Adult: 2.5-5 mg, up to10 mg (smaller joints); 5-15 mg, up to 40 mg (larger joints). Max total: 80 mg (several joints at one time). Dose is adjusted according to the degree of inflammation, size of joint, and amount of articular fluid present.
Adult: 2-3 mg depending on the size of the lesion. Max: 5 mg at any one site; 30 mg if several sites are injected. Doses may be repeated every 1-2 weeks, if necessary.
Intramuscular Allergic and inflammatory disorders
Adult: Initially, 40 mg via deep inj into gluteal muscle. Subsequent dosage depends on the patient's response and period of relief. Alternatively, initiate at 60 mg, adjust dose at a range of 40-80 mg. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Adult: Initially, 4 mg as a single dose. Additional doses may be given as necessary.
Mouth/Throat Mouth ulcer
Adult: For the adjunctive treatment and temporary relief of symptoms: As 0.1% dental paste: Apply a small amount approx 1/4 inch to the lesion until a thin film develops. Apply at bedtime and, if necessary, 2 or 3 times daily, preferably after meals.
Adult: Initially, 110 mcg (2 sprays) per nostril once daily. Once symptoms are controlled, reduce dose to 55 mcg (1 spray) per nostril once daily. Child: 2-5 years 55 mcg (1 spray) per nostril once daily; 6-11 years Initially, 55 mcg (1 spray) per nostril once daily. Doses may be increased to 110 mcg (2 sprays) per nostril once daily if necessary. Once symptoms are controlled, reduce to lowest effective dose; ≥12 years Same as adult dose.
Parenteral Macular oedema associated with uveitis
Adult: 4 mg as a single dose via suprachoroidal inj using the provided administration device (refer to specific product guidelines).
Adult: As cream/ointment/lotion: Apply a thin film to the affected area(s) 2-4 times daily. Reduce the frequency of application as conditions respond. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Contraindications
Immune thrombocytopenia (IM). Systemic fungal infections; active or suspected ocular or periocular infections including viral diseases of the cornea and conjunctiva, epithelial herpes simplex keratitis; vaccinia, varicella, mycobacterial infections (ophthalmic). Bacterial, viral, or fungal infections of the mouth, throat, or skin (topical). Recommendations for contraindication may vary among countries and individual products (refer to specific product guidelines).
Special Precautions
Patient with Strongyloides infections, CHF, recent acute MI, diabetes mellitus, myasthenia gravis, gastrointestinal diseases (e.g. diverticulosis, diverticulitis, ulcerative colitis, fresh intestinal anastomoses, active or latent peptic ulcer, abscess or other pyogenic infections), cirrhosis, cataracts; glaucoma (or family history), systemic sclerosis; exanthematous disease, metastatic carcinoma, osteoporosis (particularly in post-menopausal women); history of severe affective disorders including 1st degree relatives (e.g. depressive or manic-depressive illness, previous steroid psychosis); acute psychoses; latent tuberculosis, local or systemic viral infection, systemic fungal infections, or active infections not controlled by antibiotics; history of seizure disorder; hypo- or hyperthyroidism; tuberculosis reactivity (nasal); ocular herpes simplex, threadworm infection (ophthalmic). Not recommended for use in optic neuritis. Patient subject to stress (e.g. trauma, surgery, severe infection). Avoid use in patients with recent nasal septal ulcers, untreated nasal infections after nasal surgery or nasal trauma (until healing has occurred). Defer intra-articular administration in the presence of active infection in or near joints. Not indicated to alleviate joint pain associated with infectious states (e.g. gonococcal or tubercular arthritis). Use may mask acute infection (including fungal infections). Avoid exposure to chickenpox or measles. Avoid abrupt withdrawal. