TRIAMCINOLONE

TRIAMCINOLONE (trye-am-sin'oh-lone) Atolone, Kenacort, Kenalog-E TRIAMCINOLONE ACETONIDE Azmacort, Cenocort A2 , Kenalog, Nasacort HFA, Triam-A, Triamonide, Tri-kort, Trilog, Tri-Nasal TRIAMCINOLONE DIACETATE Kenacort TRIAMCINOLONE HEXACETONIDE Aristospan Classifications: hormone; adrenal corticosteroid; glucocorticoid; antiinflammatory; Therapeutic:adrenal corticosteroid; antiinflammatory; immunosuppressant Prototype: Prednisone Pregnancy Category: C

Availability

Triamcinolone 4 mg, 8 mg tablets; 4 mg/5 mL syrup

Triamcinolone acetonide 3 mg/mL, 10 mg/mL, 40 mg/mL injection; 100 mcg aerosol; 55 mcg inhaler; 55 mcg spray; 0.5 mg/mL nasal spray; 0.025%, 0.1%, 0.5% cream, ointment, lotion; 10.3% topical spray

Triamcinolone diacetate 4 mg tablet

Triamcinolone hexacetonide 5 mg/mL, 20 mg/mL injection

Action

Immediate-acting synthetic fluorinated adrenal corticosteroid with glucocorticoid properties. Possesses minimal sodium and water retention properties in therapeutic doses.

Therapeutic Effect

Antiinflammatory and immunosuppressant drug that is effective in the treatment of bronchial asthma.

Uses

An antiinflammatory or immunosuppressant agent. Orally inhaled: bronchial asthma in patient who has not responded to conventional inhalation treatment. Therapeutic doses do not appear to suppress HPA (hypothalamic-pituitary-adrenal) axis.

Contraindications

Kidney dysfunction; glaucoma; pregnancy (category C), lactation, children <6 y. Also see hydrocortisone.

Cautious Use

Coagulopathy, hemophilia, diabetes mellitus, GI disease; congestive heart failure; herpes infection; infection; inflammatory bowel disease; myasthenia gravis; MI; ocular exposure, ocular infection; osteoporosis; peptic ulcer disease; PVD; skin abrasion.

Route & Dosage

Inflammation, Immunosuppression Adult: PO/IM/SC 4–48 mg/d in divided doses Intraarticular/Intradermal 4–48 mg/d Inhaled 2–4 inhalations q.i.d. Topical See Appendix A Child: PO/IM/SC 3.3–50 mg/m2/d in divided doses Intraarticular/Intradermal 3.3–50 mg/m2/d Acetonide Adult: IM 60 mg, may repeat with 20–100 mg q6wk Intradermal 1 mg per injection site (max: 30 mg total) Intraarticular 2.5–4.0 mg Inhalation See Appendix A Child: IM 6–12 y, 0.03–0.2 mg q1–7d Inhalation See Appendix A Diacetate Adult: PO 4–48 mg/d in 1–4 divided doses IM 40 mg once/wk Intradermal 5–48 mg (max: 75 mg/wk), may repeat q1–2wk if needed Intraarticular 2–40 mg q1–8wk Child: PO 0.117–1.66 mg/kg/d Hexacetonide Adult: Intralesional Up to 0.5 mg/in2 of skin Intraarticular 2–20 mg q3–4wk

Administration

Oral

• Give with fluid of patient's choice; tablet may be crushed.

Subcutaneous/Intramuscular

• Do not give triamcinolone injection IV.
• See hydrocortisone for additional administration information.
• Store at 15°–30° C (59°–86° F). Protect from light.

Adverse Effects (≥1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI: Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine: Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis. Metabolic: Hypokalemia. Skin: Burning, itching, folliculitis, hypertrichosis, hypopigmentation.

Interactions

Drug: barbiturates, phenytoin, rifampin increase steroid metabolism—may need increased doses of triamcinolone; amphotericin B, diuretics add to potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines, toxoids.

Pharmacokinetics

Absorption: Readily absorbed from all routes. Onset: 24–48 h PO, IM. Peak: 1–2 h PO; 8–10 h IM. Duration: 2.25 d PO; 1–6 wk IM. Metabolism: In liver. Elimination: In urine. Half-Life: 2–5 h; HPA suppression, 18–36 h.

Nursing Implications

Assessment & Drug Effects

• Discuss adequate diet with dietitian, patient, and physician to counter natriuresis, negative nitrogen balance, with weight loss in most patients (along with headache, fatigue, and dizziness) and sodium retention with weight gain and moon facies in others. High-protein, high-potassium diet is often needed.
• Lab tests: Periodic serum electrolytes and blood glucose.
• Discontinue occlusive dressing and start appropriate antimicrobial treatment if a local infection develops at site of application. Consult physician.
• Report symptoms of hypercortisolism or Cushing's syndrome (see Appendix F), hyperglycemia (see Appendix F), and glucosuria (e.g., polyuria). These may arise from systemic absorption after topical application, especially in children and if used over extensive areas for prolonged periods or if occlusive dressings are used.

Patient & Family Education

• Be aware that postural hypotension may accompany sodium loss and weight loss.
• Adhere to drug regimen; do not increase or decrease established regimen and do not discontinue abruptly.

---

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug