Triamcinolone Acetonide

Registered South African indications:

• Seasonal and perennial allergic rhinitis symptoms

Contraindications

Registered South African contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Children below the age of 6 years

Contraindications registered in other jurisdictions

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Untreated fungal, bacterial or viral infections
• Nasal septal ulcers
• Nasal surgery or trauma
• Recent prolonged epistaxis
• History of increased intraocular pressure
• Glaucoma
• Cataracts

Forms avail. in SA and covered in this monograph: nas

South African registered indications and dosages

Seasonal and perennial allergic rhinitis symptoms
- Preventative treatment

• Nasal (nas): Initial: 220μg, as 2 sprays in each nostril once daily; Assess during the initial 3-4 days and periodically until stable, relief is typically observed in about two-thirds of patients within this time frame; Titrate to the minimum effective dose to minimise side effects; Once the maximum benefit has been achieved and symptoms have been controlled: Reduce dose to 110µg, one spray in each nostril daily to maintain symptom control

If after 3 weeks there's no adequate relief, discontinue and consider alternatives

Do not exceed the prescribed dosage. Shake the bottle well before each use

Each actuation delivers 55μg triamcinolone acetonide from the nose piece to the patient after an initial priming of 5 sprays until a fine mist is achieved. It will remain adequately primed for 2 weeks. If the product is unused for more than 2 weeks, then it can be adequately reprimed with one spray

The nozzle should be pointing away from the patient while the patient is priming the device

Paed. forms avail. in SA and covered in this monograph: nas

South African registered indications and dosages

Seasonal and perennial allergic rhinitis symptoms
- Preventative treatment

Younger than 6 years

• Contraindicated

Between 6-12 years

• Nasal (nas): Recommended dose: 110µg, one spray in each nostril daily; Assess during the initial 3-4 days and periodically until stable, relief is typically observed in about two-thirds of patients within this time frame; For severe symptoms, 220µg, two sprays in each nostril once daily can be considered; Once controlled, reduce to the lowest effective dose; Continuous use beyond 3 months is not recommended for this age group

12 years and older

• See adult dosage

If after 3 weeks there's no adequate relief, discontinue and consider alternatives

Do not exceed the prescribed dosage. Shake the bottle well before each use

Each actuation delivers 55μg triamcinolone acetonide from the nose piece to the patient after an initial priming of 5 sprays until a fine mist is achieved. It will remain adequately primed for 2 weeks. If the product is unused for more than 2 weeks, then it can be adequately reprimed with one spray

The nozzle should be pointing away from the patient while the patient is priming the device

Pregnancy

• Caution
• There are no adequate and well-controlled studies in pregnant women with triamcinolone nasal spray. Because animal studies indicate a teratogenic effect, typical of corticosteroids, triamcinolone nasal spray should not be administered during pregnancy unless the therapeutic benefit to the mother is considered to outweigh the risk to the foetus

Breastfeeding

• Caution
• It is not known whether triamcinolone acetonide is excreted in human milk. Because other corticosteroids are excreted in human milk, caution should be exercised when triamcinolone nasal spray is administered to nursing women; therefore, the therapeutic benefit to the mother should outweigh any potential risk to the baby

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Insomnia
• Headache
• Dizziness
• Fatigue

Respiratory Disorders

• Flu syndrome
• Pharyngitis
• Rhinitis
• Bronchitis 
• Epistaxis
• Cough
• Nasal septum perforation
• Nasal irritation
• Dry mucous membranes
• Nasal congestion
• Sneezing
• Dyspnoea

Gastrointestinal Disorders

• Dyspepsia
• Tooth disorder
• Nausea

Skin and Subcutaneous Tissue Disorders

• Rash
• Urticaria
• Pruritis

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity

Sensory Disorders

• Alterations to taste and smell
• Cataract
• Glaucoma
• Increased ocular pressure

• Oral corticosteroids

None routine. Specific cases may require

• Growth (children)
• Ophthalmic examination

Cleaning instructions

The triamcinolone acetonide nasal spray bottle should be cleaned at least once a week or more often if it gets blocked

To clean the nasal spray bottle:

• Pull the nozzle upwards to detach from the bottle
• Soak the nozzle and dust cap in warm water for a few minutes
• Rinse the nozzle and dust cap under clean running water
• Shake off excess water and allow to dry at room temperature before refitting onto the bottle
• Do not use a pin or other sharp object to unblock
• Re-fit the nozzle and dust cap
• Prime the unit as necessary until a fine mist is produced and then use as normal

Triamcinolone is a synthetic glucocorticoid that is approximately 8 times more potent than prednisone. The precise mechanism of action is not known but through control of protein synthesis, depression of leukocyte and fibroblast migration and effects on capilliary permeability, triamcinolone has good anti-inflammatory actions.

Nasal spray (per spray) 55μg

• Nasacor T (Sanofi)
• Triamist (Cipla)