Triamcinolone is a synthetic corticosteroid medication that is used to reduce inflammation and suppress the immune system in the body. It belongs to a class of drugs known as glucocorticoids. Triamcinolone is available in various forms, including topical creams, ointments, and gels, as well as injectable solutions and dental pastes.

A medium potency glucocorticoid is triamcinolone nasal spray (Nasacort). Inflammatory and allergic illnesses like allergic rhinitis are treated with it. 4 mg of triamcinolone and 5 mg of prednisolone are comparable in terms of dosage.

Triamcinolone (Nasacort) Uses:

• Upper respiratory allergies (OTC products):
  • Relieving symptoms of hay fever and other upper respiratory allergens in adults and kids 2 years of age and older, such as nasal congestion, runny nose, sneezing, and itchy nose
• Allergic rhinitis (Rx products):
  • Management of adults and children 2 years of age and older with seasonal and chronic allergic rhinitis
• Off Label Use of Triamcinolone in Adults:
  • Addition of acute bacterial rhinosinusitis to antibiotics (empiric treatment)
    persistent rhinosinusitis

Triamcinolone Nasal Spray (Nasacort) Dose in Adults

Triamcinolone Nasal Spray (Nasacort) Dose in the therapy of Allergic rhinitis and upper respiratory symptoms:

• Start with two sprays in each nostril, and these sprays contain 110 micrograms of the medication. Do this once a day.
• Once your symptoms are under control, you can reduce the dose to just one spray in each nostril, which contains 55 micrograms. Continue to use this lower dose once a day.
• The maximum dose you should use is two sprays (110 micrograms) in each nostril once a day.
• If you don't feel better within 3 weeks (or 1 week for over-the-counter use), you should stop using the medication.

Triamcinolone Nasal Spray (Nasacort) Dose in Children

Treatment of both seasonal and persistent allergic rhinitis with triamcinolone nasal spray (Nasacort) dosage:

Children 2 to under 6 years:

• Start with one spray in each nostril once a day (total daily dose: 110 micrograms).
• The most you should use in a day is one spray in each nostril (110 micrograms).

Children 6 to under 12 years:

• Begin with one spray in each nostril once a day (total daily dose: 110 micrograms).
• If your symptoms don't get better, you can increase it to two sprays in each nostril once a day (total daily dose: 220 micrograms).
• Once your symptoms are controlled, go back to using one spray in each nostril once a day (total daily dose: 110 micrograms).
• The maximum you should use in a day is two sprays in each nostril (220 micrograms).

Children 12 years and older, including adolescents:

• Start with two sprays in each nostril once a day (total daily dose: 220 micrograms).
• When your symptoms are under control, reduce the dose to just one spray in each nostril once a day (total daily dose: 110 micrograms).
• The most you should use in a day is two sprays in each nostril (220 micrograms).

Remember, if you don't find relief from your symptoms after using the medication for 3 weeks (or 1 week for over-the-counter use), you should stop and get in touch with a healthcare provider.

Triamcinolone (Nasacort) Pregnancy Risk Category: C

• There isn't a lot of information about using intranasal triamcinolone in pregnant women.
• However, it's generally considered okay to use it for treating rhinitis during pregnancy at the recommended doses if you were already using it and it's working for you.
• But if you're just starting this treatment while pregnant, it might be safer to choose a medication with more pregnancy-related data available.

Triamcinolone use during breastfeeding:

• It's uncertain whether enough triamcinolone gets into breast milk after inhaling it to be detected.
• However, we do know that systemic corticosteroids can be found in human breast milk.

Triamcinolone Dose in Kidney disease:

• The manufacturer's instructions do not include specific dose adjustments for people with kidney problems, as no studies have been conducted to determine the appropriate dosage changes for individuals with renal impairment.

Triamcinolone Dose in Liver disease:

• The manufacturer's labeling does not offer specific dosage adjustments for individuals with hepatic (liver) impairment, as there have been no studies conducted to determine the appropriate dosage changes for this population.

Side Effects of Triamcinolone Nasal Spray (Nasacort):

• Central nervous system:
  • Headache
• Respiratory:
  • Pharyngitis

Less Common Side Effects of Triamcinolone (Nasacort):

• Cardiovascular:
  • Facial Edema
• Central Nervous System:
  • Pain
  • Voice Disorder
• Dermatologic:
  • Skin Photosensitivity
  • Skin Rash
  • Burning Sensation Of The Nose
• Endocrine & Metabolic:
  • Weight Gain
  • Dysmenorrhea
• Gastrointestinal:
  • Dysgeusia
  • Dyspepsia
  • Abdominal Pain
  • Nausea
  • Diarrhea
  • Oral Candidiasis
  • Toothache
  • Vomiting
  • Xerostomia
• Genitourinary:
  • Cystitis
  • Urinary Tract Infection
  • Vulvovaginal Candidiasis
• Hypersensitivity:
  • Hypersensitivity Reaction
• Infection:
  • Infection
• Neuromuscular & Skeletal:
  • Back Pain
  • Bursitis
  • Myalgia
  • Tenosynovitis
• Ophthalmic:
  • Conjunctivitis
• Otic:
  • Otitis Media
• Respiratory:
  • Flu-Like Symptoms
  • Sinusitis
  • Cough
  • Epistaxis
  • Bronchitis
  • Chest Congestion
  • Asthma
  • Rhinitis
  • Stinging Sensation Of The Nose

Contraindications to Triamcinolone (Nasacort):

• Triamcinolone should not be used if you are hypersensitive or allergic to triamcinolone or any of its ingredients. When using over-the-counter (OTC) triamcinolone products for self-medication, it's not recommended for children under 2 years old.
• It's important to note that while there is limited information about allergenic cross-reactivity for corticosteroids, there's a possibility of sensitivity due to similarities in chemical structure or pharmacological actions.
• In Canada, there are additional contraindications that aren't mentioned in U.S. labeling, such as active or quiescent tuberculosis, or untreated fungal, bacterial, and viral infections. If you have any concerns or conditions related to these contraindications.

