Drugs List

Therapeutic Indications

Uses

Bursitis
Epicondylitis
Juvenile idiopathic arthritis
Osteoarthritis
Rheumatoid arthritis
Synovitis
Tendinitis

Contraindications

Children under 3 years
Uncontrolled systemic infection
Acute psychosis
Hereditary fructose intolerance
Herpes simplex keratitis
Tuberculosis

Precautions and Warnings

Children under 12 years
Exanthematous disorder
Acute glomerulonephritis
Breastfeeding
Cardiac failure
Chronic nephritis
Cushing's disease
Diabetes mellitus
Diverticulitis
Gastric ulcer
Hypertension
Hypothyroidism
Latent or healed tuberculosis
Metastatic carcinoma
Myasthenia gravis
Osteoporosis
Pregnancy
Psychosis
Recent gastrointestinal anastomosis
Renal impairment
Thromboembolic disorder
Thrombophlebitis
Ulcerative colitis

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Administration of live vaccines is not recommended
May mask symptoms or signs of infections
Exclude fungal infection before treatment
Exclude joint infection before injection
Not all routes are licensed for all indications
Contains benzyl alcohol
Contains polysorbate
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Do not inject into unstable joints
Maximum of two joints to be treated in one session
Monitor growth and development in children on prolonged therapy
Adrenal cortical atrophy may persist for years after stopping drug
Antibody response to non-live vaccines may be diminished
Discontinue if active infection develops
May precipitate diabetes mellitus
Use of live vaccines may cause severe reaction
May affect results of some laboratory tests
Do not withdraw this drug suddenly
Discontinue if serious allergic or anaphylactic reaction occurs
Maintain treatment at the lowest effective dose
Not licensed for all indications in all age groups
Avoid prolonged use
Advise patient not to take NSAIDs unless advised by clinician
Advise patient not to take St John's wort concurrently
Advise patient not to overuse joints even if symptomatic benefit is felt
Advise those on systemic corticosteroids to avoid chickenpox/H zoster
Ensure patient receives Steroid Treatment/Steroid Emergency Card
If exposed to chickenpox or Herpes zoster seek urgent medical attention

Pregnancy and Lactation

Pregnancy

Use triamcinolone hexacetonide with caution in pregnancy.

Triamcinolone crosses the placenta. Corticosteroids are teratogenic in animal experiments. The significance of this fact for humans is not exactly known, but so far the use of corticosteroids has not been shown to increase the incidence of malformations. Long-term use of corticosteroids in humans and animals has led to a decrease in weight of the placenta and the newborn. Long term corticosteroid therapy is also associated with a risk of adrenocortical suppression in the newborn. The product should be used during pregnancy only if the benefit to the mother is clearly greater than the risk to the fetus.
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 hexacetonide with caution in breastfeeding.

Triamcinolone hexacetonide is excreted in human milk, local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. Caution must be observed in the long-term use of large doses. 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

Abscess (sterile)
Acneform changes
Aggravation of pre-existing psychiatric conditions
Anaphylaxis
Arrhythmias
Aseptic necrosis
Atrophy (localised)
Calcinosis (injection site)
Cardiac failure
Charcot-like arthropathy
Cushing's syndrome
Depression
Diabetes mellitus
Ecchymosis
Erythema at injection site
Euphoria
Exacerbation of infection
Facial erythema
Fractures
Glaucoma
Growth retardation (children)
Headache
Hirsutism
Hives
Hyperhidrosis
Hyperpigmentation
Hypertension
Hypopigmentation
Increased intra-ocular pressure
Insomnia
Local pain (injection site)
Menstrual disturbances
Mood changes
Necrosis (injection site)
Negative nitrogen balance
Osteoporosis
Papilloedema
Peptic ulceration
Peptic ulceration with perforation and haemorrhage
Petechiae
Posterior subcapsular cataracts
Psychotic symptoms
Purpura
Raised intracranial pressure
Rash
Reduced carbohydrate tolerance
Reduced muscle mass
Secondary adrenocortical and pituitary unresponsiveness
Striae
Swelling (injection site)
Tendon rupture
Thinning of skin
Thromboembolism
Vertigo
Wound healing retarded

Presentation

Triamcinolone hexacetonide suspension for injection

Drugs List

Therapeutic Indications

Uses

Bursitis
Epicondylitis
Juvenile idiopathic arthritis
Osteoarthritis
Rheumatoid arthritis
Synovitis
Tendinitis

Dosage

Asepsis must be observed in the use of this product. The vial should be shaken carefully before use to ensure suspension. The injection site should be sterilised using the same technique as with lumbar puncture. At each treatment session, an injection may be given into two joints at the most.

