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Triamcinolone (Topical)

Pronunciation

Pronunciation

(trye am SIN oh lone)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Aerosol Solution, External, as acetonide:

Kenalog: 0.147 mg/g (63 g, 100 g)

Generic: 0.147 mg/g (63 g, 100 g)

Cream, External, as acetonide:

Triderm: 0.1% (28.4 g, 85.2 g) [contains propylene glycol]

Generic: 0.025% (15 g, 80 g, 454 g); 0.1% (15 g, 30 g, 80 g, 453.6 g, 454 g); 0.5% (15 g)

Kit, External, as acetonide:

Dermasorb TA: 0.1% [contains cetyl alcohol, milk protein, propylene glycol]

Pediaderm TA: 0.1% [DSC] [contains cetyl alcohol, methylparaben, polysorbate 80, propylene glycol, propylparaben]

Lotion, External, as acetonide:

Generic: 0.025% (60 mL); 0.1% (60 mL)

Ointment, External, as acetonide:

Trianex: 0.05% (17 g [DSC], 85 g [DSC], 430 g)

Generic: 0.025% (15 g, 80 g, 454 g); 0.1% (15 g, 30 g, 80 g, 453.6 g, 454 g); 0.5% (15 g)

Paste, Mouth/Throat, as acetonide:

Oralone: 0.1% (5 g)

Generic: 0.1% (5 g)

Therapy Pack, External, as acetonide:

Dermazone: 0.1% (1 ea) [contains propylene glycol]

Brand Names: U.S.

  • Dermasorb TA
  • Dermazone
  • Kenalog
  • Oralone
  • Pediaderm TA [DSC]
  • Trianex
  • Triderm

Pharmacologic Category

  • Corticosteroid, Topical

Pharmacology

Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Triamcinolone has intermediate to high range potency (dosage-form dependent).

Absorption

Topical corticosteroids are absorbed percutaneously. The extent is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, and the use of occlusive dressings.

Metabolism

Hepatic

Excretion

Urine (40%); feces (60%, some via biliary excretion)

Half-Life Elimination

Biologic: 18 to 36 hours

Use: Labeled Indications

Dermatoses (corticosteroid-responsive): Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Oral inflammatory and ulcerative lesions: Oral paste: Adjunctive treatment and temporary relief of symptoms associated with oral inflammatory and ulcerative lesions resulting from trauma

Contraindications

Hypersensitivity to triamcinolone or any component of the formulation; fungal, viral, or bacterial infections of the mouth or throat (oral topical formulation)

Oral topical formulations only: Fungal, viral, or bacterial infections of the mouth or throat

Dosing: Adult

Dermatoses (corticosteroid-responsive): Topical: Note: Frequency of application based upon severity of condition

Cream, ointment: Apply thin film to affected areas 2 to 4 times daily

Lotion:

0.025%: Apply a thin film to affected area 3 to 4 times daily

0.1%: Apply a thin film to affected area 2 to 4 times daily

Aerosol solution: Apply to affected area 3 to 4 times daily

Oral inflammatory and ulcerative lesions: Oral paste: Press a small amount (about 1/4 inch) to the lesion at bedtime; a larger quantity may be required for coverage of some lesions. For severe lesions, may be used 2 or 3 times daily after meals.

Dosing: Geriatric

Refer to adult dosing. Use the lowest effective dose.

Dosing: Pediatric

Dermatoses (corticosteroid-responsive): Children and Adolescents: Topical: Note: Frequency based upon severity of condition: Cream, ointment, lotion, aerosol solution: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Administration

Topical:

Aerosol solution: For external use only. Avoid heat, flame or smoking when using. Avoid eyes and do not inhale if spraying near face. Container may be used upright or inverted. When using the spray button, spray at a distance of three to six inches from affected area. For hard to reach areas, insert the spray tube applicator into spray button and twist to seat. Point tube away from body and face. Be sure the tube applicator is clean prior to use and wash after use. Move spray tube while applying, touching the surface of the affected area. Do not use tight fitting diapers or plastic pants on a patient being treated in the diaper area, as this constitutes an occlusive dressing. Occlusive dressing may be used if instructed by a health care professional; monitor for infection.

Cream, ointment: For external use only; avoid contact with eyes. Apply a thin film sparingly. May be used with occlusive dressings for management of psoriasis or recalcitrant conditions. If an infection develops, discontinue use of occlusive dressings.

Lotion: For external use only. Apply topical sparingly to affected areas as a thin film. May be used with occlusive dressings for management of psoriasis or recalcitrant conditions. If an infection develops, discontinue use of occlusive dressings. Not for ophthalmic use.

Oral paste: Do not apply paste to skin or eyes. Apply small amount into oral cavity until thin, smooth film develops; do not rub in; spreading the paste may result in a granular, gritty sensation and crumbling; apply at bedtime to allow contact of the medication with the lesion overnight; if more frequent application necessary, apply after meals.

Storage

Cream, ointment: Store at 20°C to 25°C (68°F to 77°F).

Lotion, oral paste: Store at 20°C to 25°C (68°F to 77°F). Do not freeze.

Aerosol solution: Store at room temperature; avoid excessive heat. Do not puncture or incinerate.

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification

Adverse Reactions

Frequency not defined.

Central nervous system: Localized burning

Dermatologic: Acneiform eruption, allergic contact dermatitis, atrophic striae, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, pruritus, secondary skin infection, skin atrophy, xeroderma

Endocrine & metabolic: HPA-axis suppression, hyperglycemia, hypokalemia

Local: Local irritation

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: 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.

• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.

• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information

Special populations:

• Elderly: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.

• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use 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.

• Administration: Aerosol solution: Do not apply to underarms or groin unless directed by a health care professional; if improvement is not seen within 2 weeks, contact prescriber. Product is flammable; avoid heat, smoking or flames when applying.

Other warnings/precautions:

• Appropriate use: For external use only; avoid contact with eyes. Do not use occlusive dressings on weeping or exudative lesions and general caution with occlusive dressings should be observed; discontinue if skin irritation or contact dermatitis should occur; do not use in patients with decreased skin circulation.

• High-potency products: Avoid the use of high-potency steroids on the face.

• Oral cavity application: Do not apply paste to skin or eyes. When used as a topical agent in the oral cavity, if significant regeneration or repair of oral tissues has not occurred in seven days, re-evaluation of the etiology of the oral lesion is advised.

Monitoring Parameters

HPA axis suppression and adrenal insufficiency, especially in children. When used in the oral cavity (topical paste), if significant regeneration or repair of oral tissues has not occurred in seven days, re-evaluation of the etiology of the oral lesion is advised. When using aerosol solution, if no improvement is seen within 2 weeks, re-evaluation is advised.

Pregnancy Risk Factor

C

Pregnancy Considerations

Corticosteroids were found to be teratogenic following topical application in animal reproduction studies. In general, the use of topical corticosteroids during pregnancy is not considered to have significant risk, however, intrauterine growth retardation in the infant has been reported (rare). The use of large amounts or for prolonged periods of time should be avoided.

Patient Education

• 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 stinging. Have patient report immediately to prescriber signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of skin changes (pimples, stretch marks, slow healing, or hair growth), 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 mouth irritation, skin irritation, vision changes, burning, dry skin, edema, skin discoloration, or skin thinning (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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