triamcinolone, intranasal (OTC)

Brand and Other Names:Nasacort Allergy 24HR
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

nasal spray

  • 55mcg/spray
  • Note: Nasacort AQ (Rx) was phased out and replaced by Nasacort Allergy 24HR (OTC) in spring 2014
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Allergic Rhinitis

2 sprays/nostril qDay (220 mcg/day); not to exceed 220 mcg/day

Dosing Considerations

Once maximum benefit has been achieved, reduce dose to 1 spray/nostril qDay (110 mcg/day) to minimize adverse effects while maintaining effectiveness

Administration

Suspension; shake well before use

Before using for first time, prime pump by releasing 5 sprays into air away from face

If not used for >2 weeks, repeat priming by releasing 1 spray into air before using

Dosage Forms & Strengths

nasal spray suspension

  • 55mcg/spray
  • Note: Nasacort AQ (Rx) was phased out and replaced by Nasacort Allergy 24HR (OTC) in spring 2014
more...

Allergic Rhinitis

<2 years: Safety and efficacy not established

2-6 years: 1 spray/nostril qDay (110 mcg/day); not to exceed 110 mcg/day

6-12 years: 1 spray/nostril qDay; may increase to 2 sprays/nostril qDay (110 mcg/day); if inadequate response, may increase to 2 sprays/nostril qDay (ie, 220 mcg/day); not to exceed 220 mcg/day

≥12 years: 2 sprays/nostril qDay (220 mcg/day); not to exceed 220 mcg/day

Dosing Considerations

>6 years: Once maximum benefit has been achieved, reduce dose to 1 spray/nostril qDay (110 mcg/day) to minimize adverse effects while maintaining effectiveness

Administration

Suspension; shake well before use

Before using for first time, prime pump by releasing 5 sprays into air away from face

If not used for >2 weeks, repeat priming by releasing 1 spray into air before using

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Adverse Effects

1-10%

Flu syndrome [children] (9%)

Pharyngitis (5-8%)

Headache [children] (6%)

Bronchitis [children] (3%)

Dyspepsia (3-5%)

Tooth disorder [children] (3%)

Epistaxis (3-5%)

Excoriation [children] (3%)

Increased cough (2- 8%)

Upper abdominal pain [children] (5%)

Diarrhea [children] (3%)

Rash [children] (3%)

Asthma [children] (3%)

Rhinorrhea [children] (2%)

Postmarketing Experience

Nasal discomfort/congestion

Sneezing

Alterations of taste and smell

Nausea

Insomnia

Dizziness

Fatigue

Dyspnea

Decreased blood cortisol

Cataract

Glaucoma

Increased IOP

Pruritus

Rash

Hypersensitivity

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Warnings

Contraindications

Hypersensitivity

Cautions

Delay initiation of treatment in patients with recent nasal surgery, nasal trauma, nasal septum ulcers (until healing has occurred)

Prolonged use may increase incidence of secondary infection

Monitor for vision change, or with history of increased IOP, glaucoma, or cataracts

Potential worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections, or ocular herpes simplex

More serious or fatal course of chickenpox or measles in susceptible patients

Risk for hypercorticism and adrenal suppression with higher than normal doses

Potential reduction of growth velocity in children

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: Unknown whether distributed in breast milk; exercise 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

Corticosteroid with potent anti-inflammatory properties; elicits effects on various cells, including mast cells and eosinophils; also elicits effects on inflammatory mediators (eg, histamine, eicosanoids, leukotrienes, cytokines)

Absorption

Minimal systemic absorption occurs, mostly by small amount swallowed during nasal administration

Distribution

Vd: 99.5 L

Peak plasma time: 1.5 hr

Peak plasma concentration: 0.5 ng/mL

Metabolism

Metabolites: 6β-hydroxytriamcinolone acetonide, 21-carboxytriamcinolone acetonide and 21-carboxy-6β-hydroxytriamcinolone acetonide (major)

Elimination

Half-life: 88 min

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