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Allergic rhinitis:
US labeling:
Rx: Management of seasonal and perennial allergic rhinitis in adults and children 2 years and older
OTC: For the relief of hay fever and other upper respiratory allergies (eg, nasal congestion, runny nose, sneezing, itchy nose) in adults and children 2 years and older
Canadian labeling:
Rx: Management of seasonal and perennial allergic rhinitis unresponsive to conventional treatment in children 4 to 12 years
OTC: Management of seasonal and perennial allergic rhinitis in adults and children 12 years and older
Hypersensitivity to triamcinolone or any component of the formulation
Documentation of allergenic cross-reactivity for corticosteroids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Canadian labeling: Additional contraindications (not in US labeling): Active or quiescent tuberculosis, or untreated fungal, bacterial and viral infection.
Allergic rhinitis: Intranasal:
US labeling: Two sprays (110 mcg) in each nostril once daily; once symptoms controlled reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if adequate symptomatic relief is not observed within 3 weeks (1 week for OTC use).
Canadian labeling: Two sprays (110 mcg) in each nostril once daily; once symptoms controlled reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if significant symptomatic relief is not observed within 1 week (for OTC use)
Refer to adult dosing.
Allergic rhinitis: Intranasal:
US labeling:Note: Discontinue therapy if adequate symptomatic relief is not observed within 3 weeks (1 week for OTC use).
Children 2 to <6 years: One spray (55 mcg) in each nostril once daily (maximum: 1 spray [55 mcg] in each nostril once daily
Children 6 to <12 years: Initial: One spray (55 mcg) in each nostril once daily; may increase to 2 sprays (110 mcg) in each nostril once daily if response not adequate; once symptoms controlled may reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily)
Children ≥12 years and Adolescents: Refer to adult dosing.
Canadian labeling:
Children 4 to <12 years: Initial: One spray (55 mcg) in each nostril once daily; may increase to 2 sprays (110 mcg) in each nostril once daily if response not adequate; once symptoms controlled may reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if significant symptomatic relief is not observed within 3 weeks.
Children ≥12 years and Adolescents: Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer 's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer 's labeling (has not been studied).
Shake well prior to use. Gently blow nose to clear nostrils. Avoid spraying into mouth or eyes and do not blow nose for 15 minutes after use. Prime prior to first use by shaking contents well and releasing 5 sprays into the air. If product is not used for more than 2 weeks, reprime with 1 spray. Consider use of a nasal vasoconstrictor for 2 to 3 days before initiating therapy in patients with excessive nasal mucous secretion or nasal mucosa edema.
Store at 20 ‚ °C to 25 ‚ °C (68 ‚ °F to 77 ‚ °F); do not freeze.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, Nasal, as acetonide:
Nasacort Allergy 24HR: 55 mcg/actuation (10.8 mL, 16.9 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Nasacort Allergy 24HR Children: 55 mcg/actuation (10.8 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Nasacort AQ: 55 mcg/actuation (16.5 g)
Nasal Allergy 24 Hour: 55 mcg/actuation (16.9 mL) [contains benzalkonium chloride, edetate disodium, polysorbate 80]
Generic: 55 mcg/actuation (16.5 g)
Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy
Growth (adolescents and children); signs/symptoms of HPA axis suppression/adrenal insufficiency; ocular changes; signs/symptoms of Candida infection (long-term therapy)
>10%:
Central nervous system: Headache (2% to 51%)
Respiratory: Pharyngitis (5% to 25%)
1% to 10%:
Cardiovascular: Facial edema (1% to 3%)
Central nervous system: Pain (1% to 3%)
Dermatologic: Photosensitivity (1% to 3%), rash (1% to 3%)
Endocrine & metabolic: Dysmenorrhea ( ≥2%)
Gastrointestinal: Taste perversion (5% to 8%), dyspepsia (3% to 5%), abdominal pain (1% to 5%), nausea (2% to 3%), diarrhea (1% to 3%), oral moniliasis (1% to 3%), toothache (1% to 3%), vomiting (1% to 3%), weight gain (1% to 3%), xerostomia (1% to 3%)
Genitourinary: Cystitis (1% to 3%), urinary tract infection (1% to 3%), vaginal moniliasis (1% to 3%)
Local: Nasal burning ( ≥2%; transient), nasal stinging ( ≥2%; transient)
Neuromuscular & skeletal: Back pain (2% to 8%), bursitis (1% to 3%), myalgia (1% to 3%), tenosynovitis (1% to 3%)
Ocular: Conjunctivitis (1% to 4%)
Otic: Otitis media ( ≥2%)
Respiratory: Sinusitis (2% to 9%), cough ( ≤8%), epistaxis ( ≤5%), bronchitis (children 3%), chest congestion (1% to 3%), asthma ( ≥2%), rhinitis ( ≥2%)
Miscellaneous: Flu-like syndrome (2% to 9%), voice alteration (1% to 3%), allergic reaction ( ≥2%), infection ( ≥2%)
<1% (Limited to important or life-threatening): Anaphylaxis, blood cortisol decreased, bone mineral density loss (rare; prolonged use), cataracts, dizziness, dry throat, dyspnea, fatigue, glaucoma, growth suppression, hoarseness, hypersensitivity, insomnia, intraocular pressure increased, nasal septum perforation, oral candidiasis, osteoporosis (rare; prolonged use), pruritus, sneezing, throat irritation, urticaria (rare), wheezing, wound healing impaired
Concerns related to adverse effects:
- Adrenal suppression: When used at excessive doses, may cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms.
- Delayed wound healing: Avoid use in patients with recent nasal septal ulcers, nasal surgery, or nasal trauma until healing has occurred.
- Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox and/or measles should be avoided.
- Local nasal effects: Nasal septal perforation, nasal ulceration, epistaxis, and localized Candida albicans infections of the nose and/or pharynx may occur. Monitor patients periodically for adverse nasal effects.
Disease-related concerns:
- Infections: Use caution or avoid in patients with ocular herpes simplex, latent tuberculosis, and/or TB reactivity, or in patients with untreated fungal, viral, or bacterial infections. Canadian labeling contraindicates in active or quiescent tuberculosis, or untreated fungal, bacterial, and viral infection.
- Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Consider routine eye exams in chronic users.
Special populations:
- Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercorticism (Cushing syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).
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Adverse events were observed in some animal reproduction studies. Intranasal corticosteroids are recommended for the treatment of rhinitis during pregnancy; the lowest effective dose should be used (NAEPP, 2005; Wallace, 2008).
Controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes and fibroblasts, reverses capillary permeability, and stabilizes lysosomal membranes at the cellular level to prevent or control inflammation
Systemic absorption may occur following intranasal administration.
Urine (~40%); feces (~60%)
Biologic: 18-36 hours; Terminal (intranasal): 3.1 hours
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience headache or pharyngitis. Have patient report immediately to prescriber signs of infection, severe dizziness, severe nasal irritation, severe nosebleed, nasal sores, wheezing, thrush, severe nausea, severe vomiting, severe loss of strength and energy, or vision changes (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.