Generic Name: triamcinolone (oral) (trye am SIN oh lone)
Brand Names: Aristocort
What is triamcinolone?
Triamcinolone belongs to a class of drugs called corticosteroids. It prevents the release of substances in the body that cause inflammation.
Triamcinolone oral (taken by mouth) is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.
Triamcinolone may also be used for purposes not listed in this medication guide.
Warnings
You should not use this medication if you are allergic to triamcinolone, or if you have a fungal infection anywhere in your body.
Before taking triamcinolone, tell your doctor about all of your medical conditions, and about all other medicines you are using. There are many other disease that can be affected by steroid use, and many other medicines that can interact with steroids.
Your steroid medication needs may change if you have any unusual stress such as a serious illness, fever or infection, or if you have surgery or a medical emergency. Tell your doctor about any such situation that affects you during treatment.
Steroid medications such as triamcinolone can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Tell your doctor about any illness or infection you have had within the past several weeks.
Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chicken pox or measles. These conditions can be serious or even fatal in people who are using steroid medication.
Do not receive a "live" vaccine while you are taking triamcinolone. Vaccines may not work as well while you are taking a steroid.
Do not stop using triamcinolone suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. Wear a medical alert tag or carry an ID card stating that you take triamcinolone. Any medical care provider who treats you should know that you take steroid medication.
Before taking this medicine
You should not use this medication if you are allergic to triamcinolone, or if you have a fungal infection anywhere in your body.
Steroid medication can weaken your immune system, making it easier for you to get an infection. Steroids can also worsen an infection you already have, or reactivate an infection you recently had. Before taking this medication, tell your doctor about any illness or infection you have had within the past several weeks.
To make sure you can safely take triamcinolone, tell your doctor if you have any of these other conditions:
liver disease (such as cirrhosis);
kidney disease;
a thyroid disorder;
diabetes;
a history of malaria;
tuberculosis;
osteoporosis;
a muscle disorder such as myasthenia gravis;
glaucoma or cataracts;
herpes infection of the eyes;
stomach ulcers, ulcerative colitis, or diverticulitis;
depression or mental illness;
congestive heart failure; or
high blood pressure
FDA pregnancy category C. It is not known whether triamcinolone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Triamcinolone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Triamcinolone can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using triamcinolone.
Triamcinolone Uses:
Intra-articular or soft tissue administration (triamcinolone hexacetonide [Canadian product]):
Indicative treatment of subacute and persistent inflammatory joint diseases comprising:
Primary or secondary adrenocortical deficiency (hydrocortisone or cortisone is the drug of choice),
genetic adrenal hyperplasia,
hypercalcemia linked with cancer, or
nonsuppurative thyroiditis.
GI diseases:
To surge the patient over a vital period of the disease in Crohn disease or ulcerative colitis.
Hematologic disorders:
Obtained (autoimmune) hemolytic anemia,
Diamond-Blackfan anemia,
sheer red cell aplasia,
limited cases of secondary thrombocytopenia.
Neoplastic diseases:
Placebo management of leukemia and lymphomas.
Nervous system:
Severe aggravations of multiple sclerosis;
cerebral edema associated with a primary or metastatic brain tumor or craniotomy.
Note: Treatment standards propose the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis.
Ophthalmic diseases:
Sympathetic ophthalmia,
temporal arteritis,
uveitis, and
ocular inflammatory conditions unresponsive to relevant corticosteroids.
Renal diseases:
To provoke diuresis or diminution of proteinuria in idiopathic nephrotic syndrome or that is caused by lupus erythematosus.
Respiratory diseases:
Berylliosis,
fulminating or disseminated pulmonary tuberculosis when used simultaneously with suitable antituberculosis chemotherapy,
idiopathic eosinophilic pneumonias,
symptomatic sarcoidosis.
Rheumatic disorders:
As adjunctive treatment for brief administration in serious gout flares;
acute rheumatic carditis;
ankylosing spondylitis;
psoriatic arthritis;
RA, including juvenile RA;
treatment of dermatomyositis,
polymyositis, and
systemic lupus erythematosus.
Miscellaneous:
Trichinosis with neurologic or myocardial participation;
tuberculous meningitis with subarachnoid block or imminent block when used with appropriate antituberculosis chemotherapy.