Warnings and precautions

Suppression of the adrenals:

• Using too much triamcinolone, especially in young children or when taking high doses for a long time, can lead to a problem with your body's natural stress response system, called the hypothalamic-pituitary-adrenal (HPA) axis.
• This might result in issues like too much cortisol in your body or even a condition called adrenal crisis.
• So, if you need to stop taking this medication, it's important to do it slowly and carefully.
• When moving from regular corticosteroids to inhaled forms like triamcinolone, you should be extra cautious, as it could lead to adrenal problems or a return of allergy symptoms.

Delay in wound healing

• If you have had recent issues with your nasal septum, like ulcers, surgery, or injuries, it's a good idea to avoid using triamcinolone in your nose until those issues have fully healed.
• Using it before healing can slow down the recovery process.
• So, it's best to wait until your nose is back to normal before using this medication in your nasal passages.

Immunosuppression:

• Using corticosteroids like triamcinolone for a long time can weaken your immune system, which may make you more vulnerable to getting other infections.
• It can also hide the signs of certain infections, like fungal ones, make viral infections last longer or get worse, and affect how well vaccines work.

Infections

• Be cautious when using triamcinolone in certain situations.
• If you have ocular herpes simplex (a type of eye infection), latent tuberculosis (TB that's not active but may become so), TB reactivity (a positive TB test), or untreated fungal, viral, or bacterial infections, it's important to be careful with this medication.

Local nasal effects:

• Using triamcinolone in your nose may lead to some local side effects, such as a hole in the nasal septum, nasal ulcers, nosebleeds (epistaxis), or fungal infections in the nose or throat caused by Candida albicans.
• It's important to keep an eye on your nasal health and have regular check-ups to catch any of these issues early if they happen.

Ocular disease:

• If you have cataracts (clouding of the eye's lens) or glaucoma (increased pressure in the eye), be cautious when using triamcinolone.
• Prolonged use of this medication can sometimes lead to increased pressure inside the eye, open-angle glaucoma, and cataracts.
• It's a good idea to have regular eye exams if you're using this medication for an extended period to monitor your eye health.
• Discuss your eye condition and medication use with an eye specialist to ensure it's safe for you.

Triamcinolone (nasal): Drug Interaction

Monitoring parameters:

Growth (adolescents and children):

• Triamcinolone can affect the growth of adolescents and children. It's essential to monitor their growth while using this medication.

Signs/Symptoms of HPA Axis Suppression/Adrenal Insufficiency:

• Prolonged use of triamcinolone may affect your body's stress response system, called the HPA axis. Pay attention to signs or symptoms of this issue, such as weakness, fatigue, or changes in weight, and discuss any concerns with your healthcare provider.

Ocular Changes:

• Be aware that triamcinolone could impact your eyes, especially if you have conditions like cataracts or glaucoma. Regular eye check-ups are a good idea if you're using this medication for an extended period.

Signs/Symptoms of Candida Infection (Long-Term Therapy):

• With long-term use of triamcinolone, you may be at risk for Candida infections in your nose or throat. Watch for signs like soreness or unusual changes in these areas.

How to administer Triamcinolone Nasal Spray (Nasacort)?

Shake Well:

• Before using the nasal spray, give it a good shake.

Clear Your Nostrils:

• Gently blow your nose to make sure your nostrils are clear.

Avoid Mouth and Eyes:

• When you spray it, make sure it doesn't go into your mouth or eyes.

Wait 15 Minutes:

• After using the spray, don't blow your nose for at least 15 minutes.

Prime the Spray:

• Before the first use, shake the spray well and release 5 sprays into the air. If you haven't used it for more than 2 weeks, give it a quick shake and do 1 spray to get it ready.

Consider a Nasal Vasoconstrictor:

• If you have a lot of mucus or swelling in your nose, think about using a nasal decongestant for 2 to 3 days before starting the triamcinolone therapy. This can help make the treatment more effective.

Mechanism of action of Triamcinolone (Nasacort):

• Triamcinolone works to manage inflammation by acting at the cellular level.
• It controls the rate of protein synthesis, reduces the movement of certain immune cells called polymorphonuclear leukocytes and fibroblasts, stops capillaries from leaking, and keeps lysosomal membranes stable.
• All of these actions help prevent or control inflammation in the body.

Absorption:

• When you use triamcinolone in your nose, some of it may enter your bloodstream and get absorbed throughout your body.

Half-life elimination:

• The time it takes for half of the triamcinolone to leave your body varies depending on how it's used.
• In your bloodstream, it can take between 18 to 36 hours for half of it to be eliminated.
• When used intranasally, it takes about 3.1 hours for half of the dose to be removed.

Excretion:

• Triamcinolone is removed from your body through urine (about 40%) and feces (about 60%). These are the ways your body gets rid of it.

International Brand Names of Triamcinolone:

• Nasacort Allergy 24HR
• GoodSense Nasal Allergy Spray
• APO-Triamcinolone AQ
• Nasacort AQ
• Actonace
• Nasacort Allergy 24HR Children
• Cenolon
• Cortefin
• Nasacor
• Nasacort
• Nasacort Allergy
• Nasacort AQ
• Nasarin
• Nasonide
• Nosolone Aq
• Nasal Allergy 24 Hou
• Nosolone-aq
• Rinex
• T-Coat
• Tilon NS
• Trispray (BD

Triamcinolone Brand Names in Pakistan: