 mg (tablets) P.O. daily. Or 110 mcg (two sprays of inhalation aerosol or acetonide suspension) in each nostril daily; may increase to 220 mcg (four sprays) in each nostril daily (110 mcg b.i.d. or 55 mcg q.i.d.). Or 100 mcg (two sprays of acetonide solution) in each nostril daily; may increase to 400 mcg (four sprays) in each nostril daily or two sprays in each nostril b.i.d.

Children ages 6 to 12: 55 mcg (one spray of inhalation aerosol or acetonide suspension) in each nostril daily

➣ Chronic asthma

Adults and children older than age 12: Two metered inhalations three to four times daily or four metered inhalations b.i.d. (100 mcg/metered inhalation), not to exceed 16 inhalations/day

Children ages 6 to 12: One to two metered inhalations three to four times daily or two to four metered inhalations b.i.d. (100 mcg/metered inhalation), not to exceed 12 inhalations/day

➣ Severe inflammation; immunosuppression

Adults and children older than age 12: 4 to 48 mg (tablets) P.O. daily in one to four divided doses. Or 60 mg (acetonide) I.M. at 6-week intervals. For intralesional or sublesional use, 1 mg at each injection site, repeated one or more times weekly; for intra-articular, intrasynovial, or soft-tissue injection, 2.5 to 40 mg, repeated when symptoms recur. Or 200 mcg (two sprays of acetonide inhalation aerosol) three to four times daily. Or 40 mg (diacetate) I.M. weekly. Or 5 to 48 mg (diacetate) by intralesional or sublesional injection, not to exceed 75 mg/week intralesionally. Or 2 to 40 mg (diacetate) by intra-articular, intrasynovial, or soft-tissue injection; may repeat at 1- to 8-week intervals. Or 0.5 mg/square inch of affected skin (hexacetonide) by intralesional or sublesional injection or 2 to 20 mg by intra-articular injection; may repeat at 3- to 4-week intervals.

Children ages 6 to 12: 100 or 200 mcg (one or two sprays of acetonide inhalation aerosol) three to four times daily, or 0.03 to 0.2 mg/kg or 1 to 6.25 mg/m² I.M. at intervals of 1 to 7 days

➣ Corticosteroid-responsive dermatoses

Adults and children older than age 12: Apply cream, ointment, or lotion sparingly to affected area two to four times daily.

➣ Adrenocortical insufficiency

Adults and children older than age 12: 4 to 12 mg (tablets) P.O. daily, used with mineralocorticoid therapy

➣ Rheumatic disorders; dermatologic disorders; severe psoriasis

Adults and children older than age 12: 8 to 16 mg (tablets) P.O. daily

➣ Systemic lupus erythematosus

Adults and children older than age 12: Initially, 20 to 32 mg (tablets) P.O. daily, continued until desired response occurs. Severe symptoms may warrant initial dosage of 48 mg.

➣ Acute rheumatic carditis

Adults and children older than age 12: Initially, 20 to 60 mg (tablets) P.O. daily (usually given with anti-infectives and salicylates) until desired clinical response occurs. Then dosage may be reduced to maintenance level and continued for 6 weeks or up to 3 months.

➣ Ophthalmic inflammatory diseases; sympathetic ophthalmia

Adults and children older than age 12: 12 to 40 mg (tablets) P.O. daily, depending on severity of condition and degree of ocular structure involvement. Response is usually rapid and length of therapy is usually brief.

➣ Respiratory diseases, tuberculous meningitis, nephrotic syndrome

Adults and children older than age 12: 16- to 48-mg tablets P.O. daily; or 32- to 48-mg tablets P.O. daily in divided doses in tuberculous meningitis. For tuberculosis, give with antitubercular therapy, as prescribed.

➣ Thrombocytopenia (in adults); autoimmune hemolytic anemia; erythroblastopenia; congenital hypoplastic anemia

Adults and children older than age 12: 16 to 60 mg (tablets) P.O. daily. Reduce dosage after adequate response.

➣ Palliative therapy in acute leukemia of childhood

Children: 1 to 2 mg/kg (tablets) P.O. daily, with expected initial response occurring in 6 to 21 days. Therapy usually continues for 4 to 6 weeks.