Triamcinolone (Kenalog) Dose in the treatment of Dermatoses (steroid-responsive):
Acetonide (Kenalog-10): 1 mg Intralesional:
The initial dose varies depending on the specific disease and lesion being treated; may be repeated at weekly or less frequent intervals; multiple sites may be injected if they are 1 cm or more apart
Note: Do not use if there is a doubt for contagious involvement. Patients whose urarthritis flare-up is limited to 1 to 2 joints and/or who are unable to take oral medications:
Intra-articular: Acetonide (Kenalog-10):
Larger joint (eg, knee): 40 mg;
Medium joint (eg, wrist, ankle, elbow): 30 mg;
Small joint: 10 mg.
Patients with polyarticular involvement unable to take oral medications and who are not contenders for intra-articular injection:
IM: Acetonide (Kenalog-40):
Initial: 40 to 60 mg as a single dose;
The dose may be repeated once or twice at ≥48-hour intervals if benefit fades or there is no flare resolution.
Triamcinolone (Kenalog) Dose in the treatment of Inflammatory/allergic conditions/other steroid-responsive systemic conditions:
Acetonide (Kenalog-40): IM:
Initial: 60 mg; adjust the dose to a range of 40 to 80 mg.
For patients with hay fever or pollen asthma who are not responding to pollen administration and other conventional therapy, a single injection of 40 mg to 100 mg per season may be given.
Triamcinolone (Kenalog) Dose in the treatment of Multiple sclerosis (acute exacerbation):
Note: Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis.
Acetonide (Kenalog-40): IM: 160 mg daily for 1 week, followed by 64 mg every other day for 1 month.
Triamcinolone (Kenalog) Dose in the treatment of Rheumatic conditions (excluding acute gout flares):
Intra-articular (or similar injection as designated):
Preliminary: Smaller joints: 2.5 to 5 mg, larger joints: 5 to 15 mg;
may need up to 10 mg for small joints and up to 40 mg for large joints;
maximum dose/treatment (several joints at one time): 80 mg
Zilretta only: Intra-articular:
Single-dose: 32 mg.
Note: For degenerative arthritis (OA) ache of the knee only (use for OA pain of shoulder and hip have not been evaluated);
Use is not suitable for small joints (eg, hand). The safety and efficacy of repeat administration have not been studied.
Hexacetonide [Canadian product]: Intra-articular:
Standard dose: 2 to 20 mg; smaller joints (interphalangeal, metacarpophalangeal):
2 to 6 mg; large joints (knee, hip, shoulder): 10 to 20 mg.
The frequency of injection into a single joint is every 3 to 4 weeks as required; to avoid possible joint damage use as infrequently as possible.
IM: Acetonide (Kenalog-40):
Initial: 60 mg; range: 2.5 to 100 mg/day
Adjust dose varying upon the condition being treated and the reaction of the patient. The lowest possible dose must be used to regulate the condition; when dose reduction is possible, the dose should be reduced slowly.
Note: Aristospan Intra-Articular and Aristospan Intralesional have been suspended in the US for more than 1 year.
Triamcinolone (Kenalog) General dosing, treatment of inflammatory and allergic conditions:
Children and Adolescents:
Manufacturer’s labeling: Acetonide (Kenolog-40):
IM: Initial: 0.11 to 1.6 mg/kg/day (or 3.2 to 48 mg/m /day) in 3 to 4 divided doses
Alternate dosing: Limited data available: Acetonide:
Children 6 to 12 years: IM: 0.03 to 0.2 mg/kg/dose every 1 to 7 days.
Triamcinolone (Kenalog) Dose in the treatment of Juvenile idiopathic arthritis (JIA), other rheumatic conditions:
Manufacturer’s labeling:
Children and Adolescents:
Acetonide (Kenalog-10 or -40): Intra-articular:
Primary:
Smaller joints: 2.5 to 5 mg,
larger joints: 5 to 15 mg;
highest dose/treatment (several joints at one time): 20 to 80 mg
The rate of injection into a single joint is every 3 to 4 weeks as required; to avoid possible joint damage use as rarely as possible
Alternate dosing: Limited data available:
Children and Adolescents:
Hexacetonide: Intraarticular:
Large joints (typically knees, ankles): 1 to 1.5 mg/kg/dose;
A maximum dose: 40 mg;
Doses larger than 1.5 mg/kg have not been linked with added clinical benefit;
Similar dosing for the acetonide salt can be used, but data shows that the response is greater and lasts longer with hexacetonide.
