1649 needed during the course of treatment. A dose of 1 to mg Triamcinolone Hexacetonide 4 may be used for visualisation during vitrectomy. (BAN, USAN, riNN) ® For doses used in children, see below. Other esters of triamcinolone that have occasionally been used include the acetonide dipotassium phosphate, acetonide hemisuccinate, aminobenzal benzamidoisobuty­ rate, and benetonide. Flupamesone (triamcinolone aceto­ nide metembonate) has also been used. Administration in children. Triamcinolone acetonide and hexacetonide have been used for intra-articular injec­ Ph. Eur. 8: tion in children. Although unlicensed in the UK for use (Triamcinolone). A white or almost white, in children under 6 years of age, the BNFC includes doses crystalline powder. It shows polymorphism. Practically for injection into larger joints in those aged from 1 to 18 insoluble in water and in dichloromethane; slightly soluble years. A dose of triamcinolone acetonide 2 mglkg may be in methyl alcohol. Protect from light. used, to a usual maximum of 40 mg, or triamcinolone USP 36: (Triamcinolone). A white or practically white, hexacetonide 1 mglkg to a usual maximum of 20 mg. odourless, crystalline powder. Very slightly soluble in water, However, higher doses have been used. Treatment may be in chloroform, and in ether; slightly soluble in alcohol and repeated for relapse if necessary, although each joint in methyl alcohol. Pharmacopoeias. In Bur. (see p. vii) and US. should usually be treated no more than 3 or 4 times in a year. Ph. Eur. 8: (Triamcinolone Hexacetonide). A white or In the treatment of allergic rhinitis triamcinolone almost white, crystalline powder. Practically insoluble in acetonide may be given by a nasal spray. Children aged 6 Triamcinolone Acetonide (BANM, rJNNMJ ® water; sparingly soluble in dehydrated alcohol and in to 12 years may be given 1 spray (55 micrograms) into each methyl alcohol. Protect from light. Acet (lido cte •'friamdno!Otm:. Trf�n•dnofor{ a�et (lld; nostril once daily. This dose may be increased to 2 sprays £ � USP 36: (Triamcinolone Hexacetonide). A white to cream­ Triarncinoiona, . &<;et(lpido .de; Triarncinolona<;etonld; Tri­ ( 110 micrograms) into each nostril once daily for control of de; coloured powder. Practically insoluble in water; soluble in am<:if1olone, .· t;cetonide. Tria(rldnoloni · �cet�mkl urni severe symptoms. The lowest effective dose should be used Triamdflolor1o <>cetcmi0<J:;; Triamcynolonu acetc>nid; Tri;lm­ chloroform; slightly soluble in methyl alcohol. once symptoms have been controlled. In children aged from sinolon t;setonid:_. T(iamsinoloniasetonidi; rpvtaM!ilH!:!OilOHa 2 to 5 years, the recommended and maximum dose is Uses and Administration 55 micrograms into each nostril once daily. Triamcinolone is a corticosteroid with mainly glucocorticoid Asthma. Corticosteroids and beta2-adrenoceptor agonists activity (p. 1597.1); 4mg of triamcinolone is equivalent in form the cornerstone of the management of asthma (see anti-inflammatory activity to about 5 mg of prednisolone. It p. 1600.3). is used, either in the form of the free alcohol or in one of the Intramuscular triamcinolone acetonide has been esterified forms, in the treatment of conditions for which reported to be more effective than oral low-dose prednisone corticosteroid therapy is indicated (see p. 1597.3 ), except in controlling exacerbations in patients with severe, adrenocortical insufficiency for which hydrocortisone with chronic, life-threatening asthma, 1 although this conclusion supplementary fludrocortisone is preferred. is controversiai.2·7 The dose may be expressed in terms of the base, and the I. Ogirala RG, et a!. High-dose intramuscular triamcinolone in severe, Pharmacopoeias. In Chin., Bur. (see p. vii), Jpn, and US. following are each equivalent to about 10mg of triamcino­ chronic, life-threatening asthma. N Eng! J Med 1991; 324: 589-9. lone: Correction. ibid.; 1380. d 2. Salmeron S, et al. Intramuscular triamcinolone in severe asthma. N Eng! Chin. also inclu es Triamcinolone Acetonide Acetate. triamcinolone acetonide ll mg • J Med 1991; 325: 429-30. triamcinolone acetonide sodium phosphate 14 mg Ph. Eur. 8: (Triamcinolone Acetonide). A white or almost • 3. Nicholas SS. Intramuscular triamcinolone in severe asthma. N Eng! 1 Mfd triamcinolone diacetate 12 mg 1991; 325: 430. white, crystalline powder. It shows polymorphism. • triamcinolone hexacetonide 14 mg 4. Kidney JC, et al. Intramuscular triamcinolone in severe asthma. N Eng! J Practically insoluble in water; sparingly soluble in alcohol. • Med 1991; 325: 430. Protect frmn light. However, esterification generally alters potency and 5. Capewcll S, Mcleod DT. Intramuscular triamcinolone in severe asthma. compounds with equivalent triamdnolone content may N Eng! J Med 1991; 325: 430. USP 36: (Triamcinolone Acetonide). A white to cream­ not have equivalent clinical effect. 