➣ Palliative therapy in acute leukemia or lymphoma in adults

Adults: 16 to 40 mg P.O. daily; may increase to 100 mg daily in leukemia

Contraindications

• Hypersensitivity to drug, tartrazine, chlorofluorocarbon propellants, alcohol, propylene glycol, or polyethylene glycol
• Acute asthma attacks, status asthmaticus (inhalation use only)
• Systemic fungal infections (oral and parenteral use)
• Idiopathic thrombocytopenic purpura (I.M. use)
• Administration of live-virus vaccines (with immunosuppressant doses of triamcinolone)

Precautions

Use cautiously in:
• active untreated infection, systemic infection, immunosuppression, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability
• pregnant or breastfeeding patients
• children younger than age 6 (safety not established).

Administration

☞ Don't withdraw systemic corticosteroids abruptly when patient begins inhalation steroid therapy.
☞ Know that patient will need additional steroids during times of stress or trauma.
• Use hand-held nebulizer supplied with aerosol form.
☞ Apply cream, lotion, or ointment sparingly. Know that triamcinolone is a high-potency steroid; it can be absorbed systemically and should not be withdrawn abruptly.
☞ Avoid intralesional injection to face or head (may cause blindness).
• Don't apply topical form near eyes.
• Know that occlusive dressing may be used with topical form when treating psoriasis or other recalcitrant conditions, but should be removed if infection occurs.

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	2.25 days
I.M.	Unknown	Unknown	1-4 wk
Intra-lesional, sublesional, intra-articular	Slow	Unknown	Unknown
Inhalation	Immediate	Unknown	Unknown
Topical	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache, vertigo, paresthesia, syncope, personality changes, pseudotumor cerebri, seizures

CV: hypertension, thrombophlebitis, arrhythmias, thromboembolism, heart failure

EENT: cataract, glaucoma, increased intraocular pressure, exophthalmos, otitis, nasal or sinus congestion, rhinitis, epistaxis, sneezing, dry mucous membranes, pharyngitis, throat discomfort

GI: nausea, vomiting, dyspepsia, abdominal distention or pain, peptic ulcer, ulcerative esophagitis, oral candidiasis, dry mouth, pancreatitis

GU: cystitis, urinary tract infection, glycosuria, menstrual irregularities, vaginal candidiasis

Metabolic: fluid retention, hypernatremia, hypokalemia, hyperglycemia, hypocalcemia, decreased growth (in children), carbohydrate intolerance, exacerbation of latent diabetes mellitus, cushingoid appearance (moon face, buffalo hump), hypokalemic alkalosis, acute adrenal insufficiency (with abrupt withdrawal or acute stress in long-term use)

Musculoskeletal: muscle weakness; steroid myopathy; loss of muscle mass; myalgia; bursitis; tenosynovitis; osteoporosis; fractures; aseptic necrosis; with intra-articular injection - osteonecrosis, tendon rupture, post-injection flare

Respiratory: cough, wheezing, chest congestion

Skin: delayed wound healing; thin and fragile skin; petechiae; bruising; with topical use - local eruptions, pruritus, hypopigmentation or hyperpigmentation, scarring, stinging, skin maceration, secondary infection, cutaneous or subcutaneous atrophy, diaphoresis, facial erythema

Other: toothache, weight gain, fever, pain, voice alteration, hypersensitivity reaction

Interactions

Drug-drug. Erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, saquinavir: increased triamcinolone blood level and effects

Fluoroquinolones: increased risk of tendon rupture

Live-virus vaccines: decreased antibody response to vaccine

Nonsteroidal anti-inflammatory drugs (including aspirin): increased risk of adverse GI reactions

Potassium-wasting drugs (including amphotericin B, thiazide and loop diuretics, mezlocillin, piperacillin, ticarcillin): additive hypokalemia

Drug-diagnostic tests. Cholesterol: increased level

Skin tests: suppressed reaction

Patient monitoring

• Monitor respiratory status. Watch for worsening signs and symptoms.
• With long-term use, assess for adverse endocrine and musculoskeletal reactions.
• Monitor carefully for signs and symptoms of infection, which drug may mask.

Patient teaching

• Teach patient correct use of drug. Make sure he has received manufacturer's patient information sheet.
☞ Advise patient to contact prescriber immediately if acute asthma attack occurs. Tell him inhalation aerosol isn't meant for rapid relief of bronchospasm.
• Inform patient that drug can affect many body systems. Urge him to report serious adverse effects promptly.
• Tell parents drug may make child more vulnerable to childhood infections, such as chicken pox and measles.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.