Triamcinolone (Kenalog) Dose in the treatment of severe Infantile hemangioma:
Infants and Children ≤49 months:
Intralesional:
Dosage reliant on upon size of lesion:
Commonly reported: 1 to 2 mg/kg/dose of the acetonide suspension (either 10 mg/mL or 40 mg/mL) administered in distributed doses along the lesion perimeter ~monthly (4 to 5 weeks most regularly reported interval);
a maximum dose of up to 30 mg/dose has been used;
others have reported: 1 to 30 mg of the 10 mg/mL acetonide injection divided into multiple injections along with the lesion; has also been used in combination with betamethasone intralesional injections.
Triamcinolone (Kenalog) Dose in the treatment of steroid-responsive dermatoses (including contact and atopic dermatitis):
Acetonide (Kenalog-10): Intradermal:
Adolescents:
Up to 1 mg per injection site and may be repeated 1 or more times weekly; multiple areas may be injected if they are 1 cm or more apart, not to exceed 30 mg
The frequency of dose is determined by clinical response
Triamcinolone (Kenalog) Pregnancy Risk Category: C
Corticosteroids have been associated with unfavorable events in animal reproduction research.
Research has found a link between oral clefts and systemic corticosteroid treatment in the first trimester. However, this information is inconsistent and could be affected by the maternal indication for use.
Monitor newborns for hypoadrenalism after the maternal use of corticosteroids during pregnancy.
It is recommended that systemic corticosteroids be used during pregnancy to treat aching disorders. This will ensure that the maximum effective dose is administered for as little time as possible.
Intra-articular Dosing is possible.
Systemic corticosteroids should not be used as an initial treatment for dermatological conditions in pregnant women. They should be used only during the second and third trimesters at the lowest dose.
Triamcinolone use during breastfeeding:
Breast milk contains corticosteroids.
Producer notes that systemic maternal use of corticosteroids can cause adverse events in breastfeeding infants (e.g. growing repression or interfering with endogenic corticosteroid generation). Therefore, it is important to be cautious when administering corticosteroids to a nursing female.
One case report describes a decrease in milk supply following a high-dose triamcinolone administration to a lactating mom with an formerly large milk supply.
When used in regular doses, corticosteroids can be considered acceptable for breastfeeding mothers. However, it is important to monitor infants while breastfeeding.
Based on a study with prednisolone, some strategies suggest waiting for 4 hours after the maternal doses of an oral corticosteroid to breastfeed before breastfeeding if there are concerns about infant exposure.
Dose in Kidney Disease:
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
Side Effects of Triamcinolone (Kenalog):
Hematologic & oncologic:
Bruise
Neuromuscular & skeletal:
Joint swelling
Respiratory:
Cough
Sinusitis
Less common side effects of Triamcinolone (Kenalog):
Most reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for systemic triamcinolone:
Allergy to triamcinolone, or any component of its formulation
Immune thrombocytopenia (formerly known idiopathic thrombocytopenicpurpura) is now managed with intramuscular injections (IM).
Triamcinolone hexacetonide [Canadian product]:
Allergy to triamcinolone, or any component of this formulation
Severe neuroses, active tuberculosis and herpes simplex, systemic mycoses, parasitosis (Strongyloides) infections
Children under 3 years old (due to benzyl Alcohol);
Intrathecal or epidural management
There is limited evidence of corticosteroids causing allergenic cross-responsiveness.However, cross-sensitivity is possible due to similarities in chemical compositions and/or pharmacologic activities.
Warnings and precautions
Suppression of the adrenals:
May trigger hypercortisolism or repression of hypothalamic-pituitary-adrenal (HPA) axis, mostly in younger children or in patients getting high doses for extended periods.
Suppression of the HPA axis may cause adrenal crisis.
It is important to withdraw and terminate a corticosteroid slowly and carefully.