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Cushing's syndrome (hypercortisolism), suppression of HPA axis (especially in younger children or during high doses for prolonged treatment), may lead to adrenal crisis; severe joint destruction with necrosis of bone (prolonged repeated intra-articular inj); tendon rupture; may increase the risk of secondary infection, activation of latent infections, prolong or exacerbate viral infections; Kaposi sarcoma; acute myopathy (high dose); psychiatric disturbances (e.g. euphoria, insomnia, mood swings, personality changes, severe depression, frank psychotic manifestations), exacerbation of pre-existing psychiatric conditions; septic arthritis (intra-articular or soft tissue administration); fluid retention, electrolyte disturbances, hypertension, myocardial rupture, impaired glucose regulation leading to hyperglycaemia, exacerbation of diabetes; transient worsening of myasthenia gravis; increased IOP, open-angle glaucoma, cataracts, corneal perforations; increased bone loss and osteoporotic fractures (high doses and/or long term use); increase in scleroderma renal crisis; changes in thyroid status. Nasal septal perforation, nasal ulceration, epistaxis, localized Candida albicans infection. Local sensitisation (topical). Cardiac disorders: CHF, arrhythmia. Ear and labyrinth disorders: Vertigo. Eye disorders: Blindness, cataract, glaucoma, exophthalmos, papilloedema. Gastrointestinal disorders: Abdominal distension, ulcerative oesophagitis, dyspepsia, peptic ulcer, peptic ulcer perforation and haemorrhage. General disorders and administration site conditions: Inj site reactions (e.g. pain, irritation, discomfort), fatigue, impaired healing, hyperthermia. Injury, poisoning and procedural complications: Spinal compression fracture. Investigations: Decreased blood K, ECG change, decreased carbohydrate tolerance, negative nitrogen balance, decreased weight, abnormal blood Ca, abnormal total protein. Metabolism and nutrition disorders: Hypokalaemic alkalosis, Ca deficiency, increased appetite. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia, musculoskeletal discomfort, muscle weakness, muscle atrophy, growth retardation, neuropathic arthropathy. Nervous system disorders: Headache, convulsion, epilepsy, benign intracranial hypertension, increased intracranial pressure, neuritis, paraesthesia, dizziness. Psychiatric disorders: Drug dependence, insomnia. Renal and urinary disorders: Glycosuria. Reproductive system and breast disorders: Menstrual irregularities, amenorrhoea, postmenopausal vaginal bleeding. Skin and subcutaneous tissue disorders: Rash, urticaria, hyperpigmentation, hypopigmentation, skin fragility, skin atrophy, petechiae, ecchymosis, erythema, hyperhidrosis, purpura, skin striae, hirsutism, acneiform dermatitis, cutaneous lupus erythematosus. Vascular disorders: Embolism, thrombophlebitis, necrotising vasculitis, hypotension, flushing. Potentially Fatal: Rarely, anaphylactic reactions.
IM/Intra-articular/Intrabursal/Intradermal/Intralesional/Intrasynovial/Parenteral/SC/Topical: C; Intravitreal: D
Monitoring Parameters
Monitor blood pressure, blood glucose, electrolytes, weight; IOP (use >6 weeks), ocular changes (e.g. glaucoma, cataracts); BMD; growth and development (in children and adolescents), HPA axis or hypercortisolism. Assess for signs and symptoms of Candida infections (long-term therapy). Monitor skin integrity (topical).
Drug Interactions
Increased risk of hypokalaemia with amphotericin B and K-depleting agents (e.g. diuretics, including acetazolamide). May inhibit the effects of anticholinesterase agents. Blood glucose levels may be increased, antidiabetic agent doses may be adjusted as needed. May diminish the therapeutic effect of antihypertensive agents and diuretics. May decrease the serum concentration of isoniazid. Increased risk of ciclosporin toxicity. May increase the risk of digitalis toxicity.
Lab Interference
May inhibit skin test reactions.
