triamcinolone (nasal)

Absorption: Action of all agents is primarily local after nasal use.

Distribution: Crosses the placenta and enters breast milk in small amounts.

Metabolism/Excretion: Rapidly and extensively metabolized by the liver; 40% excreted in urine, 60% in feces.

Half-Life: 3–5.4 hr.

Time/Action Profile ⬆ ⬇

(improvement in symptoms)

ROUTE	ONSET	PEAK	DURATION
Intranasal	few days	3–4 days	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (aerosol contains alcohol);
OB: Pregnancy.

Use Cautiously in:

Active untreated infections;
Diabetes or glaucoma;
Underlying immunosuppression (resulting from disease or concurrent therapy);
Systemic glucocorticoid therapy (should not be abruptly discontinued when intranasal therapy is started);
Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids);
Lactation: Safety not established in breastfeeding;
Pedi: Children 2 yr (safety and effectiveness not established; prolonged or high-dose therapy may lead to complications; may growth in children).

Adv. Reactions/Side Effects ⬆ ⬇

EENT: epistaxis, nasal burning, nasal irritation, nasopharyngeal fungal infection, otitis media, pharyngitis, rhinitis, sinusitis, sneezing

Endo: adrenal suppression (high-dose, long-term therapy only)

GI: vomiting

Neuro: headache

Resp: cough

Interactions ⬆ ⬇

Drug-drug:

None known.

Route/Dosage ⬆ ⬇

(Adults and Children ≥12 yr): 2 sprays in each nostril once daily; not to be used in children for longer than 2 mo.
(Children 6–11 yr): 1 spray in each nostril once daily (not to exceed 2 sprays in each nostril/day); not to be used for longer than 2 mo
(Children 2–5 yr): 1 spray in each nostril once daily; not to be used for longer than 2 mo.

Availability ⬆ ⬇

Nasal spray: 55 mcg/metered spray in 10.8–mL and 16.9–mL bottles (120 metered sprays)OTC

Assessment ⬆ ⬇

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.
- Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration.
- Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritus, swelling of face and neck, dyspnea) periodically during therapy.

Lab Test Considerations:

Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression.

Implementation ⬆ ⬇

After desired clinical effect has been obtained, attempt to decrease dose to lowest amount. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
Intranasal: Patients also using a nasal decongestant should be given decongestant 5–15 min before glucocorticoid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently before medication administration.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose.
Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Warn patient that temporary nasal stinging may occur.
Instruct patient to notify health care professional if symptoms do not improve within 3 wk, if symptoms worsen, or if nasal irritation occurs.
Nasal spray: Before first-time use, prime unit by spraying 5 times. If not used for more than 2 wk, re-prime unit with 1 spray.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