Drugs List

Therapeutic Indications

Uses

Allergic rhinitis - perennial and seasonal

Contraindications

Children under 2 years
Uncontrolled nasal infection
Pulmonary tuberculosis

Precautions and Warnings

Children aged 2 to 6 years
Breastfeeding
Cataract
Glaucoma
Pregnancy
Recent nasal surgery
Recent nasal trauma

Systemic corticosteroids may be needed during elective surgery
Systemic corticosteroids may be needed during periods of stress
Not all available brands are licensed for all age groups
Contains benzalkonium chloride
Advise patient to avoid spraying this preparation into or near the eyes
Consider adrenal suppression when transferring from systemic steroid
If growth in children is slowed, consider referral to a paediatrician
If visual disturbances occur, perform ophthalmic evaluation
Monitor regularly the height of children receiving prolonged treatment
Prolonged or high dose may lead to adrenal suppression
Treatment may result in the development of glaucoma and/or cataracts
Systemic effects possible with any inhaled corticosteroid
Discontinue therapy and use antimicrobials if secondary infection occurs
Maintain treatment at the lowest effective dose
Several days treatment needed to obtain full effect
Advise patient to seek medical advice if treatment is ineffective
Refer to doctor if symptoms persist after 2 weeks treatment

Pregnancy and Lactation

Pregnancy

Use triamcinolone acetonide with caution in pregnancy.

In animal models of inflammation, triamcinolone is approximately 1 to 2 times as potent as prednisone, whereas triamcinolone acetonide is about 8 times more potent.

Triamcinolone is teratogenic in animals. Cleft palate was induced in foetal mice and rats exposed in utero to triamcinolone acetonide. In one study with mice a high dietary fat intake increased the frequency/severity of cleft palate (48% compared with a low-fat diet of 5.6%).

In rats the teratogenic potency, as measured by the induction of cleft palate, of triamcinolone, triamcinolone acetonide and cortisol was compared and triamcinolone acetonide was 59 times more potent than triamcinolone, which in turn was more potent than cortisol. Other anomalies seen with triamcinolone acetonide were umbilical hernias, resorption and foetal death. All three agents produced foetal growth retardation.

The manufacturer notes that this medication should not be used unless the benefit to the mother outweighs the potential risk to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use triamcinolone acetonide with caution in breastfeeding.

When applied topically to the nose, only minimal doses are used and plasma levels are very low to undetectable. No data is available on triamcinolone secretion into human milk but it is likely that milk levels would be very low and not clinically relevant when administered via inhalation or intranasally.

The manufacturer notes that this medication should not be used unless the benefit to the mother outweighs the potential risk to the feeding infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Adrenal suppression
Aggression in children
Anxiety
Behavioural disturbances (children)
Blurred vision
Bronchitis
Candida albicans infection
Cataracts
Chorioretinopathy
Cough
Cushing's syndrome
Cushingoid facies
Depression
Dizziness
Dryness and irritation of nose
Dyspepsia
Dyspnoea
Epistaxis
Facial oedema
Fatigue
Glaucoma
Growth retardation (children)
Headache
Hypersensitivity reactions
Increased intra-ocular pressure
Influenza-like syndrome
Insomnia
Nasal congestion
Nausea
Perforation of nasal septum
Pharyngitis
Pruritus
Psychomotor hyperactivity
Rash
Reduction in serum cortisol levels
Rhinitis
Sleep disturbances
Smelling disturbances
Sneezing
Systemic effects (large quantities and/or prolonged use)
Taste disturbances
Throat irritation
Tooth disorder
Urticaria

Presentation

Nasal formulation containing triamcinolone acetonide

Drugs List

Therapeutic Indications

Uses

Allergic rhinitis - perennial and seasonal

Dosage

Adults

Children

Contraindications

Children under 2 years
Uncontrolled nasal infection
Pulmonary tuberculosis

Precautions and Warnings

Children aged 2 to 6 years
Breastfeeding
Cataract
Glaucoma
Pregnancy
Recent nasal surgery
Recent nasal trauma

Systemic corticosteroids may be needed during elective surgery
Systemic corticosteroids may be needed during periods of stress
Not all available brands are licensed for all age groups
Contains benzalkonium chloride
Advise patient to avoid spraying this preparation into or near the eyes
Consider adrenal suppression when transferring from systemic steroid
If growth in children is slowed, consider referral to a paediatrician
If visual disturbances occur, perform ophthalmic evaluation
Monitor regularly the height of children receiving prolonged treatment
Prolonged or high dose may lead to adrenal suppression
Treatment may result in the development of glaucoma and/or cataracts
Systemic effects possible with any inhaled corticosteroid
Discontinue therapy and use antimicrobials if secondary infection occurs
Maintain treatment at the lowest effective dose
Several days treatment needed to obtain full effect
Advise patient to seek medical advice if treatment is ineffective
Refer to doctor if symptoms persist after 2 weeks treatment

Pregnancy and Lactation

Pregnancy

Use triamcinolone acetonide with caution in pregnancy.

In animal models of inflammation, triamcinolone is approximately 1 to 2 times as potent as prednisone, whereas triamcinolone acetonide is about 8 times more potent.

Triamcinolone is teratogenic in animals. Cleft palate was induced in foetal mice and rats exposed in utero to triamcinolone acetonide. In one study with mice a high dietary fat intake increased the frequency/severity of cleft palate (48% compared with a low-fat diet of 5.6%).

In rats the teratogenic potency, as measured by the induction of cleft palate, of triamcinolone, triamcinolone acetonide and cortisol was compared and triamcinolone acetonide was 59 times more potent than triamcinolone, which in turn was more potent than cortisol. Other anomalies seen with triamcinolone acetonide were umbilical hernias, resorption and foetal death. All three agents produced foetal growth retardation.

The manufacturer notes that this medication should not be used unless the benefit to the mother outweighs the potential risk to the foetus.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use triamcinolone acetonide with caution in breastfeeding.

When applied topically to the nose, only minimal doses are used and plasma levels are very low to undetectable. No data is available on triamcinolone secretion into human milk but it is likely that milk levels would be very low and not clinically relevant when administered via inhalation or intranasally.

The manufacturer notes that this medication should not be used unless the benefit to the mother outweighs the potential risk to the feeding infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Adrenal suppression
Aggression in children
Anxiety
Behavioural disturbances (children)
Blurred vision
Bronchitis
Candida albicans infection
Cataracts
Chorioretinopathy
Cough
Cushing's syndrome
Cushingoid facies
Depression
Dizziness
Dryness and irritation of nose
Dyspepsia
Dyspnoea
Epistaxis
Facial oedema
Fatigue
Glaucoma
Growth retardation (children)
Headache
Hypersensitivity reactions
Increased intra-ocular pressure
Influenza-like syndrome
Insomnia
Nasal congestion
Nausea
Perforation of nasal septum
Pharyngitis
Pruritus
Psychomotor hyperactivity
Rash
Reduction in serum cortisol levels
Rhinitis
Sleep disturbances
Smelling disturbances
Sneezing
Systemic effects (large quantities and/or prolonged use)
Taste disturbances
Throat irritation
Tooth disorder
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2017

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Nasacort Nasal Spray. Aventis Pharma Limited. Revised June 2016.

Summary of Product Characteristics: Nasacort Allergy Nasal Spray. Aventis Pharma Limited. Revised August 2018.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 04 September 2017