triamcinolone

(trye am sin' oh lone)

triamcinolone
Oral:
Aristocort, Atolone

triamcinolone acetonide
IM, intra-articular, or soft-tissue injection; respiratory inhalant; dermatologic ointment,
cream, lotion, aerosol:
Azmacort, Flutex, Kenaject 40, Kenalog, Nasacort, Nasacort AQ, Oracort
(CAN), Tac-3, Tac-40, Triacet, Triamonide, Triam-A, Triderm, Tri-Kort, Trilog

triamcinolone diacetate
IM, intra-articular, intrasynovial, intralesional injection:
Amcort, Aristocorte Forte, Aristocort Intralesional, Clinacort, Triam-Forte,
Trilone, Tristoject

triamcinolone hexacetonide
Intra-articular, intralesional injection:
Aristospan Intra-articular, Aristospan Intralesional

Pregnancy Category C

Drug classes
Corticosteroid (intermediate acting)
Glucocorticoid
Hormone

Therapeutic actions
Enters target cells and binds to cytoplasmic receptors, thereby initiating many complex
reactions that are responsible for its anti-inflammatory and immunosuppressive effects.

Indications
• Systemic: Hypercalcemia associated with cancer
• Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg,
pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
• Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some
leukemias and lymphomas
• Trichinosis with neurologic or myocardial involvement
 • Pulmonary emphysema with bronchial spasm or edema; diffuse interstitial
pulmonary fibrosis; with diuretics in CHF with refractory edema and in cirrhosis
with refractory ascites
• Postoperative dental inflammatory reactions
• Intra-articular, soft-tissue administration: Arthritis, psoriatic plaques, and so forth
• Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in
conjunction with other therapy
• Prophylactic therapy in the maintenance treatment of asthma (bid use)
• Dermatologic preparations: To relieve inflammatory and pruritic manifestations of
dermatoses that are steroid responsive
• Nasal spray: Treatment of seasonal and perennial allergic-rhinitis symptoms

Contraindications and cautions

• Contraindicated with infections, especially tuberculosis, fungal infectons,
amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation.
• Use cautiously with pregnancy (teratogenic in preclinical studies); kidney or liver
disease, hypothyroidism, ulcerative colitis with impending perforation,
diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF,
hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes
mellitus.

Available forms
Tablets—1, 2, 4, 8 mg; syrup—4 mg/5 mL; injection—5, 20, 25, 40 mg/mL; aerosol—
100 mcg/actuation; topical ointment—0.25, 0.1, 0.5%; cream—0.25, 0.1, 0.5%; lotion—
0.025, 0.1%; nasal spray—50, 55 mcg/actuation

Dosages
ADULTS
Systemic
Individualize dosage, depending on the severity of the condition and the patient's
response. Administer daily dose before 9 AM to minimize adrenal suppression. If long-
term therapy is needed, consider alternate-day therapy. After long-term therapy, withdraw
drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose
in small increments at intervals until the lowest effective dose is reached.
Oral (triamcinolone)
• Adrenal insufficiency: 4–12 mg/day, plus a mineralocorticoid.
• Rheumatic, dermatologic, allergic, ophthalmologic, hematologic disorders and
asthma: 8–60 mg/day.
• TB meningitis: 32–48 mg/day.
• Acute leukemia: 16–40 mg up to 100 mg/day.
IM (triamcinolone acetonide)
2.5–60 mg/day.
IM (triamcinolone diacetate)
40 mg/wk. A single parenteral dose 4–7 times oral daily dose provides control for 4 days–
4 wk.
Respiratory inhalant (triamcinolone acetonide)
200 mcg released with each actuation delivers about 100 mcg to the patient. 2 inhalations
tid–qid, not to exceed 16 inhalations/day.
Nasal spray
2 sprays in each nostril daily—maximum of 4 sprays/day.
ADULTS AND PEDIATRIC PATIENTS
Intra-articular, intralesional
Dose will vary with joint or soft-tissue site to be injected.
Triamcinolone acetonide: 2.5–15 mg.
Triamcinolone diacetate: 5–40 mg intra-articular; 5–48 mg intralesional; do not use >
12.5 mg per injection site or 25 mg per lesion.
Triamcinolone hexacetatonide: 2–20 mg intra-articular; up to 0.5 mg/square inch of
affected area intralesional.
Topical dermatologic preparations
Apply sparingly to affected area bid–qid.
PEDIATRIC PATIENTS
Systemic
Individualize dosage, depending on the severity of the condition and the patient's
response rather than by formulae that correct adult doses for age or body weight.
Carefully observe growth and development in infants and children on prolonged therapy.
Oral (triamcinolone)
• Acute leukemia: 1–2 mg/kg/day.
Respiratory inhalant (triamcinolone acetonide)
200 mcg released with each actuation delivers about 100 mcg to the patient.
6–12 yr: 1–2 inhalations tid–qid, not to exceed 12 inhalations/day.

