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TRIAMCINOLONE HEXACETONIDE 20MG/ML SUSPENSION FOR INJECTION

Active substance(s): TRIAMCINOLONE HEXACETONIDE

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PACKAGE LEAFLET: INFORMATION FOR THE USER

Triamcinolone hexacetonide 20 mg/ml suspension for injection
Read all of this leaflet carefully before you start using this medicine because it contains important information for you.
- Triamcinolone hexacetonide is a steroid medicine, prescribed for many different conditions, including serious illnesses.
- You need to take it regularly to get the maximum benefit.
- Don't stop taking this medicine without talking to your doctor – the dose may need to be reduced gradually.
- Triamcinolone hexacetonide can cause side effects in some people (read section 4 below). Some problems such as
mood changes (feeling depressed, or 'high'), or stomach problems can happen straight away. If you feel unwell in any way,
keep using your medicine, but see your doctor straight away.
- Some side effects only happen after weeks or months. These include weakness of arms and legs, or developing a
rounder face (read section 4 for more information).
- If you take it for more than 3 weeks, you will get a blue 'steroid card': always keep it with you and show it to any
doctor or nurse treating you.
- Keep away from people who have chicken-pox or shingles, if you have never had them. They could affect you
severely. If you do come into contact with chicken pox or shingles, see your doctor straight away.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness
are the same as yours.
- If you get any side effects talk to your doctor or pharmacist. This includes any possible side effects not listed in this
leaflet. See section 4.

What is in this leaflet:
1. What Triamcinolone hexacetonide is and what it is used for
2. What you need to know before you are given Triamcinolone
hexacetonide
3. How Triamcinolone hexacetonide is given
4. Possible side effects
5. How to store Triamcinolone hexacetonide
6. Contents of the pack and other information
1. WHAT TRIAMCINOLONE HEXACETONIDE IS AND
WHAT IT IS USED FOR
Triamcinolone hexacetonide 20 mg/ml suspension for injection
contains a steroid medicine. Triamcinolone hexacetonide belongs
to a group of medicines called corticosteroids (steroids). These
corticosteroids occur naturally in the body, and help to maintain
health and well-being. Boosting your body with extra corticosteroid (such as Triamcinolone hexacetonide) is an effective way
to treat various illnesses involving inflammation in the body.
Triamcinolone hexacetonide reduces this inflammation, which
could otherwise go on making your condition worse. You must
take this medicine regularly to get maximum benefit from it.
Triamcinolone hexacetonide is injected into and around the
joints. It is given to adults, adolescents for the treatment of
joint pain, swelling and stiffness in subacute and chronic
inflammatory joint diseases including
- Rheumatoid arthritis,
- Juvenile Idiopathic Arthritis (JIA, arthritis in children)
- Osteoarthritis (a joint disease caused by wear and tear)
and post-traumatic arthritis
- Synovitis (mild swelling of the tissues around the joint),
tendinitis (inflammation of a tendon), bursitis (inflammation
of one or more bursae (small fluid-filled sacs) of synovial
fluid in the body), epicondylitis (lateral elbow pain, also
known as tennis elbow)

• Usually they start within a few days or weeks of starting
the medicine.
• They are more likely to happen at high doses.
• Most of these problems go away if the dose is lowered or
the medicine is stopped. However, if problems do happen,
they might need treatment.
Talk to a doctor straight away if you (or someone taking this
medicine), show any signs of mental problems. This is
particularly important if you are depressed, or might be
thinking about suicide. In a few cases, mental problems have
happened when doses are being lowered or stopped.
The product must not be administered intravenously (into a
vein), intradermal (into the skin), subcutaneous (below the skin),
intramuscular (into the muscle), intraocularly (into the eye),
epidurally (into the spinalcanal) or intrathecally (into the brain or
spinal cord).
You must take care not to over-use a joint which feels better
after you receive a Triamcinolone hexacetonide injection. The
joint will need to recover from the inflammation which caused
your symptoms. Repeated injections may damage the joint.
You should not be vaccinated or immunized with live vaccines
while you are under treatment with moderate or high dose
corticosteroids for longer than 2 weeks treatment, since a
possible lack of an antibody response may predispose to
medical, and particularly neurological, complications.
If you develop serious reactions or acute infections, the
treatment must be stopped and appropriate treatment given.
Steroid medicines suppress your body's natural immune
response. Therefore, if you come into contact with anyone
who has an infectious disease such as chickenpox, shingles
or measles, consult your doctor as soon as possible.
Children and adolescents
Growth and development of children on long term corticosteroid
therapy should be monitored.
Triamcinolone hexacetonide must not be administered to
newborn or premature babies because it contains benzyl
alcohol. It may provoke toxic and serious allergic reactions in
children under 3 years of age.

