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- Triamcinolone Acetonide
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol, Nasal, as acetonide:
Nasacort Allergy 24HR: 55 mcg/actuation (10.8 mL, 16.9 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Nasacort Allergy 24HR Children: 55 mcg/actuation (10.8 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Nasacort AQ: 55 mcg/actuation (16.5 g [DSC])
Nasal Allergy 24 Hour: 55 mcg/actuation (16.9 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Generic: 55 mcg/actuation (16.5 g, 16.9 mL)
Brand Names: U.S.
- Nasacort Allergy 24HR Children [OTC]
- Nasacort Allergy 24HR [OTC]
- Nasacort AQ [DSC]
- Nasal Allergy 24 Hour [OTC]
- Corticosteroid, Nasal
Controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes and fibroblasts, reverses capillary permeability, and stabilizes lysosomal membranes at the cellular level to prevent or control inflammation
Systemic absorption may occur following intranasal administration.
Urine (~40%); feces (~60%)
Biologic: 18-36 hours; Terminal (intranasal): 3.1 hours
Use: Labeled Indications
Allergic rhinitis (Rx products): Management of seasonal and perennial allergic rhinitis in adults and children 2 years and older
Upper respiratory allergies (OTC products): Relief of hay fever and other upper respiratory allergies (eg, nasal congestion, runny nose, sneezing, itchy nose) in adults and children 2 years and older
Adjunct to antibiotics in empiric treatment of acute bacterial rhinosinusitis (ABRS) (Chow, 2012)
Hypersensitivity to triamcinolone or any component of the formulation
OTC labeling: When used for self-medication, do not use in children <2 years of age.
Documentation of allergenic cross-reactivity for corticosteroids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Canadian labeling: Additional contraindications (not in US labeling): Active or quiescent tuberculosis, or untreated fungal, bacterial and viral infection.
Allergic rhinitis/upper respiratory symptoms: Intranasal: Two sprays (110 mcg) in each nostril once daily; once symptoms controlled reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if adequate symptomatic relief is not observed within 3 weeks (1 week for OTC use).
Refer to adult dosing.
Allergic rhinitis/upper respiratory symptoms: Intranasal: Note: Discontinue therapy if adequate symptomatic relief is not observed within 3 weeks (1 week for OTC use).
Children 2 to <6 years: One spray (55 mcg) in each nostril once daily (maximum: 1 spray [55 mcg] in each nostril once daily
Children 6 to <12 years: Initial: One spray (55 mcg) in each nostril once daily; may increase to 2 sprays (110 mcg) in each nostril once daily if response not adequate; once symptoms controlled may reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily)
Children ≥12 years and Adolescents: Refer to adult dosing.
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).
Shake well prior to use. Gently blow nose to clear nostrils. Avoid spraying into mouth or eyes and do not blow nose for 15 minutes after use. Prime prior to first use by shaking contents well and releasing 5 sprays into the air. If product is not used for more than 2 weeks, reprime with 1 spray. Consider use of a nasal vasoconstrictor for 2 to 3 days before initiating therapy in patients with excessive nasal mucous secretion or nasal mucosa edema.
Store at 20°C to 25°C (68°F to 77°F); do not freeze.
Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy
Central nervous system: Headache (2% to 51%)
Respiratory: Pharyngitis (5% to 25%)
1% to 10%:
Cardiovascular: Facial edema (1% to 3%)
Central nervous system: Pain (1% to 3%), voice disorder (1% to 3%)
Dermatologic: Skin photosensitivity (1% to 3%), skin rash (1% to 3%), burning sensation of the nose (≥2%; transient)
Endocrine & metabolic: Weight gain (1% to 3%), dysmenorrhea (≥2%)
Gastrointestinal: Dysgeusia (5% to 8%), dyspepsia (3% to 5%), abdominal pain (1% to 5%), nausea (2% to 3%), diarrhea (1% to 3%), oral candidiasis (1% to 3%), toothache (1% to 3%), vomiting (1% to 3%), xerostomia (1% to 3%)
Genitourinary: Cystitis (1% to 3%), urinary tract infection (1% to 3%), vulvovaginal candidiasis (1% to 3%)
Hypersensitivity: Hypersensitivity reaction (≥2%)
Infection: Infection (≥2%)
Neuromuscular & skeletal: Back pain (2% to 8%), bursitis (1% to 3%), myalgia (1% to 3%), tenosynovitis (1% to 3%)
Ophthalmic: Conjunctivitis (1% to 4%)
Otic: Otitis media (≥2%)
Respiratory: Flu-like symptoms (2% to 9%), sinusitis (2% to 9%), cough (≤8%), epistaxis (≤5%), bronchitis (children: 3%), chest congestion (1% to 3%), asthma (≥2%), rhinitis (≥2%), stinging sensation of the nose (≥2%; transient)
<1% (Limited to important or life-threatening): Anaphylaxis, cataract, decreased bone mineral density (prolonged use), decreased plasma cortisol, dizziness, dry throat, dyspnea, fatigue, glaucoma, growth suppression, hoarseness, increased intraocular pressure, insomnia, nasal septum perforation, osteoporosis (prolonged use), pruritus, sneezing, throat irritation, urticaria, wheezing, wound healing impairment
Concerns related to adverse effects:
• Adrenal suppression: When used at excessive doses, may cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms.
• Delayed wound healing: Avoid use in patients with recent nasal septal ulcers, nasal surgery, or nasal trauma until healing has occurred.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox and/or measles should be avoided.
• Local nasal effects: Nasal septal perforation, nasal ulceration, epistaxis, and localized Candida albicans infections of the nose and/or pharynx may occur. Monitor patients periodically for adverse nasal effects.
• Infections: Use caution or avoid in patients with ocular herpes simplex, latent tuberculosis, and/or TB reactivity, or in patients with untreated fungal, viral, or bacterial infections.
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Consider routine eye exams in chronic users.
• Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercorticism (Cushing syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).
• Self-medication (OTC use): Consult a health care provider before use if you have had recent nose ulcers or nose surgery; have a nose injury that has not healed; or are using a steroid for asthma, allergies or skin rash. Discontinue use and consult a health care provider if symptoms do not improve after 1 week, or if infection (eg, persistent fever), changes in vision, or frequent nosebleeds occur. Do not use for the common cold.
Growth (adolescents and children); signs/symptoms of HPA axis suppression/adrenal insufficiency; ocular changes; signs/symptoms of Candida infection (long-term therapy)
Pregnancy Risk Factor
Adverse events have been observed in some animal reproduction studies. Intranasal corticosteroids are recommended for the treatment of rhinitis during pregnancy; the lowest effective dose should be used (NAEPP, 2005; Wallace, 2008).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience headache, flu-like symptoms, or pharyngitis. Have patient report immediately to prescriber signs of infection, signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), signs of Cushing’s disease (weight gain in upper back or abdomen; moon face; severe headache; or slow healing), severe nasal irritation, severe nosebleed, nasal sores, wheezing, thrush, or vision changes (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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