Pharmacokinetics
Route Onset Peak Duration
Oral 24–48 hr 1–2 hr 2.25 days
IM 24–48 hr 8–10 hr 1–6 wk

Metabolism: Hepatic; T1/2: 2–5 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
Effects depend on dose, route, and duration of therapy.
• CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts,
increased IOP, glaucoma (long-term therapy)
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention,
thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias
• Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased
carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect),
increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels,
hypothalamic-pituitary-adrenal (HPA) suppression with systemic therapy longer
than 5 days
 • GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea,
vomiting, increased appetite, weight gain (long-term therapy)
• Hypersensitivity: Hypersensitivity or anaphylactoid reactions
• Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, spontaneous fractures (long-term therapy)
• Other: Immunosuppression, aggravation, or masking of infections; impaired
wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae;
subcutaneous fat atrophy
Intra-articular
• Local: Osteonecrosis, tendon rupture, infection
Intralesional (face and head)
• Local: Blindness (rare)
Respiratory inhalants
• Local: Oral, laryngeal, and pharyngeal irritation; fungal infections
Topical dermatologic ointments, creams, sprays
• Local: Local burning, irritation, acneiform lesions, striae, skin atrophy

Interactions
Drug-drug
• Increased therapeutic and toxic effects with troleandomycin
• Risk of severe deterioration of muscle strength when given to myasthenia gravis
patients who are also receiving ambenonium, edrophonium, neostigmine,
pyridostigmine
• Decreased steroid blood levels with barbiturates, phenytoin, rifampin
• Decreased effectiveness of salicylates
Drug-lab test
• False-negative nitroblue-tetrazolium test for bacterial infection
• Suppression of skin test reactions

Nursing considerations
Assessment
• History: Infections; kidney or liver disease; hypothyroidism; ulcerative colitis
with impending perforation; diverticulitis; active or latent peptic ulcer;
inflammatory bowel disease; CHF; hypertension; thromboembolic disorders;
osteoporosis; seizure disorders; diabetes mellitus; pregnancy; lactation
• Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP,
peripheral perfusion, prominence of superficial veins, R, adventitious sounds,
serum electrolytes, blood glucose

Interventions
• Administer once-a-day doses before 9 AM to mimic normal peak corticosteroid
blood levels.
• Increase dosage when patient is subject to stress.
• Taper doses when discontinuing high-dose or long-term therapy.
• Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
 • Taper systemic steroids carefully during transfer to inhalational steroids; deaths
caused by adrenal insufficiency have occurred.
• Use caution when occlusive dressings, tight diapers, and so forth cover affected
area; these can increase systemic absorption when using topical preparations.
• Avoid prolonged use of topical preparations near the eyes, in genital and rectal
areas, and in skin creases.

Teaching points
• Do not stop taking the drug without consulting your health care provider.
• Avoid exposure to infections.
• Report unusual weight gain, swelling of the extremities, muscle weakness, black
or tarry stools, fever, prolonged sore throat, colds or other infections, worsening
of your disorder.
Intra-articular administration
• Do not overuse joint after therapy, even if pain is gone.
Respiratory inhalant
• Do not use during an acute asthmatic attack or to manage status asthmaticus.
• Do not use with systemic fungal infections.
• Do not use more often than prescribed.
• Do not stop using this drug without consulting your health care provider.
• Administer inhalational bronchodilator drug first, if receiving concomitant
bronchodilator therapy; rinse mouth after use.
Nasal spray
• Do not spray in eyes.
• Prime pump before first use and again if not used for > 2 wk.
Topical dermatologic preparations
• Apply drug sparingly, avoid contact with eyes.
• Report irritation or infection at the site of application.

Adverse effects in Italic are most common; those in Bold are life-threatening.