Triamcinolone (EENT)

Brand names: Nasacort
Drug class: Antineoplastic Agents

Usage of Triamcinolone (EENT)

Allergic Rhinitis

Symptomatic treatment of seasonal or perennial allergic rhinitis.

Self-medication for temporary symptomatic relief of hay fever or other upper respiratory allergies.

Relate drugs

How to use Triamcinolone (EENT)

Administration

Intranasal Administration

Administer by nasal inhalation using a metered-dose nasal spray pump.

Prime metered-dose spray pump prior to first use and after a period of nonuse (i.e., ≥ 2 weeks).

Gently blow the nose to clear nasal passages. Shake inhaler well prior to administration.

Tilt head slightly backward, insert spray tip into one nostril, and point tip toward back of the nose. Pump the drug into one nostril while holding the other nostril closed and concurrently inspire through the nose. Repeat this procedure for the other nostril. Avoid blowing nose for 15 minutes after inhalation.

Dosage

Nasal spray pump delivers about 55 mcg of triamcinolone acetonide per metered spray.

Do not continue intranasal triamcinolone acetonide for >3 weeks in the absence of adequate symptomatic improvement.

For self-medication, discontinue therapy and contact a clinician if no improvement after 1 week.

Pediatric Patients

Seasonal or Perennial Allergic Rhinitis Intranasal Inhalation

Children 2–5 years of age: 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Children 6–11 years of age: Initially 55 mcg (1 spray) in each nostril once daily (110 mcg total). If response inadequate, may increase dosage to 110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, may reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Children ≥12 years of age: 110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, may reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total) to maintain symptomatic control.

Self-medication for Hay Fever or Other Upper Respiratory Allergies Intranasal Inhalation

Children 2–5 years of age: 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Children 6–11 years of age: 55 mcg (1 spray) in each nostril once daily (110 mcg total). If response inadequate, may increase dosage to 110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Children ≥12 years of age: Initially 110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Adults

Seasonal or Perennial Allergic Rhinitis Intranasal Inhalation

110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, may reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total) to maintain symptomatic control.

Self-medication for Hay Fever or Other Upper Respiratory Allergies Intranasal Inhalation

110 mcg (2 sprays) in each nostril once daily (220 mcg total); once symptomatic relief achieved, reduce dosage to 55 mcg (1 spray) in each nostril once daily (110 mcg total).

Prescribing Limits

Pediatric Patients

Seasonal or Perennial Allergic Rhinitis Intranasal Inhalation

Children 2–5 years of age: Maximum 110 mcg (1 spray in each nostril) daily.

Children 6–11 years of age: Maximum 220 mcg (2 sprays in each nostril) daily.

Children ≥12 years of age: Maximum 220 mcg (2 sprays in each nostril) daily.

Self-medication for Hay Fever or Other Upper Respiratory Allergies Intranasal Inhalation

Children 2–5 years of age: Maximum 110 mcg (1 spray in each nostril) daily.

Children 6–11 years of age: Maximum 220 mcg (2 sprays in each nostril) daily.

Children ≥12 years of age: Maximum 220 mcg (2 sprays in each nostril) daily.

Adults

Seasonal or Perennial Allergic Rhinitis Intranasal Inhalation

Maximum 220 mcg (2 sprays in each nostril) daily.

Self-medication for Hay Fever or Other Upper Respiratory Allergies Intranasal Inhalation

Maximum 220 mcg (2 sprays in each nostril) daily.

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.

Renal Impairment

No specific dosage recommendations at this time.

Geriatric Patients

Select dosage with caution, usually starting at low end of the dosage range, because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy. (See Geriatric Use under Cautions.)

Warnings

Contraindications

  • Known hypersensitivity to triamcinolone acetonide or any ingredient in the formulation.

    • Warnings/Precautions

    Nasopharyngeal Effects

    Epistaxis reported more frequently in patients receiving triamcinolone than in those receiving placebo.

    Nasal septal perforation reported.

    Localized candidal infections of the nose and pharynx reported rarely. Local or systemic treatment of such infections and/or discontinuance of intranasal therapy may be required. Periodically evaluate patients receiving the drug over several months or longer for evidence of candidal infections or other adverse nasal mucosal effects.

    Avoid use until healing occurs in patients with recent nasal ulcers, surgery, or trauma.

    Glaucoma and Cataracts

    Nasally and orally inhaled corticosteroid use may result in glaucoma and/or cataracts; carefully monitor patients with vision changes or those with history of increased IOP, glaucoma, and/or cataracts.

    Immunosuppressed Patients

    Increased susceptibility to infections in patients receiving drugs that suppress the immune system. Certain infections (e.g., varicella [chickenpox], measles) can be serious or fatal in susceptible children or adults receiving corticosteroids. Not known how dosage, route, duration, or prior use of corticosteroid therapy and/or underlying disease affect risk of developing a disseminated infection.

    Avoid exposure to varicella and measles in children or adults without history of or not properly immunized against these diseases. If exposure to varicella or measles occurs in such individuals, consider administering varicella zoster immune globulin (VZIG) or pooled IM immune globulin (IG), respectively. Consider treatment with antiviral agents if varicella develops.

    Use with caution, if at all, in patients with clinical or asymptomatic Mycobacterium tuberculosis infections of the respiratory tract; untreated local or systemic fungal or bacterial infections; ocular herpes simplex; or systemic viral or parasitic infections.

    Systemic Corticosteroid Effects

    Possible reduction in growth velocity in pediatric patients. (See Pediatric Use under Cautions.)

    Systemic corticosteroid effects (e.g., hypercorticism, adrenal suppression) may occur when intranasal corticosteroids used at higher than recommended dosages or in susceptible individuals at recommended dosages. If such effects occur, gradually discontinue the drug according to accepted procedures for discontinuing oral corticosteroid therapy.

    Withdrawal of Systemic Corticosteroid Therapy

    Possible corticosteroid withdrawal symptoms (e.g., joint pain, muscular pain, lassitude, depression), acute adrenal insufficiency, or severe symptomatic exacerbation of asthma or other clinical conditions if prolonged systemic corticosteroid therapy is replaced with topical corticosteroid therapy; careful monitoring recommended.

    Sensitivity Reactions

    Hypersensitivity reactions reported during postmarketing experience.

    Specific Populations

    Pregnancy

    Category C. Use during pregnancy may result in hypoadrenalism in infants; monitor these infants carefully.

    Lactation

    Not known whether triamcinolone acetonide is distributed into milk. Caution if used in nursing women.

    Pediatric Use

    Safety and efficacy not established in children <2 years of age.

    May reduce growth velocity; routinely monitor (e.g., via stadiometry) growth of children receiving this drug. Weigh benefits of therapy against possibility of growth suppression and risks and benefits of alternative therapies. To minimize systemic effects of intranasal triamcinolone, titrate dosage to lowest possible effective level.

    Potential to cause growth suppression in susceptible patients and when used at higher than recommended dosages cannot be ruled out.

    Geriatric Use

    Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults. No substantial differences in safety and efficacy observed relative to younger adults based on other clinical experience. (See Geriatric Patients under Dosage and Administration.)

    Common Adverse Effects

    Adults and children ≥12 years of age: Pharyngitis, epistaxis, increased cough.

    Children 2–12 years of age: Flu syndrome, headache, increased cough, pharyngitis, pharyngolaryngeal pain, epistaxis, nasopharyngitis, bronchitis, asthma, rhinorrhea, dyspepsia, upper abdominal pain, diarrhea, tooth disorder, rash, excoriation.

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