Dosing & Uses
Dosage Forms & Strengths
injectable, powder for reconstitution
- 32mg/single-dose vial
- When reconstituted, forms an extended-release suspension
Osteoarthritis
Indicated for management of osteoarthritis knee pain
32 mg as a single intra-articular injection in the knee
Also see Administration
Dosing Considerations
Not interchangeable with other formulations of injectable triamcinolone acetonide
Not suitable for use in small joints (eg, hand)
Limitations of use: Efficacy and safety of repeat administration have not been demonstrated
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (6)
- axicabtagene ciloleucel
triamcinolone acetonide extended-release injectable suspension, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Consider the use of prophylactic corticosteroid in patients after weighing the potential benefits and risks. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
- brexucabtagene autoleucel
triamcinolone acetonide extended-release injectable suspension, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid prophylactic use of systemic corticosteroids as premedication before CAR-T cell therapy. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
- ciltacabtagene autoleucel
triamcinolone acetonide extended-release injectable suspension, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid prophylactic use of systemic corticosteroids as premedication before CAR-T cell therapy. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
- idecabtagene vicleucel
triamcinolone acetonide extended-release injectable suspension, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid prophylactic use of systemic corticosteroids as premedication before CAR-T cell therapy. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
- lisocabtagene maraleucel
triamcinolone acetonide extended-release injectable suspension, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid prophylactic use of systemic corticosteroids as premedication before CAR-T cell therapy. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
- tisagenlecleucel
triamcinolone acetonide extended-release injectable suspension, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid prophylactic use of systemic corticosteroids as premedication before CAR-T cell therapy. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
Monitor Closely (16)
- cyclosporine
triamcinolone acetonide extended-release injectable suspension, cyclosporine. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may increase or decrease cyclosporine concentrations. Also, cyclosporine may increase the plasma concentrations of the corticosteroids. Monitor for changes in cyclosporine concentrations and for toxicities of corticosteroids and/or cyclosporine.
- dengue vaccine
triamcinolone acetonide extended-release injectable suspension decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.
- isavuconazonium sulfate
triamcinolone acetonide extended-release injectable suspension and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.
- lomustine
lomustine and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects.
- lonapegsomatropin
lonapegsomatropin decreases effects of triamcinolone acetonide extended-release injectable suspension by Other (see comment). Use Caution/Monitor. Comment: Growth hormone (GH) inhibits microsomal enzyme 11 beta-hydroxysteroid dehydrogenase type 1, which converts cortisone to its active metabolite, cortisol. Patients with untreated GH deficiency may have increases in serum cortisol, and initiation of lonapegsomatropin may result decreased serum cortisol. Patients with hypoadrenalism treated with glucocorticoids may require an increase glucocorticoid stress or maintenance doses following lonapegsomatropin initiation.
triamcinolone acetonide extended-release injectable suspension decreases effects of lonapegsomatropin by Other (see comment). Use Caution/Monitor. Comment: Glucocorticoid therapy and supraphysiologic glucocorticoid treatment may attenuate the growth promoting effects of lonapegsomatropin in children. Carefully adjust glucocorticoid replacement dosing in children receiving glucocorticoid treatments to avoid both hypoadrenalism and an inhibitory effect on growth. - ofatumumab SC
ofatumumab SC, triamcinolone acetonide extended-release injectable suspension. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.
- oxaliplatin
oxaliplatin and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Use of oxaliplatin with concomitant immunosuppressants or with impaired immune systems may increased risk for serious infections.
- ozanimod
ozanimod, triamcinolone acetonide extended-release injectable suspension. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.
- ponesimod
ponesimod and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of triamcinolone acetonide extended-release injectable suspension by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of triamcinolone acetonide extended-release injectable suspension by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- somapacitan
somapacitan decreases effects of triamcinolone acetonide extended-release injectable suspension by Other (see comment). Modify Therapy/Monitor Closely. Comment: Microsomal enzyme 11-beta-hydroxysteroid dehydrogenase type 1 (11-beta-HSD-1) required for cortisone conversion to its active metabolite, cortisol, in hepatic and adipose tissue. GH inhibits 11-beta-HSD-1. Patients treated with glucocorticoid for hypoadrenalism may require increased maintenance or stress doses after initiating somapacitan.
- trastuzumab
trastuzumab, triamcinolone acetonide extended-release injectable suspension. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.
- trastuzumab deruxtecan
trastuzumab deruxtecan, triamcinolone acetonide extended-release injectable suspension. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy.
- ublituximab
ublituximab and triamcinolone acetonide extended-release injectable suspension both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered
- warfarin
triamcinolone acetonide extended-release injectable suspension increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (0)
Adverse Effects
1-10%
Joint swelling (3%)
Contusion (2%)
Sinusitis (2%)
Cough (2%)
Contusions (2%)
Postmarketing Reports
Endocrine: Increased blood glucose (in diabetic patients)
General and administration site conditions: Pain including injection site pain or discomfort and leg pain
Immune system: Hypersensitivity reactions including pruritis, rash, angioedema, and anaphylaxis
Infections and infestations: Septic arthritis
Musculoskeletal: Arthralgia, joint swelling or effusion, muscle spasms
Nervous system: Headache.
