TRIAMCINOLONE
(trye-am-sin'oh-lone)
Aristocort, Atolone, Kenacort, Kenalog-E
TRIAMCINOLONE ACETONIDE
Azmacort, Cenocort A₂ , Kenalog, Nasacort HFA, Triam-A, Triamonide, Tri-kort, Trilog, Tri-Nasal
TRIAMCINOLONE DIACETATE
Amcort, Aristocort Forte, Articulose LA, Cenocort Forte, Kenacort, Triam-Forte, Trilone, Tristoject
TRIAMCINOLONE HEXACETONIDE
Aristospan
Classifications: hormones & synthetic substitutes; adrenal corticosteroid; glucocorticoid; antiinflammatory
Prototype: Prednisone
Pregnancy Category: C

Availability

Triamcinolone 4 mg, 8 mg tablets; 4 mg/5 mL syrup

Triamcinolone acetonide 3 mg/mL, 10 mg/mL, 40 mg/mL injection; 100 mcg aerosol; 55 mcg inhaler; 55 mcg spray; 0.5 mg/mL nasal spray; 0.025%, 0.1%, 0.5% cream, ointment, lotion; 10.3% topical spray

Triamcinolone diacetate 25 mg/mL, 40 mg/mL injection

Triamcinolone hexacetonide 5 mg/mL, 20 mg/mL injection.

Actions

Immediate acting synthetic fluorinated adrenal corticosteroid with glucocorticoid and antirheumatic activity 7–13 times more potent than that of hydrocortisone. Possesses minimal sodium and water retention properties in therapeutic doses.

Therapeutic Effects

Antiinflammatory and immunosuppressant drug that is effective in the treatment of bronchial asthma.

Uses

An antiinflammatory or immunosuppressant agent. Orally inhaled: bronchial asthma in patient who has not responded to conventional inhalation treatment. Therapeutic doses do not appear to suppress HPA (hypothalamic-pituitary-adrenal) axis.

Contraindications

Safety during pregnancy (category C), lactation, or in children <6 y is not established. Kidney dysfunction; glaucoma. Also see hydrocortisone.

Cautious Use

Coagulopathy, hemophilia, diabetes mellitus, GI disease; congestive heart failure; herpes infection; infection; inflammatory bowel disease; myasthenia gravis; MI; ocular exposure, ocular infection; osteoporosis; peptic ulcer disease; PVD; skin abrasion.

Route & Dosage

Inflammation, Immunosuppression
Adult: PO/IM/SC 4–48 mg/d in divided doses Intraarticular/Intradermal 4–48 mg/d Inhaled 2–4 inhalations q.i.d. Topical See Appendix A
Child: PO/IM/SC 3.3–50 mg/m²/d in divided doses Intraarticular/Intradermal 3.3–50 mg/m²/d

Acetonide
Adult: IM 60 mg, may repeat with 20–100 mg q6wk Intradermal 1 mg per injection site (max: 30 mg total) Intraarticular 2.5–4.0 mg Inhalation See Appendix A.
Child: IM 6–12 y, 0.03–0.2 mg q1–7d Inhalation See Appendix A.

Diacetate
Adult: PO 4–48 mg/d in 1–4 divided doses IM 40 mg once/wk Intradermal 5–48 mg (max: 75 mg/wk), may repeat q1–2wk if needed Intraarticular 2–40 mg q1–8wk
Child: PO 0.117–1.66 mg/kg/d

Hexacetonide
Adult: Intralesional Up to 0.5 mg/in² of skin Intraarticular 2–20 mg q3–4wk

Administration

Oral

Give with fluid of patient's choice; tablet may be crushed.

Subcutaneous/Intramuscular

Do not give triamcinolone injection IV.
See hydrocortisone for additional administration information.
Store at 15°–30° C (59°–86° F). Protect from light.

Adverse Effects (1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI: Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine: Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis. Metabolic: Hypokalemia. Skin: Burning, itching, folliculitis, hypertrichosis, hypopigmentation.

Interactions

Drug: barbiturates, phenytoin, rifampin increase steroid metabolism—may need increased doses of triamcinolone; amphotericin B, diuretics add to potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody response to vaccines, toxoids.

Pharmacokinetics

Absorption: Readily absorbed from all routes. Onset: 24–48 h PO, IM. Peak: 1–2 h PO; 8–10 h IM. Duration: 2.25 d PO; 1–6 wk IM. Metabolism: Metabolized in liver. Elimination: Excreted in urine. Half-Life: 2–5 h; HPA suppression, 18–36 h.

Nursing Implications

Assessment & Drug Effects

Discuss adequate diet with dietitian, patient, and physician to counter natriuresis, negative nitrogen balance, with weight loss in most patients (along with headache, fatigue, and dizziness) and sodium retention with weight gain and moon facies in others. High-protein, high-potassium diet is often needed.
Lab tests: Periodic serum electrolytes and blood glucose.
Discontinue occlusive dressing and start appropriate antimicrobial treatment if a local infection develops at site of application. Consult physician.
Report symptoms of hypercortisolism or Cushing's syndrome (see Appendix F), hyperglycemia (see Appendix F), and glucosuria (e.g., polyuria). These may arise from systemic absorption after topical application, especially in children and if used over extensive areas for prolonged periods or if occlusive dressings are used.

Patient & Family Education

Be aware that postural hypotension may accompany sodium loss and weight loss.
Adhere to drug regimen; do not increase or decrease established regimen and do not discontinue abruptly.
Do not breast feed while using or taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug