triamcinolone acetonide (oral and nasal inhalant)
Azmacort, Nasacort, Nasacort AQ

Available forms
Available by prescription only
Nasal aerosol: 55 mcg/metered spray
Nasal spray: 50 mcg/metered spray
Oral inhalation aerosol: 55 mcg/metered spray

Indications and dosages
 Corticosteroid-dependent asthma. Adults: 2 inhalations t.i.d. or q.i.d. Maximum dose is 16 inhalations daily.
Children ages 6 to 12: 1 or 2 inhalations t.i.d. or q.i.d. Maximum dose is 12 inhalations daily.
 Rhinitis, allergic disorders, inflammatory conditions, nasal polyps. Adults: 2 sprays (Nasacort) in each nostril daily; may increase dose to maximum of 4 sprays per nostril daily, if needed. Or 2 sprays (Nasacort AQ) in each nostril daily; may decrease to 1 spray in each nostril daily for allergic disorders.
Children ages 6 to 12: 2 sprays (Nasacort) in each nostril daily. Or, 1 spray (Nasacort AQ) in each nostril daily. Maximum 2 sprays in each nostril daily.

Pharmacodynamics
Anti-inflammatory action: Glucocorticoids stimulate the synthesis of enzymes needed to decrease the inflammatory response. Triamcinolone acetonide is used as an oral inhalant to treat bronchial asthma in patients who require corticosteroids to control symptoms.

Pharmacokinetics
Absorption: Systemic absorption from the lungs is similar to oral administration.
Distribution: After oral inhalation, 10% to 25% is distributed to the lungs; the rest is swallowed or deposited within the mouth. After nasal use, only a small amount reaches systemic circulation.
Metabolism: Metabolized mainly by the liver. Some that reaches the lungs may be metabolized locally.
Excretion: The major portion of a dose is eliminated in feces. Biologic half-life of triamcinolone is 18 to 36 hours.

Contraindications and precautions
Oral form is contraindicated in patients hypersensitive to any component of the formulation and in those with status asthmaticus. Nasal form is contraindicated in patients with hypersensitivity or untreated localized infections.
  Use oral form cautiously in patients with tuberculosis of the respiratory tract; untreated fungal, bacterial, or systemic viral infections; or ocular herpes simplex and in those receiving corticosteroids. Use both forms cautiously in breast-feeding women.

Interactions
None reported.

Adverse reactions
EENT: dry or irritated nose or throat, hoarseness.
GI: oral candidiasis, dry or irritated tongue or mouth.
Respiratory: cough, wheezing (oral form).
Other: facial edema (oral form).

Effects on lab test results
None reported.

Overdose and treatment
No information available.

Special considerations
• Recommendations for use of triamcinolone and for care and teaching of patients during therapy are the same as those for all inhalant adrenocorticoids.
• Most adverse reactions to corticosteroids are dose- or duration-dependent.
• Monitor patient for symptom resolution.
• Monitor patient’s respiratory status.
Breast-feeding patients
• Use drug cautiously in breast-feeding women.
Pediatric patients
• Safety and efficacy haven’t been established for children younger than age 12 for nasal aerosol and younger than age 6 for oral aerosol.

Patient education
• Instruct patient to rinse mouth or gargle after inhaler use.
• Instruct patient to report lack of therapeutic effect or any adverse effects.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use