Triamcinolone hexacetonide may also be used for the intraarticular use (injection into the joint) in children aged 3-12 years
with Juvenile Idiopathic Arthritis.

Other medicines and Triamcinolone hexacetonide
Please tell your doctor if you are taking, have recently taken
or might take any other medicines. It is especially important
that you tell your doctor if you are also taking:

2. WHAT YOU NEED TO KNOW BEFORE YOU ARE
GIVEN TRIAMCINOLONE HEXACETONIDE

Amphotericin B injection and potassium-depleting agents:
since the combination of these with Triamcinolone hexacetonide
may cause potassium levels in the blood to become too low.

You should not be given Triamcinolone hexacetonide
- if you are allergic to triamcinolone hexacetonide or any of
the other ingredients of this medicine (listed in section 6).
- Must not be given to newborn and premature babies and
children up to 3 years of age.
- if you suffer from active tuberculosis, herpes simplex
infection of the eye, acute psychosis or a generalised fungal
and parasite infections.

Anticholinesterases (AChEI): since they may be less effective.

Warnings and precautions

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Triamcinolone hexacetonide contains a potent steroid and so
should be used with caution if you have any of the following
diseases.
Therefore you must tell your doctor before administration
of Triamcinolone hexacetonide if you have any of the
following conditions:
- heart failure, acute coronary artery disease
- hypertension (high blood pressure)
- thrombophlebitis (blood clots), thromboembolism (blood
clot that breaks loose and is carried by the blood stream
to plug another vessel)
- myasthenia gravis (muscle weakness)
- osteoporosis (brittle bones)
- gastric ulcer (stomach ulcer), diverticulitis (inflammation
of the small pouches of the inner lining of the large
intestine), ulcerative colitis (chronic inflammation in the
large intestine), recent intestinal anastomosis (surgery
following removal of part of the intestines)
- any skin disease such as eczema
- psychosis (mental health problems with hallucinations or
delusions),
- “moon face” and obesity of the trunk (Cushing's syndrome),
- diabetes mellitus,
- underactive thyroid gland (hypothyroidism)
- reduced kidney function, acute glomerulonephritis (damage
to the tiny filters inside the kidney), chronic nephritis (longlasting inflammation of the kidney)
- liver cirrhosis
- infections that cannot be treated with antibiotics
- metastatic carcinoma (cancer that spreads from one organ
or part to another non-adjacent organ or part)
Check with your doctor first:
• If you have ever had severe depression or manicdepression (bipolar disorder). This includes having had
depression before or while taking steroid medicines like
Triamcinolone hexacetonide.
• If any of your close family has had these illnesses.
If either of these applies to you, talk to a doctor before
Triamcinolone hexacetonide is given to you.
Mental health problems while taking triamcinolone
hexacetonide
Mental health problems can happen while taking steroids like
triamcinolone hexacetonide (see also section 4 Possible Side
Effects).
• These illnesses can be serious.

