Triamcinolone

Triamcinolone is indicated for intramuscular use to treat allergic states, dermatologic diseases, endocrine disorders, gastrointestinal diseases, hematologic disorders, neoplastic diseases, nervous system (multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor, or craniotomy), ophthalmic diseases, renal diseases, respiratory diseases, rheumatic disorders, trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy.

Triamcinolone is indicated for intra-articular or soft tissue administration as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis or osteoarthritis.

Triamcinolone is available under the following different brand names: Kenalog IV, Aristospan, and Trivaris.

Adult and Pediatric Dosage Forms and Strengths

Injectable Suspension

• 5 mg/mL
• 10 mg/mL
• 20 mg/mL
• 40 mg/mL

Dosing Consideraations – Should be Given as Follows:

Triamcinolone Acetonide

Adult:

• Treatment of rheumatic or arthritic disorders
• 60 mg intramuscularly (IM) every 6 weeks; may be supplemented by additional 20-100 mg IM as needed
• Intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day
• Intra-articular/intrasynovial/soft-tissue injection: Large joints, 15-40 mg; small joints/tendon sheath inflammation, 2.5-10 mg

Pediatric:

• Treatment of rheumatic conditions
• 0.11-1.6 mg/kg/day intramuscularly (IM) divided every 3-4 hours
• Children 6-12 years: 0.03-0.2 mg/kg IM every 1-7 days
• Children over 12 years: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM as needed
• Children over 12 years, intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day

Triamcinolone Hexacetonide

• Treatment of rheumatic or arthritic disorders
• Intralesional injection: 0.5 mg/²; repeated as needed
• Intra-articular injection (20 mg/mL suspension): 10-20 mg (large joint); 2-6 mg (small joints); repeated every 3-4 weeks as needed

Dosing Considerations

• 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
• Avoid diluents containing parabens or phenols

Common side effects of triamcinolone include:

• Abnormal or excessive hair growth
• Acne
• Adrenal suppression
• Appetite changes
• Bloating
• Blood clots
• Bruising or swelling
• Cardiac enlargement
• Cataract
• Circulatory collapse
• Delayed wound healing
• Diabetes mellitus
• Euphoria
• Fracture
• Headache
• Increased appetite
• Increased intracranial pressure
• Indigestion
• Irregular heart rate (arrhythmia)
• Joint pain
• Joint tissues damage
• Lupus erythematosus-like lesions
• Male-pattern hair growth on women
• Muscle tissue disease
• Nausea
• Nerve pain
• Nosebleed
• Osteoporosis
• Other skin changes
• Pseudotumor cerebri (on withdrawal)
• Psychosis
• Irregular menstrual periods
• Scaling
• Severe allergic reaction (anaphylaxis)
• Sleep problems (insomnia)
• Spinning sensation (vertigo)
• Stomach or side pain
• Stroke
• Sweating more than usual
• Tendon rupture
• Thinning hair
• Vasculitis

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe Interactions of triamcinolone include:
  • mifepristone
• Triamcinolone has serious interactions with at least 72 different drugs.
• Triamcinolone has moderate interactions with at least 229 different drugs.
• Triamcinolone has mild interactions with at least 121 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

This medication contains triamcinolone. Do not take Kenalog IV, Aristospan, or Trivaris if you are allergic to triamcinolone or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Systemic fungal infection, except as intra-articular injection for localized joint conditions
• Documented hypersensitivity
• Intramuscular (IM) corticosteroids contraindicated for idiopathic thrombocytopenic purpura (ITP)
• Triamcinolone diacetate injectable suspension contraindicated for intrathecal administration
• Cerebral malaria
• Benzyl alcohol-containing formulations associated with potentially fatal "gasping syndrome" in premature newborns
• Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Triamcinolone?"

Long-Term Effects

• Monitor bone density in long-term use
• Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts
• Prolonged use of Kaposi's sarcoma reported to be associated with development of Kaposi's sarcoma
• See "What Are Side Effects Associated with Using Triamcinolone?"

Cautions

• Triamcinolone acetonide injectable suspension is for intra-articular or intralesional use only, not for intravenous (IV), intramuscular (IM), intraocular, epidural, or intra-thecal (IT) use
• Not for use in neonates (contains benzyl alcohol)
• Use caution in patients with cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic
• infections, renal insufficiency, or pregnancy
• May cause higher degree of muscle wasting
• Psychiatric disorders including depression, personality changes, insomnia, euphoria, and mood swings, may occur
• High doses of corticosteroids, including triamcinolone, may increase mortality in patients with traumatic brain injury
• Ophthalmic effects: Cataracts, infections, glaucoma
• Monitor patients for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia; decrease dose gradually
• Increased susceptibility to infection and increased risk of exacerbation, dissemination, or reactivation of latent infection
• Monitor blood pressure and serum sodium and potassium levels
• Increased risk of gastrointestinal (GI) perforation with certain GI disorders
• Monitor bone density in long-term use
• Behavioral and mood disturbances
• Pregnancy: Fetal harm can occur with use in 1st trimester
• Rare instances of anaphylaxis reported
• Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts
• Acute myopathy, involving ocular and/or respiratory muscles, reported with high-dose corticosteroids, especially in patients with neuromuscular transmission disorders
• Prolonged use of Kaposi's sarcoma reported to be associated with development of Kaposi's sarcoma
• Killed or inactivated vaccines may be administered; however, the response to such vaccines cannot be predicted
• Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy in physiologic doses (e.g., for Addison's disease)
• Epidural injection:
  • Serious neurologic events, some resulting in death, have been reported with epidural injection
  • Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke
  • These serious neurologic events have been reported with and without use of fluoroscopy
  • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use

Pregnancy and Lactation

• Use triamcinolone with caution during pregnancy if benefits outweigh risks
• Animal studies show risk and human studies are not available or neither animal nor human studies were done
• Fetal harm can occur with use of triamcinolone in the first trimester
• Triamcinolone is excreted in breast milk; use caution if breastfeeding