triamcinolone hexacetonide

Action

Unknown. Thought to decrease inflammation mainly by inhibiting activities of mast cells, macrophages, and other mediators of allergic reactions. Also suppresses immune system by depressing lymphatic activity.

Availability

triamcinolone acetonide

Cream: 0.025%, 0.1%, 0.5%

Injectable suspension: 10 mg/ml, 40 mg/ml

Lotion: 0.025%, 0.1%

Ointment: 0.025%, 0.1%, 0.5%

Suspension: 55 mcg/metered spray

triamcinolone hexacetonide

Injectable suspension: 5 mg/ml, 20 mg/ml

Indications and dosages

➣ Allergic rhinitis

Adults and children older than age 12: 220 mcg (two sprays of acetonide suspension) in each nostril daily. When maximum benefit has been achieved and symptoms have been controlled, reduce dosage to 110 mcg/day (one spray in each nostril daily).

Children ages 6 to 12: Initially, 110 mcg (two sprays of acetonide suspension) as one spray in each nostril once daily. Use 220 mcg (two sprays in each nostril) daily in children not responding adequately to 110 mcg daily.

Children ages 2 to 5: Recommended and maximum dosage is 110 mcg as one spray in each nostril once daily.

➣ Severe inflammation; immunosuppression

Adults and children older than age 12: 60 mg (acetonide) I.M. at 6-week intervals. For intralesional or sublesional use, 1 mg at each injection site, repeated one or more times weekly; for intra-articular, intrasynovial, or soft-tissue injection, 2.5 to 40 mg, repeated when symptoms recur. Or 0.5 mg/square inch of affected skin (hexacetonide) by intralesional or sublesional injection or 2 to 20 mg by intra-articular injection; may repeat at 3- to 4-week intervals.

Children ages 6 to 12: 0.03 to 0.2 mg/kg or 1 to 6.25 mg/m² I.M. at intervals of 1 to 7 days

➣ Corticosteroid-responsive dermatoses

Adults and children older than age 12: Apply cream, ointment, or lotion sparingly to affected area two to four times daily.

Contraindications

• Hypersensitivity to drug, tartrazine, chlorofluorocarbon propellants, alcohol, propylene glycol, or polyethylene glycol

• Systemic fungal infections (parenteral use)

• Idiopathic thrombocytopenic purpura (I.M. use)

• Administration of live-virus vaccines (with immunosuppressant doses of triamcinolone)

Precautions

Use cautiously in:

• active untreated infection, systemic infection, immunosuppression, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability

• pregnant or breastfeeding patients

• children younger than age 2 (safety not established).

Administration

See Don't withdraw systemic corticosteroids abruptly when patient begins inhalation steroid therapy.

See Know that patient will need additional steroids during times of stress or trauma.

See Apply cream, lotion, or ointment sparingly. Know that triamcinolone is a high-potency steroid; it can be absorbed systemically and should not be withdrawn abruptly.

See Avoid intralesional injection to face or head (may cause blindness).

• Don't apply topical form near eyes.

• Know that occlusive dressing may be used with topical form when treating psoriasis or other recalcitrant conditions, but should be removed if infection occurs.

Adverse reactions

CNS: headache, vertigo, paresthesia, syncope, personality changes, pseudotumor cerebri, seizures

CV: hypertension, thrombophlebitis, arrhythmias, thromboembolism, heart failure

EENT: cataract, glaucoma, increased intraocular pressure, exophthalmos, otitis, nasal or sinus congestion, rhinitis, epistaxis, sneezing, dry mucous membranes, pharyngitis, throat discomfort

GI: nausea, vomiting, dyspepsia, abdominal distention or pain, peptic ulcer, ulcerative esophagitis, oral candidiasis, dry mouth, pancreatitis

GU: cystitis, urinary tract infection, glycosuria, menstrual irregularities, vaginal candidiasis

Metabolic: fluid retention, hypernatremia, hypokalemia, hyperglycemia, hypocalcemia, decreased growth (in children), carbohydrate intolerance, exacerbation of latent diabetes mellitus, cushingoid appearance (moon face, buffalo hump), hypokalemic alkalosis, acute adrenal insufficiency (with abrupt withdrawal or acute stress in long-term use)

Musculoskeletal: muscle weakness; steroid myopathy; loss of muscle mass; myalgia; bursitis; tenosynovitis; osteoporosis; fractures; aseptic necrosis; with intra-articular injection-osteonecrosis, tendon rupture, post-injection flare

Respiratory: cough, wheezing, chest congestion

Skin: delayed wound healing; thin and fragile skin; petechiae; bruising; with topical use-local eruptions, pruritus, hypopigmentation or hyperpigmentation, scarring, stinging, skin maceration, secondary infection, cutaneous or subcutaneous atrophy, diaphoresis, facial erythema

Other: toothache, weight gain, fever, pain, voice alteration, hypersensitivity reaction

Interactions

Drug-drug. Erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, saquinavir: increased triamcinolone blood level and effects

Fluoroquinolones: increased risk of tendon rupture

Live-virus vaccines: decreased antibody response to vaccine

Nonsteroidal anti-inflammatory drugs (including aspirin): increased risk of adverse GI reactions

Potassium-wasting drugs (including amphotericin B, thiazide and loop diuretics, mezlocillin, piperacillin, ticarcillin): additive hypokalemia

Drug-diagnostic tests. Cholesterol: increased level

Skin tests: suppressed reaction

Patient monitoring

• Monitor respiratory status. Watch for worsening signs and symptoms.

• With long-term use, assess for adverse endocrine and musculoskeletal reactions.

• Monitor carefully for signs and symptoms of infection, which drug may mask.

Patient teaching

• Teach patient correct use of drug. Make sure he has received manufacturer's patient information sheet.

• Inform patient that drug can affect many body systems. Urge him to report serious adverse effects promptly.

• Tell parents drug may make child more vulnerable to childhood infections, such as chicken pox and measles.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.