triamcinolone (Rx)

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Brand and Other Names:Kenalog IV, Aristospan, more...Trivaris

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable suspension

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

Triamcinolone Acetonide

Treatment of rheumatic or arthritic disorders

60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM PRN

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

Triamcinolone Hexacetonide

Treatment of rheumatic or arthritic disorders

Intralesional injection: 0.5 mg/²; repeated PRN

Intra-articular injection (20 mg/mL suspension): 10-20 mg (large joint) ; 2-6 mg (small joints); repeated every 3-4 weeks PRN

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

Dosage Forms & Strengths

injectable suspension

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

Triamcinolone Acetonide

Treatment of rheumatic conditions

0.11-1.6 mg/kg/day IM divided q3-4hr 

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

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Interactions

Interaction Checker

and triamcinolone

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Acne

            Arrhythmia

            Cardiac enlargement

            Circulatory collapse

            Adrenal suppression

            Anaphylaxis

            Vasculitis

            Increased intracranial pressure

            Thromboembolism

            Euphoria

            Arthragia

            Stroke

            Fracture

            Joint tissues damage

            Lupus erythematosus-like lesions

            Hypertrichosis

            Cataract

            Delayed wound healing

            Diabetes mellitus

            Epistaxis

            Neuritis

            Hirsutism

            Increased appetite

            Indigestion

            Tendon rupture

            Insomnia

            Myopathy

            Osteoporosis

            Pseudotumor cerebri (on withdrawal)

            Psychosis

            Vertigo

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            Warnings

            Contraindications

            Systemic fungal infection, except as intra-articular injection for localized joint conditions

            Documented hypersensitivity

            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

            Cautions

            Triamcinolone acetonide injectable suspension is for intra-articular or intralesional use only, not for IV, IM, intraocular, epidural, or 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, 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 (eg, 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
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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Excreted in breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Potent glucocorticoid with minimal to no mineralocorticoid activity

            Controls or prevents inflammation by suppressing migration of polymorphonuclear leukocytes and fibroblasts and reversing capillary permeability

            Suppresses immune system by reducing volume and activity of lymphatic system

            Absorption

            Bioavailability: Complete with intra-articular injection

            Duration: 8-12 hr (PO)

            Peak plasma time: 8-10 hr (IM)

            Distribution

            Protein bound: 68%

            Vd: 99.5 L

            Metabolism

            Metabolized in liver

            Elimination

            Half-life: Plasma, 2-3 hr; biologic, 18-36 hr

            Renal clearance: 9.5 mL/min

            Excretion: Urine (40%), feces (60%)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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