Dosing & Uses
Dosage Forms & Strengths
ophthalmic suspension for suprachoroidal injection
- 40mg/mL single-dose vial
Macular Edema
Indicated for macular edema associated with uveitis
4 mg as a single suprachoroidal injection for treatment of 1 eye
Safety and efficacy not established
Adverse Effects
>10%
Increased intraocular pressure (IOP), nonacute (14%)
Eye pain, nonacute (12%)
1-10%
Cataract (7%)
Increased IOP, acute (6%)
Vitreous detachment (5%)
Headache (5%)
Injection site pain (4%)
Conjunctival hemorrhage (4%)
Reduced visual acuity (4%)
Dry eye (3%)
Eye pain, acute (3%)
Photophobia (3%)
Vitreous floaters (3%)
Uveitis (2%)
Conjunctival hyperemia (2%)
Punctate keratitis (2%)
Conjunctival edema (2%)
Meibomianitis (2%)
Anterior capsule contraction (2%)
Chalazion (2%)
Eye irritation (2%)
Eye pruritus (2%)
Eyelid ptosis (2%)
Photopsia (2%)
Vision blurred (2%)
Warnings
Contraindications
Hypersensitivity to triamcinolone and other product components
Cautions
Corticosteroid-related effects
- May produce cataracts, increased IOP, and glaucoma
- May enhance establishment of secondary ocular infections due to bacteria, fungi, or viruses
- Caution with history of ocular herpes simplex
- Do not use with active ocular herpes simplex
Altered endocrine function
- Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia can occur, particularly with long-term use
- Corticosteroids can produce reversible HPA axis suppression with potential for glucocorticosteroid insufficiency following withdrawal; minimize by gradual dose reduction
- This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, reinstitute hormone therapy
- Corticosteroid clearance decreased with hypothyroid and increased with hyperthyroid; changes in thyroid status may necessitate dose adjustment
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women to inform drug-associated risks
Systemic exposure is negligible following suprachoroidal injection
Animal studies
- Topical ocular administration of corticosteroids has been shown to produce teratogenicity at clinically relevant doses
Lactation
Unknown if ocular administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk
Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects
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; suppresses inflammation by inhibiting multiple inflammatory cytokines, resulting in decreased edema, fibrin deposition, capillary leakage, and migration of inflammatory cells
Absorption
Among 19 patients, 18 of 19 had serum concentrations below the lower limit of quantitation
Administration
Suprachoroidal Injection Preparation
Suprachoroidal injection procedure is performed under controlled aseptic conditions, including use of sterile gloves, sterile drape, sterile eyelid speculum (or equivalent), and sterile cotton swab
Apply adequate anesthesia and broad-spectrum microbicide to periocular skin, eyelid, and ocular surface before the injection
See prescribing information for complete preparation instructions and diagrams
Suprachoroidal Injection
See prescribing information for complete preparation instructions and diagrams
Monitor intraocular pressure immediately after injection
Storage
Store at 15-25ºC (59-77ºF)
Store in original carton to protect from light
Do not freeze
Discard unused portion
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Formulary
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