Anticholinergics (e.g. atropine): since the pressure in the eye
may increase.
Anti-blood clotting tablets (Anticoagulants, oral): Steroids
may increase or decrease blood-thinning (anticoagulant) effect.
Blood sugar lowering drugs (antidiabetics, e.g. sulfonylurea derivatives, and insulin): Steroids may increase the
levels of glucose in the blood.
Blood pressure lowering drugs (antihypertensives,
including diuretics): may become less effective.
Drugs to treat tuberculosis, e.g. isoniazid: The concentration of isoniazid in the blood may be decreased.
Immune suppressing drugs (cyclosporin): When used
together, cyclosporin may produce an increase in both
cyclosporin and steroid activity.
Heart failure medicines (digitalis glycosides): administered
together with Triamcinolone hexacetonide may increase the
likelihood of digitalis toxicity.
Drugs that increase the amount of special liver enzymes
(e.g. barbiturates, phenytoin, carbamazepine, rifampicin,
primidone, aminoglutethimide): may reduce the effect of
Triamcinolone hexacetonide.
Human growth hormone (somatropin): The growth promoting effect may be reduced during long-term therapy
with Triamcinolone hexacetonide.
Drugs to treat fungal infections (ketoconazole): Steroid
effects of Triamcinolone hexacetonide may be increased.
Protease inhibitors to treat HIV infection (ritonavir):
Steroid effects may be increased or prolonged. These include
Cushing's syndrome (high levels of a hormone called cortisol
with symptoms such as weight gain, thin skin and a rounded
"moon" face) and underactive adrenal glands.
Non-depolarising muscle relaxants: Steroids may decrease
or increase the neuromuscular blocking action.
Non-steroidal anti-inflammatory agents (NSAIDs): Steroids
may increase the incidence and/or severity of gastrointestinal
bleeding and ulceration associated with NSAIDs. Steroids may
also reduce serum salicylate levels and therefore decrease their
efficacy. Discontinuing steroids during high-dose salicylate
therapy may result in salicylate toxicity. If you use aspirin and
have low prothrombin levels, inform your doctor or nurse.
Hormones to prevent pregnancy, including the “pill”
(oral contraceptives): The steroid effect of Triamcinolone
hexacetonide may last longer.
Thyroid drugs: If you have an underactive thyroid (hypothyroid), or overactive thyroid (hyperthyroid), inform your doctor
or nurse since the dose may need to be adjusted.
Vaccines: Neurological complications and a reduced antibody
response may occur in special situations when patients

The following information is intended for medical or
healthcare professionals only

long-acting, no joint should be treated more than once every
3-4 weeks.

How to prepare and administer Triamcinolone hexacetonide 20 mg/ml
Aseptic techniques must be observed when using the
medicine. Medicines that are administered by injection must
be inspected visually for particles and discolouration before
injecting. The Triamcinolone hexacetonide ampoule must be
shaken well before use to ensure an even suspension.
Sterilisation technique should be the same as that used at
lumbar puncture. No more than two joints should be treated
at each treatment session.

Use in children aged 3 - 12 years with Juvenile
Idiopathic Arthritis
The dosage regime for triamcinolone hexacetonide intraarticular injection for JIA in children is 1 mg/kg for large
joints (knees, hips, and shoulders) and 0.5 mg/kg for smaller
joints (ankles, wrists, and elbows). For the hands and feet,
1-2 mg/joint for metacarpophalangeal/metatarsophalangeal
(MCP/MTP) joints, and 0.6-1 mg/joint for proximal interphalangeal (PIP) joints may be used.

If necessary, Triamcinolone hexacetonide can be mixed with
1% or 2% lidocaine hydrochloride or other equivalent local
anaesthetic. Triamcinolone hexacetonide must be drawn up
into the syringe before the local anaesthetic in order to
prevent contamination. Tip the syringe gently backwards
and forwards, and inject the solution immediately.
The use of solvents containing methylparaben, propyl paraben, phenol, etc. should be avoided. These can cause
precipitation of the steroid.
Recommended dose

For periarticular use (injections around the joint,
dosage for adults and adolescents only)
Bursitis/Epicondylitis: Usually 10- 20 mg (0.5- 1.0 ml)
depending on the size of the bursa and the severity of the
condition. In most cases, one treatment is sufficient.
Synovitis/Tendinitis: Usually 10-20 mg (0.5-1.0 ml). The need
for further injections is based on the response to treatment.
How to store TRIAMCINOLONE HEXACETONIDE
This medicinal product does not require any special storage
conditions.
Keep this medicine out of the sight and reach of children.

For intraarticular use (injections into the joint, dosage
for adults and adolescents) for all indications
The dose is determined for you individually. It can vary from
2-20 mg depending on the size of the joint and the amount
of fluid in the joint. Usually, 10-20 mg (0.5-1 ml) is used in
large joints (such as hips, knees and shoulders), 5-10 mg
(0.25-0.5 ml) is used in medium-sized joints (such as elbows
and wrists) and 2-6 mg (0.1-0.3 ml) is used in smaller joints
(such as hands and feet). If a lot of fluid is present in the
joint, this may be withdrawn before the injection. The next
dose and the number of injections depend on how your
disease responds. Because Triamcinolone hexacetonide is

Do not use Triamcinolone hexacetonide after the expiry date
which is stated on the ampoule label and outer carton after
“EXP”. The expiry date refers to the last day of that month.
Do not use Triamcinolone hexacetonide if you notice any
visible change in the appearance of the medicine.
Do not throw away any medicines via waste water or
household waste. Ask your pharmacist how to dispose of
medicines no longer required. These measures will help to
protect the environment.
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Now read the rest of this leaflet. It includes other important
information on the safe and effective use of this medicine that
might be especially important to you. This leaflet was last
updated on 15/2/2016.

Medicines that prolong the QT interval or induce torsade
de pointes: Use of Triamcinolone hexacetonide and class Ia
antiarrhythmic agents such as disopyramide, quinidine and
procainamide, or other class II antiarrhythmic drugs such as
amiodarone, bepridil and sotalol, is not recommended.
Extreme caution is required when Triamcinolone hexacetonide
is used in combination with phenothiazines, tricyclic antidepressants, terfenadine and astemizole, vincamine, erythromycin i.v., halofantrine, pentamidine and sultopride.
Combination with agents that cause electrolyte disturbances
such as low potassium levels (potassium-depleting diuretics,
amphotericin B i.v. and certain laxatives), low magnesium
levels and severely reduced calcium levels in the blood is not
recommended.
Athletes should be informed that this medicinal product
contains an ingredient that may produce a positive result in
anti-doping tests.
Paediatric population
Interaction studies have only been performed in adults.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you are pregnant
or are planning to have a baby, ask your doctor for advice
before taking any medicine.
Driving and using machines
Triamcinolone hexacetonide is not expected to have an
influence on the ability to drive and use machines.
Steroid Treatment Card
Your doctor or pharmacist may give you a Steroid Treatment
Card with your prescription or medicine.
YOU SHOULD ALWAYS CARRY THIS CARD WITH YOU as it
must be shown to any of the following persons:
Doctor or Nurse - before having any surgery or emergency
treatment or if any new treatment is prescribed.
Dentist - before having any dental surgery
Pharmacist - before buying any medicine
Optician - it is advisable to have regular eye tests
Triamcinolone hexacetonide contains benzyl alcohol
and sorbitol (E420).
Benzyl alcohol may cause toxic and serious allergic reactions
in infants and children up to 3 years old.
Triamcinolone hexacetonide contains sorbitol. If you have been
told by your doctor that you have an intolerance to some sugars,
contact your doctor before taking this medicinal product.
3. HOW TRIAMCINOLONE HEXACETONIDE IS GIVEN
A doctor (or nurse instructed by the doctor) will give the
injection of Triamcinolone hexacetonide. The dose is determined
by the doctor.
This formulation is intended for intraarticular, periarticular and intrasynovial use (into and around the joints).
This formulation must not be used intravenously (into the
vein), intradermally (into the skin), subcutaneously (below the
skin), intramuscularly (into the muscle), intraocularly (into the
eye), epidurally (into the spinal canal) or intrathecally use (into
the brain or spinal cord).

