Child: As triamcinolone hexacetonide: 3-12 years 0.5 mg/kg (small joints); 1 mg/kg (large joints). Hands and feet: 0.6-1 mg/kg per joint (proximal interphalangeal joint); 1-2 mg/kg per joint (metacarpophalangeal/metatarsophalangeal joints). >12-18 years 2-20 mg, adjusted according to the degree of inflammation, size of joint, and amount of articular fluid (refer to detailed product guideline). Dose may be repeated at intervals of 3-4 weeks.
Adult: As triamcinolone hexacetonide: 2-20 mg, adjusted according to the degree of inflammation, size of joint, and amount of articular fluid (refer to detailed product guideline). Dose may be repeated at intervals of 3-4 weeks. Child: 10-18 years Same as adult dose.
Adult: As triamcinolone hexacetonide: 10-20 mg. Dosage is individualised according to the size of joint and severity of the disease. Child: 10-18 years Same as adult dose.
Administration
Should be taken with food.
Reconstitution
Susp for inj may be mixed with preservative-free lidocaine hydrochloride 1% or 2%, or other similar anaesthetics. Instructions for reconstitution may vary among countries and individual products (refer to specific product guidelines).
Incompatibility
May cause precipitation with diluents containing parabens, phenol, or other preservatives.
Patient with cardiac insufficiency, acute CAD, hypertension, recent MI, thrombophlebitis, thromboembolism, diabetes mellitus, myasthenia gravis, Cushing’s syndrome, hypothyroidism, osteoporosis, exanthematous diseases, psychosis; gastrointestinal diseases (e.g. diverticulosis, diverticulitis, active or latent peptic ulcer, ulcerative colitis, fresh intestinal anastomoses, pyogenic infection); cataracts, glaucoma, history of ocular herpes simplex; seizure disorder, systemic sclerosis, acute glomerulonephritis, chronic nephritis, cirrhosis, infections untreatable with antibiotics, metastatic carcinoma. Not for intra-articular administration during active infection or near joints. Not for use to alleviate joint pain associated with infectious states (e.g. gonococcal or tubercular arthritis). Patient subject to stress (e.g. trauma, surgery, severe infection). Use may mask acute infection. Avoid exposure to chickenpox or measles. Avoid abrupt withdrawal. Children and elderly. Hepatic and renal impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Hypercortisolism or suppression of HPA axis (prolonged use); immunosuppression (e.g. secondary infections, activation of latent infection, mask acute infections); Kaposi sarcoma (prolonged use); acute myopathy (high doses); psychiatric disturbances (e.g. insomnia, mood swings, euphoria, personality changes, severe depression, frank psychotic manifestations); exacerbation of pre-existing psychiatric conditions; septic arthritis; fluid retention, electrolyte disturbance, hypertension, myocardial rupture; hyperglycaemia; worsening of myasthenia gravis; increased IOP, open-angle glaucoma, cataracts (prolonged use); increased bone loss, osteoporotic fractures; scleroderma renal crisis; menstrual irregularities; vaginal bleeding (particularly in postmenopausal women). Rarely, anaphylactoid reactions. Ear and labyrinth disorders: Rarely, vertigo. General disorders and administration site conditions: Sterile abscess, post-inj erythema; pain, swelling, and necrosis at the inj site. Skin and subcutaneous tissue disorders: Rarely, hyper- or hypo-pigmentation. Vascular disorders: Rarely, thromboembolism. Potentially Fatal:Strongyloides hyperinfection and dissemination; serious anaphylactoid reactions.
IM/Intra-articular/Intrabursal/Intradermal/Intralesional/Intrasynovial/Parenteral/SC/Topical: C; Intravitreal: D
Monitoring Parameters
Monitor weight, blood pressure, blood glucose, electrolytes, IOP, BMD; growth and development in children, HPA axis suppression.
Drug Interactions
Increased risk of additive hypokalaemia with Amphotericin B inj and K-depleting agents. Increased risk of acute myopathy with neuromuscular blocking agents. May inhibit the effect of anticholinesterases. Additional increase of IOP with anticholinergics (e.g. atropine). May increase or diminish the therapeutic effect of oral anticoagulants. May diminish the therapeutic effect of antidiabetics (e.g. sulfonylurea derivatives) and insulin. May diminish therapeutic effect of antihypertensive agents, including diuretics. Increase in both ciclosporin and corticosteroids activity when used concomitantly. May decrease serum concentration of isoniazid. May increase the risk of digitalis toxicity. Increased clearance with hepatic enzyme inducers (e.g. barbiturates, phenytoin, carbamazepine, rifampicin, primidone, and aminoglutethimide). May decrease clearance and increase the risk of Cushing’s syndrome and adrenal suppression with CYP3A4 inhibitors (e.g. ritonavir) including cobicistat-containing products. May decrease therapeutic effect of somatropin. Increased risk and severity of gastrointestinal bleeding and ulceration associated with NSAIDs. May decrease serum salicylate levels. Increased serum levels with oestrogen (including oral contraceptives). Neurological complications and diminished antibody response with live vaccines.
Lab Interference
May attenuate skin test reactions. May cause false-negative results with nitroblue tetrazolium test for bacterial infection. May cause a positive result with anti-doping tests.
Action
Description: Mechanism of Action: Triamcinolone is a synthetic glucocorticoid with minimal mineralocorticoid effects. It decreases inflammation by suppressing the migration of polymorphonuclear leucocytes and reverses the increased capillary permeability, inhibiting immune reactions by decreasing the activity and volume of the lymphatic system, and prevents adrenal function at high doses. Onset: >24 hours (intra-articular). Duration: 4-6 weeks (intra-articular). Pharmacokinetics: Absorption: Slowly absorbed from the inj site. Distribution: Crosses the placenta, enters breast milk. Excretion: Plasma half-life: Approx 2-5 hours.
Chemical Structure
Triamcinolone Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 31307, Triamcinolone. https://pubchem.ncbi.nlm.nih.gov/compound/Triamcinolone. Accessed Nov. 22, 2023.
Storage
Store between 15-30°C. Protect from light. Do not freeze.
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