Reproductive system: Postmenopausal vaginal bleeding (similar to a menstrual period)
Skin and subcutaneous tissue: Pruritis
Warnings
Contraindications
Hypersensitivity
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 metabolic-endocrine#corticosteroids; cases of serious anaphylaxis, including death, reported in individuals receiving triamcinolone acetonide injection, regardless of route of administration; institute appropriate care upon occurrence of an anaphylactic reaction
Rare instances of anaphylaxis have been reported in individuals receiving triamcinolone acetonide injection, regardless of the route of administration (see Contraindications)
Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, potential for adrenal sufficiency after withdrawal of treatment, which may persist for months; institute corticosteroid replacement therapy in situations of stress (eg, stress) during that period
Corticosteroids may increase blood pressure, salt and water retention, and potassium and calcium excretion; monitor for signs or symptoms (eg, edema, weight gain, and imbalance in serum electrolytes) in congestive heart failure or hypertensive patients
Corticosteroid may be associated with 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 (eg, active or latent peptic ulcers, diverticulosis, diverticulitis, ulcerative colitis, fresh intestinal anastomoses); avoid metabolic-endocrine#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 (eg, 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 metabolic-endocrine#corticosteroids are systemically absorbed; patients taking metabolic-endocrine#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 metabolic-endocrine#corticosteroids are systemically absorbed; in patient treated with metabolic-endocrine#corticosteroids, there may be decreased resistance and inability to localize infection when metabolic-endocrine#corticosteroids are used
- Infection with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the body may be associated with use of metabolic-endocrine#corticosteroids alone or in combination with other immunosuppressive agents; these infections may be mild to severe
- With increasing doses of metabolic-endocrine#corticosteroids, the rate of occurrence of infectious complications increases; metabolic-endocrine#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 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 use of fluoroscopy
- Safety and effectiveness of epidural administration of metabolic-endocrine#corticosteroids have not been established, and metabolic-endocrine#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 (ie, 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 metabolic-endocrine#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 metabolic-endocrine#corticosteroids and warfarin usually results in inhibition of response to warfarin; monitor INR
- Corticosteroids may increase blood glucose concentrations, 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 metabolic-endocrine#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 metabolic-endocrine#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 metabolic-endocrine#corticosteroids increases risk of gastrointestinal side effects Use this combination cautiously in hypoprothrombinemia
- Salicylate clearance may be increased if coadministered with metabolic-endocrine#corticosteroids
-
CYP3A4 inducers/inhibitors
- Concomitant use with CYP3A4 inducers may enhance the metabolism of metabolic-endocrine#corticosteroids and may require an increase in the corticosteroid dose
- Ketoconazole, a strong CYP3A4 inhibitor, has been reported to decrease the metabolism of certain metabolic-endocrine#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 potentiate 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 & Lactation
Pregnancy
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 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 (eg, deviations in timing, duration of menses, increased/decreased blood loss)
Lactation
There are no available data on the presence of triamcinolone acetonide in either human or animal milk, the effects on the breastfed infant, or the effects on milk production
Corticosteroids have been detected in human milk and may suppress milk production
Caution should be exercised when metabolic-endocrine#corticosteroids are administered to breastfeeding women
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.Pharmacology
Mechanism of Action
Corticosteroid with anti-inflammatory and immunomodulating properties; it binds to and activates the glucocorticoid receptor, leading to activation of anti-inflammatory transcription factors (eg, lipocortins); it also inhibits inflammatory transduction pathways by blocking arachidonic acid release and preventing prostaglandin and leukotriene synthesis
Absorption
Peak plasma time: 7 hr
Peak plasma concentration: 1143.7 pg/mL
AUC: 21,219.2 pg·h/mL (0-24 hr); 842,149.2 pg·h/mL (0-inf hr)
Elimination
Half-life: 633.9 hr
Administration
Intra-articular Preparation
Tap vial firmly on a padded surface to loosen up powder
Visually inspect vial to ensure powder is properly dislodged
Gently push vial adapter down onto powder vial until the adapter will snap into place
Withdraw 5 mL of supplied diluent with syringe and needle
Remove plastic holder from vial; remove needle from syringe containing diluent
Attach syringe onto vial adapter by pushing down and turning clockwise
Slowly and completely push down the plunger; slowly pull back on plunder to the 5 mL mark
Mix diluent and powder; tap bottom edge of the vial repeatedly and firmly
Swirl gently every five or six taps; tap for at least 1 minute until all powder is completely dispersed
Avoid vigorous shaking of the vial to minimize foaming
Inspect vial to ensure a uniform suspension has been achieved; properly mixed suspensions appear milky white, contain no clumps, and move freely down the vial wall
Intra-articular Administration
Intra-articular use only
Administered via a single dose device
Swirl the vial gently for at least 10 seconds to ensure the powder is fully suspended
Promptly inject after preparation to avoid settling of the suspension
If needed, the suspension can be stored in the vial for up to 4 hr at ambient conditions; gently swirl the vial to resuspend any of the settled microspheres prior to preparing the syringe for injection
Withdraw the full contents from vial into the syringe
Do not reuse
Discard any excess suspension in the vial immediately after the injection
Storage
Unopened kit
- Store refrigerated 36-46°F (2-8°C)
- Do not freeze
- If refrigeration is unavailable, may store at temperatures not exceeding 77°F (25°C) for up to 6 weeks and then discard
- Do not expose the single-dose kits to temperatures above 77°F (25°C)
Diluted suspension
- If needed, may store in the vial for up to 4 hr at ambient conditions
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Formulary
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