Triamcinolone Acetonide

Indications

Triamcinolone Acetonide is used for: Allergic and inflammatory responses, Inflammatory joint disease, Inflammatory skin conditions

Adult Dose

Intramuscular Suppression of allergic and inflammatory disorders Adult: As acetonide: 20-80 mg via deep IM into gluteal muscles. Symptomatic control for hay fever Adult: As acetonide: 40-100 mg via deep IM into gluteal muscles. Rheumatic or arthritic disorders Adult: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRN Intra-articular Inflammatory joint diseases Adult: As acetonide: Smaller joints: 2.5-5 mg (up to 10 mg), larger joints: 5-15 mg (up to 40 mg). Max: 20-80 mg/treatment. Intradermal Inflammatory skin conditions Adult: As acetonide: 1-3 mg/site. Max: 30 mg in total if several sites of inj used. Max: 12.5 mg/inj site. Max: 25 mg/lesion.

Child Dose

Intramuscular Suppression of allergic and inflammatory disorders Child: As acetonide: deep IM into gluteal muscle: initial 0.11 to 1.6 mg/kg/day in 3-4 divided doses. Do not use in premature infants and infants of low birth weight as it contains benzyl alcohol. Child: 6-12 years: 0.03-0.2 mg/kg IM every 1-7 days >12 years: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRN >12 years, intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day Symptomatic control for hay fever Child: As acetonide: deep IM into gluteal muscle: initial 0.11 to 1.6 mg/kg/day in 3-4 divided doses. Do not use in premature infants and infants of low birth weight as it contains benzyl alcohol.

Renal Dose

Administration

Dilute with local anesthetic (1% or 2% lidocaine without parabens) before intra-articular or intralesional injection Dilute with D5/NS or D10/NS or NS or SWI before intralesional injection

Contra Indications

Triamcinolone Acetonide is contraindicated in patients with a sensitivity to the active or inactive ingredients. Untreated systemic fungal, bacterial, viral or parasitic infection, hypersensitivity. Neonates (Parenteral)

Precautions

Diabetes; hypertension, renal and liver impairment; glaucoma; psychosis; delayed tissue healing; cirrhosis; heart failure; recent MI; hypothyroidism; osteoporosis; peptic ulceration; thromboembolic disorders. Monitor height in children on prolonged therapy. Avoid rapid drug withdrawal. Elderly, children, pregnancy, lactation. Lactation: Excreted in breast milk; use caution

Pregnancy-Lactation

Pregnancy There are no data regarding the use of triamcinolone acetonide in pregnant women to inform a drug associated risk of adverse developmental outcomes In animal reproductive studies from published literature, pregnant mice, rats, rabbits, or primates administered triamcinolone acetonide during organogenesis period at doses that produced exposures less than the maximum recommended human dose (MRHD) caused resorptions, decreased fetal body weight, craniofacial and/or other abnormalities such as omphalocele Corticosteroids may result in menstrual pattern irregularities (eg, deviations in timing, duration of menses, increased/decreased blood loss) Lactaction There are no available data on the presence of triamcinolone acetonide in either human or animal milk, the effects on the breastfed infant, or the effects on milk production Corticosteroids have been detected in human milk and may suppress milk production Caution should be exercised when corticosteroids are administered to a nursing woman

Interactions

Lowering of plasma salicylates levels. Increased risk of GI bleeding and ulceration with NSAIDs. Antagonised blood glucose-lowering effects of the antidiabetics. Increased risk of hyperkalaemia with amphotericin B, beta agonists, beta-blockers, potassium-depleting diuretics, theophylline. Increased clearance of the triamcinolone with ciclosporin, carbamazepine, phenytoin, barbiturate, rifampicin. Infections may develop if given with live vaccines.

Adverse Effects

Side effects of Triamcinolone Acetonide : HPA axis supression, intracranial hypertension, Cushing's syndrome, growth retardation in children; osteoporosis, fractures. Peptic ulceration; glaucoma; hyperglycaemia; GI upsets; increased appetite; increased fragility of skin; behavioural changes. Potentially Fatal: Acute adrenal insufficiency may be precipitated by infection or trauma in patients on long-term corticosteroid therapy or rapid withdrawal.

Mechanism of Action

Triamcinolone has mainly glucocorticoid activity. It suppresses the migration of polymorphonuclear leukocytes and reduces capillary permeability thereby decreasing inflammation.