Adults

Children

Contraindications

Children under 3 years
Uncontrolled systemic infection
Acute psychosis
Hereditary fructose intolerance
Herpes simplex keratitis
Tuberculosis

Precautions and Warnings

Children under 12 years
Exanthematous disorder
Acute glomerulonephritis
Breastfeeding
Cardiac failure
Chronic nephritis
Cushing's disease
Diabetes mellitus
Diverticulitis
Gastric ulcer
Hypertension
Hypothyroidism
Latent or healed tuberculosis
Metastatic carcinoma
Myasthenia gravis
Osteoporosis
Pregnancy
Psychosis
Recent gastrointestinal anastomosis
Renal impairment
Thromboembolic disorder
Thrombophlebitis
Ulcerative colitis

Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
Administration of live vaccines is not recommended
May mask symptoms or signs of infections
Exclude fungal infection before treatment
Exclude joint infection before injection
Not all routes are licensed for all indications
Contains benzyl alcohol
Contains polysorbate
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Do not inject into unstable joints
Maximum of two joints to be treated in one session
Monitor growth and development in children on prolonged therapy
Adrenal cortical atrophy may persist for years after stopping drug
Antibody response to non-live vaccines may be diminished
Discontinue if active infection develops
May precipitate diabetes mellitus
Use of live vaccines may cause severe reaction
May affect results of some laboratory tests
Do not withdraw this drug suddenly
Discontinue if serious allergic or anaphylactic reaction occurs
Maintain treatment at the lowest effective dose
Not licensed for all indications in all age groups
Avoid prolonged use
Advise patient not to take NSAIDs unless advised by clinician
Advise patient not to take St John's wort concurrently
Advise patient not to overuse joints even if symptomatic benefit is felt
Advise those on systemic corticosteroids to avoid chickenpox/H zoster
Ensure patient receives Steroid Treatment/Steroid Emergency Card
If exposed to chickenpox or Herpes zoster seek urgent medical attention

Pregnancy and Lactation

Pregnancy

Use triamcinolone hexacetonide with caution in pregnancy.

Triamcinolone crosses the placenta. Corticosteroids are teratogenic in animal experiments. The significance of this fact for humans is not exactly known, but so far the use of corticosteroids has not been shown to increase the incidence of malformations. Long-term use of corticosteroids in humans and animals has led to a decrease in weight of the placenta and the newborn. Long term corticosteroid therapy is also associated with a risk of adrenocortical suppression in the newborn. The product should be used during pregnancy only if the benefit to the mother is clearly greater than the risk to the fetus.
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 hexacetonide with caution in breastfeeding.

Triamcinolone hexacetonide is excreted in human milk, local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. Caution must be observed in the long-term use of large doses. 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

Counselling

Athletes should be informed that this medicinal product contains an ingredient (triamcinolone hexacetonide) that may produce a positive result in anti-doping tests.

Side Effects

Abscess (sterile)
Acneform changes
Aggravation of pre-existing psychiatric conditions
Anaphylaxis
Arrhythmias
Aseptic necrosis
Atrophy (localised)
Calcinosis (injection site)
Cardiac failure
Charcot-like arthropathy
Cushing's syndrome
Depression
Diabetes mellitus
Ecchymosis
Erythema at injection site
Euphoria
Exacerbation of infection
Facial erythema
Fractures
Glaucoma
Growth retardation (children)
Headache
Hirsutism
Hives
Hyperhidrosis
Hyperpigmentation
Hypertension
Hypopigmentation
Increased intra-ocular pressure
Insomnia
Local pain (injection site)
Menstrual disturbances
Mood changes
Necrosis (injection site)
Negative nitrogen balance
Osteoporosis
Papilloedema
Peptic ulceration
Peptic ulceration with perforation and haemorrhage
Petechiae
Posterior subcapsular cataracts
Psychotic symptoms
Purpura
Raised intracranial pressure
Rash
Reduced carbohydrate tolerance
Reduced muscle mass
Secondary adrenocortical and pituitary unresponsiveness
Striae
Swelling (injection site)
Tendon rupture
Thinning of skin
Thromboembolism
Vertigo
Wound healing retarded

Effects on Laboratory Tests

Corticosteroids may interfere with the nitroblue tetrazolium test for bacterial infection, producing false-negative results.

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: September 2014

Reference Sources

Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 18th September, 2014.

Summary of Product Characteristics: Triamcinolone Hexacetonide 20 mg/ml suspension for injection. Intrapharm Laboratories Ltd. Revised June 2014.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Triamcinolone Last revised: 16th January, 2014
Last accessed: 18th September, 2014