Very rare side effects (may affect up to 1 in 10,000
people)
• serious allergic reaction which causes difficulty
breathing or dizziness, swelling of the face lips or
throat, skin itching, redness or rash
• formation of blot clots
• formation of calcium deposits in and around of the
treated joints; tearing of the tendon
• darkening or lightening of the skin
Not known side effects (frequency cannot be estimated
from the available data)
• changes in blood chemicals which can cause fluid retention, heart failure or irregular heart beat
• high blood pressure
• weak muscles; osteoporosis (brittle bone disease);
destruction of the ends of bones; spontaneous fractures; Charcot-like arthropathy with swollen joints and
edema
• stomach ulcers and stomach pain; inflammation of the
pancreas
• delayed wound healing; thin and fragile skin; pinpoint
bleeding in the skin and bruises; facial redness and/or
rash; increased sweating; red or purple discoloration on
the skin; stretch marks; skin condition looking like
acne; hives
• raised blood pressure within the brain with no known
cause usually after treatment with headache, ear ringing,
blurred or dimmed vision, nausea, vomiting, dizziness,
seeing light flashes, neck shoulder or back pain (pseudotumor cerebri); headache
• insomnia (sleeplessness); depression (sometimes severe);
euphoria; mood swings; halucinations and delusions
• irregular periods; in postmenopausal women vaginal
bleeding may occur; abnormal hair growth; development
of a cushingoid state (large rounded face, obesity of the
trunk); inactivity or shrinkage of parts of the adrenal
gland, particularly during periods of stress (e.g. trauma,
surgery or illness); decreased tolerance to sugars; high
blood sugar (characterised by symptoms such as
excessive thirst, passing large amounts of urine, increase
in appetite and feeling weak)
• eye problems including cataracts and glaucoma
• negative nitrogen balance due to breakdown of proteins
• increased risk of infections
Hypersensitivity reactions caused by benzyl alcohol may
rarely occur.
Children:
There is a risk that their growth may be slowed down.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or
nurse. This includes any possible side effects not listed in this
leaflet. You can also report side effects directly via the Yellow
Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects you can help provide more infor mation on the safety of this medicine.
5. HOW TO STORE TRIAMCINOLONE HEXACETONIDE
Your doctor, nurse or pharmacist know how to store this
medicine properly (see section 6).

Your doctor will prescribe the dose which is best for you.
Post-treatment pain control: The pain in a joint caused by intraarticular injection can be prevented or relieved by avoiding
unnecessary movement for 12 hours after injection.
If you are given too much Triamcinolone hexacetonide
Overdose can cause changes to the skin around the injection
site as is the case when the interval between injections at
the same site is too short. If this occurs, it can take many
months to heal due to the long-acting effect of the medicine.
If you have any further questions on the use of this medicine,
ask your doctor or pharmacist.
4. POSSIBLE SIDE EFFECTS

6. CONTENTS OF THE PACK AND OTHER INFORMATION
What Triamcinolone hexacetonide contains
- The active substance is triamcinolone hexacetonide
20 mg/ml.
- 1 ampoule with 1 ml suspension for injection contains
20 mg triamcinolone hexacetonide.
- The other ingredients per 1 ml are sorbitol (E420) 455 mg,
polysorbate 80:4 mg, benzyl alcohol 9 mg and water for
injection.
What Triamcinolone hexacetonide looks like and contents
of the pack
Triamcinolone hexacetonide is a milky white suspension.

Like all medicines, this medicine can cause side effects,
although not everybody gets them.

Triamcinolone hexacetonide is available in packs of 10
ampoules.

Side effects depend on the dose and the duration of treat ment. Systemic side effects are rare, but may occur as a
result of repeated periarticular injection. As with other
intraarticular steroid treatments, transient adrenocortical
suppression has been observed during the first week after
injection. This effect is enhanced if corticotropin or oral
steroids are used in combination.

A colourless 1 ml glass ampoule.

Serious effects: tell a doctor straight away
Steroids including Triamcinolone hexacetonide can cause
serious mental health problems. These are common in both
adults and children. They can affect about 5 in every 100
people who have been given medicines like Triamcinolone
hexacetonide.
• Feeling depressed, including thinking about suicide.
• Feeling high (mania) or moods that go up and down.
• Feeling anxious, having problems sleeping, difficulty in
thinking or being confused and losing your memory.
• Feeling, seeing or hearing things which do not exist.
Having strange and frightening thoughts, changing how
you act or having feelings of being alone.
If you notice any of these problems talk to a doctor straight
away.

Marketing Authorisation Holder
Intrapharm Laboratories Ltd.
The Courtyard Barns
Choke Lane
Maidenhead
Berkshire, SL6 6PT
United Kingdom
Manufacturer
RIEMSER Pharma GmbH
An der Wiek 7, D-17493 Greifswald - Insel Riems
Germany
This medicinal product is authorised in the Member
States of the EEA under the following names:
Austria, Czech Republic, Slovenia, The Netherlands: TRISPAN,
in Portugal and Spain: BLUXAM and in the United Kingdom:
Triamcinolone hexacetonide.
This leaflet was last revised in February 2016.

