Triamcinolone Acetonide Injection

Triamcinolone Acetonide extended-release injectable suspension is a prescription medication used as an intra-articular injection for the management of osteoarthritis knee pain.

Triamcinolone Acetonide extended-release injectable suspension is available under the following different brand names: Zilretta

Common side effects of Triamcinolone Acetonide extended-release injectable suspension include:

• sinus infections (sinusitis)
• cough bruising
• joint swelling

Serious side effects of Triamcinolone Acetonide extended-release injectable suspension include:

• weakness
• puffy face
• unusual weight gain
• thinning skin
• bone pain
• menstrual period changes
• mental/mood changes (such as depression, mood swings, agitation)
• easy bruising/bleeding
• vision problems
• swelling ankles/feet/hands
• fast/slow/irregular heartbeat

Rare side effects of Triamcinolone Acetonide extended-release injectable suspension include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms include sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Injectable, powder for reconstitution

• 32 mg/single-dose vial
• When reconstituted, forms an extended-release suspension

Osteoarthritis

Adult dosage

• 32 mg as a single intra-articular injection in the knee

Dosage Considerations – Should be Given as Follows:

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, 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, healthcare provider, or pharmacist first.

• Triamcinolone Acetonide extended-release injectable suspension has severe interactions with no other drugs
• Triamcinolone Acetonide extended-release injectable suspension has serious interactions with the following drugs:
  • axicabtagene ciloleucel
  • brexucabtagene autoleucel
  • ciltacabtagene autoleucel
  • idecabtagene vicleucel
  • lisocabtagene maraleucel
  • tisagenlecleucel
• Triamcinolone Acetonide extended-release injectable suspension has moderate interactions with the following drugs:
  • cyclosporine
  • dengue vaccine
  • isavuconazonium sulfate
  • lomustine
  • lonapegsomatropin
  • ofatumumab SC
  • oxaliplatin
  • ozanimod
  • ponesimod
  • sodium sulfate/magnesium sulfate/potassium chloride
  • sodium sulfate/potassium sulfate/magnesium sulfate
  • somapacitan
  • somatrogon
  • somatropin
  • trastuzumab
  • trastuzumab deruxtecan
  • ublituximab
  • warfarin
• Triamcinolone Acetonide extended-release injectable suspension has minor interactions with no other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about 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 healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Triamcinolone Acetonide extended-release injectable suspension?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Triamcinolone Acetonide extended-release injectable suspension?”

Cautions

• Triamcinolone Acetonide extended-release injectable suspension is for intra-articular use only, not for IV, IM, SC, intradermal, intraocular, epidural, intraocular, or intrathecal (IT) use
• Instances of anaphylaxis reported in patients with hypersensitivity to corticosteroids; cases of serious anaphylaxis, including death, reported in individuals receiving Triamcinolone Acetonide injection, regardless of route of administration; institute appropriate care upon the occurrence of an anaphylactic reaction
• Rare instances of anaphylaxis have been reported in individuals receiving Triamcinolone Acetonide injection, regardless of the route of administration
• Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, the potential for adrenal sufficiency after withdrawal of treatment, which may persist for months; institute corticosteroid replacement therapy in situations of stress (e.g., stress) during that period
• Corticosteroids may increase blood pressure, salt and water retention, and potassium and calcium excretion; monitor for signs or symptoms (e.g., edema, weight gain, and imbalance in serum electrolytes) in congestive heart failure or hypertensive patients
• Corticosteroid may be associated with the development or exacerbation of increased intraocular pressure; monitor patients with elevated intraocular pressure for potential treatment adjustment
• Increased risk of gastrointestinal perforation with certain GI disorders e.g., active or latent peptic ulcers, diverticulosis, diverticulitis, ulcerative colitis, fresh intestinal anastomoses); avoid corticosteroids in these patients because signs of peritoneal irritation following gastrointestinal perforation may be minimal or absent
• Corticosteroids decrease bone formation and increase bone resorption through their effect on calcium regulation and inhibition of osteoblast function; give special consideration to patients with or at increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy
• Risk of behavioral and mood disturbances may be associated with corticosteroid use; advise patients and/or caregivers to immediately report any new or worsening behavior or mood disturbances; give special consideration to patients with previous or current emotional instability or psychiatric illness before initiating corticosteroid therapy
• Infections
  • Intra-articular injection of corticosteroid may be complicated by joint infection; avoid injection into an infected site; intra-articular infection may result in damage to joint tissues
  • Intra-articularly injected corticosteroids are systemically absorbed; patients taking corticosteroids are more susceptible to infections than are healthy individuals
  • A marked increase in pain accompanied by local swelling, further restriction of joint motion, fever, and malaise are suggestive of septic arthritis; if this complication occurs and a diagnosis of septic arthritis is confirmed, institute appropriate antimicrobial therapy
  • Local injection of a corticosteroid into a previously infected joint is not usually recommended; examine any joint fluid present to exclude a septic process
  • Intra-articularly injected corticosteroids are systemically absorbed; in patients treated with corticosteroids, there may be decreased resistance and inability to localize infection when corticosteroids are used
  • Infection with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the body may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents; these infections may be mild to severe
  • With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases; corticosteroids may also mask some signs of current infection
  • Advise patients to inform their health care provider if they develop fever or other signs or symptoms of an infection; advise patients who have not been vaccinated to avoid exposure to chicken pox or measles; instruct patients to contact their health care provider immediately if they are exposed
  • Serious neurologic adverse events with epidural or IT injection
  • Serious neurologic events, some resulting in death, have been reported with epidural or IT 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 the use of fluoroscopy
  • Safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use
• Drug interaction overview
  • Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression
  • Concomitant with potassium-depleting agents (i.e., amphotericin B, diuretics), observe for development of hypokalemia
  • Cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure
  • Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance
  • Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis; if possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy
  • Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin; monitor INR
  • Corticosteroids may increase blood glucose concentrations, and dosage adjustments of antidiabetic agents may be required
  • Corticosteroids may decrease isoniazid serum concentrations
  • Cholestyramine may increase corticosteroid clearance
  • Increased activity of both cyclosporine and corticosteroids may occur when the 2 are used concurrently; convulsions have been reported with this concurrent use
  • Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect
  • Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia
  • Corticosteroids may suppress reactions to allergy-related skin tests
  • Aspirin and NSAIDs
    • Coadministration of aspirin (or other NSAIDs) and corticosteroids increases the risk of gastrointestinal side effects Use this combination cautiously in hypoprothrombinemia
    • Salicylate clearance may be increased if coadministered with corticosteroids
  • CYP3A4 inducers/inhibitors
    • Concomitant use with CYP3A4 inducers may enhance the metabolism of corticosteroids and may require an increase in the corticosteroid dose
    • Ketoconazole, a strong CYP3A4 inhibitor, has been reported to decrease the metabolism of certain corticosteroids by up to 60% leading to an increased risk of corticosteroid side effects
  • Vaccines
    • Prolonged corticosteroid therapy may cause a diminished response to toxoids, live, or inactivated vaccines due to inhibition of antibody response; possibly potentiating the replication of some organisms contained in live attenuated vaccines
    • If possible, defer routine administration of vaccines or toxoids until corticosteroid therapy is discontinued

Pregnancy and Lactation

• There are no data regarding the use 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 the 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 (e.g., deviations in timing, duration of menses, increased/decreased blood loss)
• Lactation
  • There is no available data on the presence of Triamcinolone Acetonide in either human or animal milk, the effects on the breastfed infant, or milk production
  • Corticosteroids have been detected in human milk and may suppress milk production
  • Caution should be exercised when corticosteroids are administered to breastfeeding women