Patients who are being switched from systemic corticosteroids in order to inhale products from steroid withdrawal or adrenal insufficiency, such as an increase in allergy symptoms, need to be careful.
Adults who are taking >20mg of prednisone or equivalent daily may be the most at risk.
There have been deaths due to adrenal insufficiency among asthmatic patients after and during transfer from systemic corticosteroids spray steroids to systemic corticosteroids; spray steroids don’t provide the systemic steroids needed to treat trauma, surgery, or other infections.
Anaphylactoid reactions
Patients who have received corticosteroids have not had as many anaphylactic reactions.
Triamcinolone Acetonide has been implicated in cases of severe anaphylaxis including fatalities.
Dermal changes:
It is possible to see atrophy in the injection area.
Avoid IM deltoid injections; subcutaneous atrophy could occur.
Immunosuppression:
Corticosteroids can also be used for extended periods to increase the likelihood of secondary infections, activate dormant infection, cloak severe infections (including fungal infections), or limit the effectiveness of killed or inactivated vaccinations.
Avoid exposure to chickenpox and measles. Corticosteroids should never be used to treat ocular herpes, cerebral malaria, fungal infections or viral hepatitis.
Patients with dormant tuberculosis or TB reactivity require close observation. Limit active TB use (only fulminating and disseminated TB) in conjunction with antituberculosis therapy.
Before initiating corticosteroids, it is important to rule out amebiasis in patients who have recently traveled to tropical climates.
Kaposi Sarcoma:
Kaposi Sarcoma can be caused by prolonged treatment with corticosteroids (case reports). If this happens, it is worth discontinuing therapy.
Myopathy
High-dose corticosteroids have been associated with severe myopathy in patients with neuromuscular transmission disorder or concomitant with neuromuscular blocking drugs. This may occur when high-dose corticosteroids are administered to patients with neuromuscular block agents.
Psychiatric disorders:
Corticosteroid abuse can cause psychiatric disorders, such as ecstasy and mood swings, personality changes, severe depression, and blunt psychotic indications.
Corticosteroid treatment can worsen pre-existing mental conditions.
Septic arthritis:
This may occur in the course of intra-articular and soft tissue administration. If necessary, you should establish antimicrobic therapy.
Cardiovascular disease
Patients with hypertension and HF should use caution. It has been shown to be associated with fluid retention, electrolyte disruptions, hypertension, and fluid retention.
Take care after acute MI. Corticosteroids have been linked to myocardial tears.
Diabetes:
Use corticosteroids with caution in patients with diabetes mellitus; may change glucose production/regulation which can lead to hyperglycemia.
Gastrointestinal Disease:
Patients with GI disorders (diverticulosis and diverticulitis), fresh intestinal anastomoses or active or latent pepticul, ulcerative colitis or any other pyogenic infections, should be restricted or avoided from using the device due to the risk of perforation.
Head injury
Patients who received high-dose IV methylprednisolone had an increased death rate. High-dose corticosteroids should never be used to treat a head injury.
Hepatic impairment
Patients with cirrhosis or hepatic impairment should be cautious. Long-term use of retaining fluid has been shown to be beneficial.
Myasthenia gravis:
Patients with myasthenia Gravis should be cautious. There has been an increase in symptoms, especially in the initial treatment with corticosteroids.
Ocular disease:
Patients with cataracts or glaucoma may need to be restrained. Long-term use has been associated with increased intraocular pressure, open angle glaucoma, cataracts, and open-angle glaucoma.
Patients with a history ocular shepes simplex should be restrained; corneal perforation may have occurred. Do not use active ocular herpes simplux.
Optic neuritis medication is not recommended. It may lead to more frequent episodes.
Consider regular eye exams for frequent users.
Osteoporosis
Patients with osteoporosis should use restraint. Corticosteroids taken in high doses or for long periods of time have been shown to increase bone loss and fractures.
Renal impairment
Patients with impaired renal function may require fluid retention.
Seizure disorders:
Patients with seizure disorders should be treated with corticoids. Seizures have been reported in association with adrenal predicament.
Thyroid disease:
Dosage adjustments may be required for thyroid conditions. The metabolic clearance of corticoids is increased in hyperthyroid patients, while it drops in hypothyroid.
