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Triamcinolone (Ophthalmic)

Medically reviewed by Drugs.com. Last updated on May 7, 2020.

Pronunciation

(trye am SIN oh lone)

Index Terms

  • Triamcinolone acetonide

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Intraocular, as acetonide:

Triesence: 40 mg/mL (1 mL) [contains polysorbate 80]

Brand Names: U.S.

  • Triesence

Pharmacologic Category

  • Corticosteroid, Ophthalmic

Pharmacology

Suppresses the immune system by reducing activity and volume of the lymphatic system

Half-Life Elimination

Intravitreal: Nonvitrectomized patients: 18.7 ± 5.7 days; Vitrectomized patients: ~3.2 days (based upon 1 patient)

Use: Labeled Indications

Ocular disease: Treatment of sympathetic ophthalmia, temporal arteritis, uveitis, ocular inflammatory conditions unresponsive to topical corticosteroids

Vitrectomy visualization: Visualization during vitrectomy

Contraindications

Hypersensitivity to triamcinolone or any component of the formulation; systemic fungal infections

Canadian labeling: Additional contraindications (not in US labeling): Active or suspected ocular herpes simplex

Dosing: Adult

Ocular disease: Intravitreal: Initial: 4 mg as a single dose; additional doses may be given as needed

Visualization during vitrectomy: Intravitreal: 1 to 4 mg

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Ocular disease: Infants, Children, and Adolescents: Intravitreal: Initial: 4 mg as a single dose; additional doses may be given as needed over the course of treatment

Visualization during vitrectomy: Infants, Children, and Adolescents: Intravitreal: Initial: 1 to 4 mg

Reconstitution

Vitrectomy: May be diluted with sterile irrigating solution (eg, BSS Sterile Irrigating Solution) prior use. Range of dilution is typically 1:10 to 1: 20. In a clinical study, a 2 mg/mL was administered by diluting 0.05 mL of triamcinolone in 0.95 mL of sterile irrigating solution (Triesence Canadian product labeling 2016).

Administration

For intravitreal administration only; do not administer IV. Administer under controlled aseptic conditions (eg, sterile gloves, sterile drape, sterile eyelid speculum). Shake vial vigorously for 10 seconds before withdrawing dose; do not use if agglomerated (clumpy or granular appearance); inject immediately after suspension is withdrawn from the vial. Adequate anesthesia and a broad-spectrum bactericidal agent should be administered prior to injection. If administration is required in the second eye, a new vial/syringe should be used.

Storage

Store at 4°C to 25°C (39°F to 77°F); do not freeze. Protect from light.

Drug Interactions

Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Ophthalmic: Increased intraocular pressure (20% to 60%), progression of cataract (20% to 60%)

1% to 10%: Ophthalmic: Blurred vision (≤2%), conjunctival hemorrhage (≤2%), decreased visual acuity (≤2%), endophthalmitis (≤2%), eye discomfort (transient) (≤2%), glaucoma (≤2%), hypopyon (≤2%), ophthalmic inflammation (≤2%), optic disc disorder (vascular disorder: ≤2%), retinal detachment (≤2%), vitreous opacity (≤2%)

<1%, postmarketing, and/or case reports: Exophthalmos

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: Prolonged use may cause hypercortisolism 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.

• Hypersensitivity: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.

• Immunosuppression: Prolonged use may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to killed or inactivated vaccines. Exposure to chickenpox or measles should be avoided. Close observation is required in patients with latent tuberculosis and/or TB reactivity; restrict use in active TB (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to initiation of corticosteroids. Use with caution in patients with threadworm infection; may cause serious hyperinfection. Use with extreme caution in patients with Strongyloides infections; hyperinfection, dissemination and fatalities have occurred.

• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).

• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles.

• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including euphoria, insomnia, mood swings, and personality changes, and severe depression to psychotic manifestations. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with HF and/or hypertension; corticosteroids have been associated with fluid retention, electrolyte disturbances, and hypertension. Use with caution following acute MI; corticosteroids have been associated with myocardial rupture.

• Diabetes: Use corticosteroids with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.

• GI disease: Use with caution in patients with GI diseases (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, abscess or other pyogenic infection) due to perforation risk.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred, especially during initial treatment with corticosteroids.

• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; elevated intraocular pressure may occur with effects lasting up to 6 months following injection. Use has also been associated with endophthalmitis and cataracts, particularly posterior subcapsular cataracts. Consider routine eye exams in chronic users.

• Osteoporosis: Use with caution in patients with osteoporosis; corticosteroids have been associated with increased bone loss and osteoporotic fractures.

• Renal impairment: Use with caution in patients with renal impairment.

• Thyroid disease: Use with caution in patients with thyroid disease; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid patients.

Special populations:

• Pediatric: May affect growth velocity; growth should be routinely monitored in pediatric patients.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.

Other warnings/precautions:

• Appropriate use: For ophthalmic use only; do not administer IV.

Monitoring Parameters

Following injection, monitor for increased intraocular pressure and endophthalmitis; check for perfusion of optic nerve head immediately after injection, tonometry within 30 minutes, biomicroscopy between 2 to 7 days after injection.

Pregnancy Risk Factor

D

Pregnancy Considerations

Adverse events were have been observed in animal reproduction studies. Some studies have shown an association between first trimester corticosteroid use and oral clefts, intrauterine growth restriction, and decreased birth weight. The amount of triamcinolone absorbed systemically following ophthalmic administration is not known. Use of intravitreal triamcinolone in pregnancy has been noted in case reports (Errera 2013; Fazelat 2011).

Patient Education

What is this drug used for?

• It is used to treat eye swelling.

• It is used during eye surgery.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Blurred vision

• Increased appetite

• Weight gain

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• High blood sugar like confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit

• Adrenal gland problems like severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss

• Cushings disease like weight gain in upper back or abdomen; moon face; severe headache; or slow healing

• Severe headache

• Dizziness

• Passing out

• Vision changes

• Eye pain

• Severe eye irritation

• Seeing floaters

• Chills

• Sore throat

• Shortness of breath

• Excessive weight gain

• Swelling of the arms and legs

• Mood changes

• Behavioral changes

• Muscle pain

• Muscle weakness

• Abdominal pain

• Black, tarry, or bloody stools

• Vomiting blood

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.