6. Ogirala RG, et al. Intramuscular triamcinolone in severe asthma. N Eng! J coloured crystalline powder, having not more than a slight For oral dosage triamcinolone is used in doses ranging Med 1991; 325: 431. odour. Practically insoluble in water; sparingly soluble in 7. Capewell S, McLeod D. Injected corticosteroids in refractory asthma. from 4 to 48 mg daily. Lancet 1991; 338: 1075-6. dehydrated alcohol. in chloroform, and in methyl alcohol. For parenteral use the acetonide ester is given in doses of Store at a temperature of 2 5 degrees, excursions permitted about 40 to 80 mg by intramuscular injection. It is between 15 degrees and 30 degrees. usually given as a suspension to provide a prolonged Chronic obstructive pulmonary disease. Inhaled corticos­ systemic effect. A single dose of 40 to 100 mg of the teroids may be used in chronic obstructive pulmonary dis­ acetonide may provide symptomatic control throughout the ease (see p. 1603.1). Triamcinolone Acetonide Sodium pollen season for hay fever sufferers (but see Rhinitis, Phosphate (BANM. USAN. rJNNMI ® p. 1650.1). The diacetate ester has also been given Eye disorders. Intravitreal injection of triamcinolone intramuscularly. acetonide has been tried in the management of eye disor­ CL-61 965; cL-106359; Fos�ato i.le sodio del ' atetol)ido de For intra-articular injection triamcinolone acetonide, ders characterised by oedema and the abnormal prolifera­ triamcinolona; triamcfnotona. acetonido de.fosfzitode sodio diacetate, and hexacetonide have all been used. Doses for tion of intra-ocular cells. Promising results have been del; Triamcinolone. Acetpnlde, . Phosphate Sodique de; these esters have typically been in the range of 2.5 to 40 mg, reported in diabetic macular oedema, L2 cystoid macular Triamcino!onl Acetonidi Natrici Phosphas; TpMaMu!'fHOnoHa depending upon the size of the joint injected. oedema, and oedema associated with retinal vein occlu­ 1\ceTOH�A& Ha;p11A Qoc<(>ar. For topical application in the treatment of various skin sion.2·5 It has also been used in age-related macular Triamcinokme aq;tooiel\';2hiispdium phosph<Jte: disorders triamcinolone acetonide is used, usually in degeneration (p. 880.2; better results being seen when it is C24H30FNa209P"'55&.40 creams, lotions, or ointments containing 0.1% although combined with photodynamic therapy), in proliferative CA S i 997·1:5·5. concentrations ranging from 0.025 to 0.5% have been diabetic retinopathy, and in the management of some employed. Several topical preparations also contain an forms of cataract and non-infectious uveitis.2•3 Complica­ ATC -- AOlA(Ol,' P.03BA06; SO IBA05. antimicrobial drug. For recommendations concerning the tions of treatment may include raised intra-ocular pressure ATCVer QA (JIACo l; Q[)07t�B09," '(�H612Al�IJ8. correct use of corticosteroids on the skin, and a rough guide (IOP)6 and both infectious and non-infectious endophthal­ 0-" QC05AA I2; mitis 2 Patients with a baseline lOP greater than 16mmHg CJR0 1 AD II; QR03BA06; QSO IMO.'i. to the clinical potencies of topical corticosteroids, see p. 1599.2. or receiving a second injection should be carefully moni­ Triamcinolone esters are also commonly used by tared, as they may be at greater risk of an increase; moni­ intralesional or intradermal injection in the treatment toring should continue beyond 6 months 6 of some inflammatory skin disorders such as keloids. Dissolved drugs are not retained in the eye for prolonged Suggested doses for the various esters have been: periods, and early studies and off-label treatment have used acetonide: to 3 mg per site with no more than 5 mg injectable suspensions to achieve long-lasting concentra­ • I injected into any one site or not more than 30 mg in total tions of triamcinolone in the vitreous bodyJ However, these if several sites of injection are used commercial products were intended for intramuscular and diacetate: a total of 5 to 25 mg, injected as no more than intra-articular use and not licensed for intravitreal injection, • 100 micrograms/cm2 of skin surface area and there has been concern about the potential ocular hexacetonide: up to 500 micrograms per square inch toxicity of their preservative, benzyl alcohoJ.2·7 Various • (about 80 microgramslcm2) of affected skin techniques, such as sedimentation, centrifugation, and In the treatment of allergic rhinitis (p. 1650.1) triamcino­ 1 filtration, have been used extemporaneously to reduce the lone acetonide may be given by a nasal spray in a usual benzyl alcohol content of such products, but the quantity of initial dose of 2 sprays ( 110 micrograms) into each nostril triamcinolone in the final preparation may be altered once daily, reduced to 1 spray (55 micrograms) into each depending on the technique used.8 More recently, nostril once daily when control is achieved. preservative-free products have been licensed in the USA Pharmacopoeias. In US. Preservative-free suspensions of triamcinolone acetonide for intravitreal use ( Triesence; Alcon, USA and Tn·varis; see Uses and Administration, above). USP 36: (Triamcinolone Diacetate). A fine, white to off­ are available for intravitrea1 injection (see Eye Disorders, Allergan, USA - white, crystalline powder, having not more than a slight below). A dose of 4mg is used for the treatment of I.