Monitoring parameters:
Blood pressure,
blood glucose,
electrolytes;
weight;
intraocular pressure (use >6 weeks);
bone mineral density;
growth and development in children;
HPA axis suppression
How to administer Triamcinolone (Kenalog)?
Mix well before usage to certify suspension is consistent. Examine visually to make sure that there are no lumps; administer instantly after removal so does not settle down in the syringe. Do not administer any product IV or via the epidural or intrathecal route.
Acetonide:
Kenalog-10 injection:
For intra-articular or intralesional administration only. When administered intralesional, inject precisely into the lesion (i.e., intradermally or subcutaneously). One mL syringes with a 23- to 25-gauge needle are better for intralesional injections.
Kenalog-40 injection:
For intra-articular, soft tissue, or IM administration. When administered IM, inject deep into the gluteal muscle utilizing the least possible needle length of 1 1/2 inches. Overweight patients might need a longer needle. Alternative sites for consequent injections. Avoid IM injections into the deltoid muscle area.
Zilretta injection:
For intra-articular administration only. Do not administer IV, IM, SubQ, intrathecally, intraocularly, intradermally, or via epidural.
Make suspension only consuming the dilutant provided in the kit (refer to manufacturer labeling for making instructions and administration methods).
Quickly inject subsequently preparation. If required, can store the suspension in the flask ≤ 4 hours at ambient circumstances; tenderly twirl container to mix any settled microspheres before formulating syringe for injection.
Aspiration of synovial liquid may be done based on clinical judgment prior to administration.
Hexacetonide [Canadian product]:
For intra-articular and soft tissue administration only; use a 25- or 26-gauge needle.
Mechanism of action of Triamcinolone (Kenalog):
It is an adrenal cortical steroid that has marginal sodium-preserving capabilities.It decreases inflammation through the repression of migration polymorphonuclear WBCs, and reverses enhanced capillary absorbtivity.It suppresses the immune response by reducing the activity and quantity in the lymphatic system.
Initial:
Suppression of the adrenals:
Acetonide (IM): 24-48 hours
Intra-articular: >24 Hours
Duration:
Adrenal suppression:
IM (acetonide): 30 to 40 days;
Intra-articular: 28 to 42 days
Metabolism:
Hepatic.
Half-life elimination:
Plasma: 300 minutes.
Excretion:
Urine (75% primarily);
bile and feces (25%).
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
An overdose of triamcinolone is not expected to produce life threatening symptoms. However, long term use of high steroid doses can lead to symptoms such as thinning skin, easy bruising, changes in the shape or location of body fat (especially in your face, neck, back, and waist), increased acne or facial hair, menstrual problems, impotence, or loss of interest in sex.
International Brand Names of Triamcinolone:
Arze-Ject-A
Kenalog
Kenalog-80
P-Care K40
P-Care K80
Pod-Care 100K
Pro-C-Dure 5
Pro-C-Dure 6
ReadySharp Triamcinolone
Zilretta
Aristospan
Kenalog-10
Kenalog-40
Acetidrona
Aftab
Albicort
Amcinol
Aristocort
Aristocort A
Atrinat
Avcort
Bluxam
Cenalog
Cenolon
Cynocort
Danizax
Delphicort
Deltrianolona
Epirelefan
Flamicort
Forticinolone
Intralon
Introlan
Ioncort
Kenacort
Kenacort A
Kenacort E
Kenacort IM
Kenacort Retard
Kenacort T
Kenacort-A
Kenacort-A I.M.
Kenalog
Kenalog-40
Kilcort
Konicort
Ledercort
Lederlon
Lederspan
Loncort
MaQaid
Maquaid
Oracort
Panbicort
Polkortolon
Rabeolone
Rheudenolone
Shincort
Sivkort
Softram
Solu-Volon
Sterocort
Stucort
T-Cort
Thainocort
Tracinone
Tramsicort
Trecilon
Tri-Ject
Triam
Triamcort
TriamHEXAL
Triamhexal
Triamon
Trica
Tricort
Trigon Depot
Trilac
Trimcort
Trinakor
Trincort
Trispan
Trispane
Volon A
Volon A 10
Volon A 40
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