triamcinolone intravitreal (Rx)

Frequency Not Defined

Abnormal sensation in eye

Anterior chamber cells

Anterior chamber flare

Cataract

Cataract cortical

Cataract nuclear

Cataract subcapsular

Conjunctival hemorrhage

Exophthalmos

Eye irritation

Eye pain

Eye pruritus

Foreign body sensation in eyes

Glaucoma

Hypopion

Increased intraocular pressure

Injection site hemorrhage

Lacrimation increased

Optic disc vascular disorder

Vitreous detachment

Vitreous floaters

Rare instances of blindness associated with intravitreal or periocular injections

Contraindications

Hypersensitivity

Idiopathic thrombocytopenia purpura

Systemic fungal infections

Cerebral malaria

Cautions

Prolonged use may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses

The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes

Intraocular pressure may become elevated in some individuals; if steroid therapy is continued for more than 6 weeks, IOP should be monitored

Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex because of possible corneal perforation; do NOT use in active ocular herpes simplex

Rate of infectious culture positive endophthalmitis is 0.5%; proper aseptic techniques should always be used when administering triamcinolone acetonide

In addition, patients should be monitored following the injection to permit early treatment should an infection occur

Children who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity

Pregnancy Category: D

Lactation: Distributed in breast milk; caution advised

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.

Mechanism of Action

Glucocorticoid

Elicits anti-inflammatory effects; edema, fibrin deposition, capillary dilatation, migration of leukocytes and phagocytosis and the later stages of wound healing (capillary proliferation, deposition of collagen, cicatrization) are inhibited

Depresses the production of eosinophils and lymphocytes

Pharmacokinetics

Peak aqueous humor concentration: 2151-7202 ng/mL

AUC: 231-1911 ng•h/mL

Half-Life: 18.7 ± 5.7 days

Intravitreal Preparation

Trivaris Intravitreal

• Available without an attached needle, therefore, it is necessary to firmly attach a desired needle to the syringe (27 gauge, 0.5-inch needle suggested)
• Prepare the proper volume to be injected by advancing the plunger to the single line marked on the prefilled glass syringe shaft; hold the syringe and the needle at an angle and express excess gel suspension over a sterile surface
• The plunger is correctly positioned when white compound is no longer visible between the plunger and the fill line on the syringe
• This will provide the recommended dose of 4 mg/0.05 mL
• Always check the needle to ensure it is firmly attached to the syringe before injecting the patient

Triesence

• The vial should be vigorously shaken for 10 seconds before use to ensure a uniform suspension
• Prior to withdrawal, the suspension should be inspected for clumping or granular appearance (agglomeration)
• An agglomerated product results from exposure to freezing temperatures and should not be used
• After withdrawal, inject without delay to prevent settling in the syringe

Intravitreal Administration

The intravitreal injection procedure should be carried out under controlled aseptic conditions which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent)

Adequate anesthesia and a broad-spectrum antimicrobial should be administered prior to the injection

Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis

Each syringe should only be used for the treatment of a single eye

If the contralateral eye requires treatment, a new syringe should be used and the sterile field, syringe, gloves, drapes, and eyelid speculum and injection needles should be changed before administered to the other eye

Storage

Keep refrigerated 36-46 degrees F (2-8 degrees C) until use

Avoid freezing and protect from light