550

Serious allergic reactions and anaphylactic shock including
death have been reported. If you notice any of the following,
contact your doctor immediately:
• Swelling of the face, lips or throat
• Breathing difficulties
• Skin itching, redness or a rash
As these may be signs of an allergic reaction.
Tell your doctor immediately if you notice any sticky black
stools, get severe abdominal pain or if you vomit blood.
Other side effects of Triamcinolone hexacetonide include:
Common side effects (may affect up to 1 in 10 people)
• local reactions at the injection site such as abscesses,
redness, pain, swelling and tissue damage
Rare side effects (may affect up to 1 in 1,000 people)
• Excess dosage or too-frequent administration of injections into the same site may cause localised thinning of
the top two layers in the skin, the dermis or epidermis,
causing a depression in the skin. Due to the long-lasting
effect of Triamcinolone hexacetonide, the skin will only
return to normal after several months.
• Vertigo (a feeling of dizziness or “spinning”)

The following information is intended for medical or
healthcare professionals only

long-acting, no joint should be treated more than once every
3-4 weeks.

How to prepare and administer Triamcinolone hexacetonide 20 mg/ml
Aseptic techniques must be observed when using the
medicine. Medicines that are administered by injection must
be inspected visually for particles and discolouration before
injecting. The Triamcinolone hexacetonide ampoule must be
shaken well before use to ensure an even suspension.
Sterilisation technique should be the same as that used at
lumbar puncture. No more than two joints should be treated
at each treatment session.

Use in children aged 3 - 12 years with Juvenile
Idiopathic Arthritis
The dosage regime for triamcinolone hexacetonide intraarticular injection for JIA in children is 1 mg/kg for large
joints (knees, hips, and shoulders) and 0.5 mg/kg for smaller
joints (ankles, wrists, and elbows). For the hands and feet,
1-2 mg/joint for metacarpophalangeal/metatarsophalangeal
(MCP/MTP) joints, and 0.6-1 mg/joint for proximal interphalangeal (PIP) joints may be used.

If necessary, Triamcinolone hexacetonide can be mixed with
1% or 2% lidocaine hydrochloride or other equivalent local
anaesthetic. Triamcinolone hexacetonide must be drawn up
into the syringe before the local anaesthetic in order to
prevent contamination. Tip the syringe gently backwards
and forwards, and inject the solution immediately.
The use of solvents containing methylparaben, propyl paraben, phenol, etc. should be avoided. These can cause
precipitation of the steroid.
Recommended dose

For periarticular use (injections around the joint,
dosage for adults and adolescents only)
Bursitis/Epicondylitis: Usually 10- 20 mg (0.5- 1.0 ml)
depending on the size of the bursa and the severity of the
condition. In most cases, one treatment is sufficient.
Synovitis/Tendinitis: Usually 10-20 mg (0.5-1.0 ml). The need
for further injections is based on the response to treatment.
How to store TRIAMCINOLONE HEXACETONIDE
This medicinal product does not require any special storage
conditions.
Keep this medicine out of the sight and reach of children.

For intraarticular use (injections into the joint, dosage
for adults and adolescents) for all indications
The dose is determined for you individually. It can vary from
2-20 mg depending on the size of the joint and the amount
of fluid in the joint. Usually, 10-20 mg (0.5-1 ml) is used in
large joints (such as hips, knees and shoulders), 5-10 mg
(0.25-0.5 ml) is used in medium-sized joints (such as elbows
and wrists) and 2-6 mg (0.1-0.3 ml) is used in smaller joints
(such as hands and feet). If a lot of fluid is present in the
joint, this may be withdrawn before the injection. The next
dose and the number of injections depend on how your
disease responds. Because Triamcinolone hexacetonide is

Do not use Triamcinolone hexacetonide after the expiry date
which is stated on the ampoule label and outer carton after
“EXP”. The expiry date refers to the last day of that month.
Do not use Triamcinolone hexacetonide if you notice any
visible change in the appearance of the medicine.
Do not throw away any medicines via waste water or
household waste. Ask your pharmacist how to dispose of
medicines no longer required. These measures will help to
protect the environment.
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taking steroids are vaccinated. (see section 2 Warnings and
precautions)

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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