Action
Description: Mechanism of Action: Triamcinolone acetonide is a long-acting corticosteroid. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reduces capillary permeability. It also suppresses the immune system by reducing activity and volume of the lymphatic system. Onset: Adrenal suppression: 24-48 hours (IM); >24 hours (intra-articular). Duration: Adrenal suppression: 30-40 days (IM); 28-42 days (intra-articular). Pharmacokinetics: Absorption: Systemically absorbed after nasal administration; absorbed percutaneously after topical administration. Distribution: Crosses the placenta. Volume of distribution: 99.5 L. Metabolism: Metabolised in the liver. Excretion: Systemic: Via urine (75%); bile and faeces (25%). Nasal: Via faeces (approx 60%); urine (approx 40%). Topical: Via faeces (60%; some via biliary excretion); urine (40%). Elimination half-life: 2-5 hours (plasma); 18-36 hours (biologic). Terminal half-life: 3.1 hours (nasal).
Chemical Structure
Triamcinolone acetonide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 6436, Triamcinolone Acetonide. https://pubchem.ncbi.nlm.nih.gov/compound/Triamcinolone-Acetonide. Accessed Mar. 25, 2024.
Storage
Store between 20-25°C. Do not freeze. Protect from light.
D07AB09 - triamcinolone ; Belongs to the class of moderately potent (group II) corticosteroids. Used in the treatment of dermatological diseases. A01AC01 - triamcinolone ; Belongs to the class of local corticosteroid preparations. Used in the treatment of diseases of the mouth. 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. H02AB08 - triamcinolone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations. R03BA06 - triamcinolone ; Belongs to the class of other inhalants used in the treatment of obstructive airway diseases, glucocorticoids.
References
Adcortyl Intra-articular/Intradermal Injection 10 mg/mL (Bristol-Myers Squibb Pharmaceuticals Unlimited Company). MHRA. https://products.mhra.gov.uk. Accessed 30/09/2022.AFT Pharmaceuticals Ltd. Triamcinolone Acetonide Dental Paste USP, 0.1% data sheet October 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 30/09/2022.Anon. Triamcinolone (Nasal). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/09/2022.Anon. Triamcinolone (Ophthalmic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/09/2022.Anon. Triamcinolone (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/09/2022.Anon. Triamcinolone (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/09/2022.Buckingham R (ed). Triamcinolone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/09/2022.Joint Formulary Committee. Triamcinolone Acetonide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/09/2022.Kenalog-10 Injection, Suspension (E.R. Squibb & Sons, L.L.C.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Nasacort 55 micrograms/dose Nasal Spray, Suspension (Opella Healthcare UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 30/09/2022.Nasacort AQ Nasal Spray Solution (DKSH Malaysia SDN. BHD.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 30/09/2022.Oralon Dental Paste (Malaysian Pharmaceuticals Industries SDN BHD). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 30/09/2022.Pharmacy Retailing (NZ) Limited Trading as Healthcare Logistics. Aristocort Topical Cream & Aristocort Topical Ointment data sheet 27 July 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 30/09/2022.Pharmacy Retailing (NZ) Limited Trading as Healthcare Logistics. Kenacort-A 40 Suspension for Injection data sheet 28 May 2018. Medsafe. http://www.medsafe.govt.nz. Accessed 30/09/2022.Sanofi-Aventis New Zealand Limited. Telnase 55 micrograms/dose Nasal Spray Suspension data sheet 7 December 2017. Medsafe. http://www.medsafe.govt.nz. Accessed 30/09/2022.Shincort Injection 10 mg, 40 mg/mL (Y.S.P. Industries [M] SDN. BHD.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 30/09/2022.Triamcinolone Acetonide Cream (Ascend Laboratories, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Triamcinolone Acetonide Lotion (Micro Labs Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Triamcinolone Acetonide Ointment (CMP Pharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Triamcinolone Acetonide Paste (Burel Pharmaceutical, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Tricilon Cream 0.1% (Prime Pharmaceutical Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 30/09/2022.Triesence Injection, Suspension (Alcon Laboratories, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.Xipere Injection, Suspension (Bausch & Lomb Incorporated). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 30/09/2022.
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