Nasacort

Buy Nasacort

Nasacort Information

Brand Name: Nasacort

Generic Names: Triamcinolone acetonide

Other Common Names: Nasacort AQ

Nasacort (Triamcinolone acetonide) is a corticosteroid product used primarily for its ability to decrease inflammation and relieve irritation. It is available as a nasal inhaler or an oral inhaler to decrease inflammation in the lungs of those with asthma or allergies.

Nasacort Indications

Oral Inhaler: Nasacort (Triamcinolone acetonide) Oral Inhaler is indicated only for patients who require chronic treatment with corticosteroids for the control of the symptoms of bronchial asthma. Such patients would include those already receiving systemic corticosteroids and selected patients who are inadequately controlled on a non-steroid regimen and in whom steroid therapy has been withheld because of concern over potential adverse effects.

Nasacort oral inhaler is NOT indicated:

1. For relief of asthma which can be controlled by bronchodilators and other non-steroid medications.
2. In patients who require systemic corticosteroid treatment infrequently.
3. In the treatment of non-asthmatic bronchitis.

AQ Nasal Spray: Triamcinolone Acetonide AQ Nasal Spray is indicated for the treatment of seasonal and perennial allergic rhinitis symptoms.

Nasal Inhaler: Triamcinolone acetonide Nasal Inhaler is indicated for the nasal treatment of seasonal and perennial allergic rhinitis symptoms in adults and children 6 years of age and older.

Dental Paste: Triamcinolone acetonide dental paste is indicated for adjunctive treatment and for the temporary relief of symptoms associated with oral inflammatory lesions and ulcerative resulting from trauma.

Injection-10: Intra-Articular: Triamcinolone acetonide Injection-10 is indicated for intra-articular or intrabursal administration, and for injection into tendon sheaths, as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: synovitis of osteoarthritis, rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific, tenospecific, and posttraumatic osteoarthritis.

Intradermal: Intralesional administration is indicated for the treatment of keloids, discoid lupus erythematosus, necrobiosis, lipoidica, diabeticorum, alopecia areata, and localized hypertrophic, infiltrated, inflammatory lesions of: licheplanus, psoriatic plaques, granuloma annulare, and lichen simplex chronicus (neurodermatitis). This drug may be useful in cystic tumors of an aponeurosis or tendon (ganglia).

Injection-40: Intramuscular: When oral therapy is not feasible or is temporarily undesirable in the judgement of the physician, triamcinolone acetonide Injection-40 is indicated for IM use as follows:

Endocrine disorders: Nonsuppurative thyroiditis

Rheumatic disorders: As adjunctive therapy for short-term administration (to side the patient over an acute episode or exacerbation) in: posttraumatic osteoarthritis; synovitis of osteoarthritis; rheumatoid arthritis; acute and subacute bursitis; epicondylitis; acute nonspecific tenosynovitis; acute gouty arthritis; psoriatic arthritis; ankylosing spondylitis; juvenile rheumatoid arthritis.

Collagen disease: During an exacerbation or as maintenance therapy in selected cases of: systemic lupus erythematosus; acute rheumatic carditis.

Dermatologic diseases: Pemphigus: severe erythema multiforme (Stevens-Johnson syndrome); exfoliative dermatitis; bullous dermatitis herpetiformis; severe seborrheic dermatitis; severe psoriasis.

Allergic states: Controls of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in: bronchial asthma; contact dermatitis; atopic dermatitis; seasonal or perennial allergic rhinitis.

Ophthalmic diseases: Severe chronic allergic and inflammatory processes involving the eye, such as: herpes zoster ophthalmicus; iritis; iridocyclitis; chorioretinitis; diffuse posterior uveitis and choroiditis; optic neuritis; sympathetic ophthalmia; anterior segment inflammation.

Gastrointestinal diseases: To tide the patient over a critical period of disease in: ulcerative colitis (systemic therapy); regional enteritis (systemic therapy).

Respiratory diseases: Symptomatic sarcoidosis; berylliosis; aspiration pneumonitis.

Hematologic disorders: Acquired (autoimmune) hemolytic anemia.

Neoplastic diseases: For palliative management of: leukemias and lymphomas in adults; acute leukemia of childhood.

Edematous state: To induce diuresis or remission of proteinuria in the nephrotic syndrome without uremia, of the idiopathic type or that due to lupus erythematosus.

Intra-Articular: Nasacort is indicated for the intra-articular or intrabursal administration, and for injections into tendon sheaths as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: synovitis of osteoarthritis; rheumatoid arthritis; epicondylitis; acute nonspecific tenosynovitis; post traumatic osteoarthritis

Aerosol Spray: Nasacort aerosol spray is indicated for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Cream: (All Strengths) Indicated for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Ointment: (All Strengths) Indicated for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Nasacort Ingredients and Composition

How Does Nasacort Work?

Nasacort Oral Inhaler

The precise mechanism of the action of the inhaled drug is unknown. However, use of the inhaler makes it possible to provide effective local steroid activity with minimal systemic effect.

Triamcinolone acetonide, the active ingredient in Nasacort, is a more potent derivative of triamcinolone. Although triamcinolone itself is approximately one to two times as potent as prednisone in animal models of inflammation, triamcinolone acetonide is approximately 8 times more potent than prednisone.

Pharmacokinetic studies with radiolabeled triamcinolone acetonide have been carried out by the oral route and intravenous route in several species. The pharmacokinetic behavior of the triamcinolone acetonide was similar in all species within each route of administration. The major portion of the dose was eliminated in the feces irrespective of route of administration with only one species (rabbit) showing significant urinary excretion of radioactivity.

The results of studies in which triamcinolone acetonide, the active ingredient in Nasacort, was administered as an aerosol showed rapid disappearance of radioactivity from the lungs comparable to that observed following oral administration with peak blood levels occurring in one to two hours. Virtually no radioactivity was present in the lung and trachea 24 hours after dosing.

Based upon intravenous dosing of triamcinolone acetonide phosphate ester, the half-life of triamcinolone acetonide was reported to be 88 minutes. The volume of distribution (Vd) reported was 99.5 L (SD ± 27.5) and clearance was 45.2 L/hour (SD ± 9.1) for triamcinolone acetonide. The plasma half-life of corticoids does not correlate well with the biologic half-life.

Three metabolites of triamcinolone acetonide have been identified. They are 6b-hydroxytriamcinolone acetonide, 21-carboxytriamcinolone acetonide and 21-carboxy-6b-hydroxytriamcinolone acetonide. All three metabolites are expected to be substantially less active than the parent compound due to (a) the dependence of anti-inflammatory activity on the presence of anti-inflammatory activity on the presence of a 21-hydroxyl group, (b) the decreased activity observed upon 6-hydroxylation, and (c) the markedly increased water solubility favoring rapid elimination. There appeared to be some quantitative differences in the metabolites among species. No differences were detected in metabolic pattern as a function of route of administration.

Nasacort Nasal Inhaler and AQ Nasacort Nasal Spray

Triamcinolone acetonide is a more potent derivative of triamcinolone. Although triamcinolone itself is approximately one to two times as potent as prednisone in animal models of inflammation, triamcinolone acetonide is approximately 8 times more potent than prednisone.

Although the precise mechanism of corticosteroid antiallergic action is unknown, corticosteroids are very effective. However, they do not have an immediate effect on allergic signs and symptoms. When allergic symptoms are very severe, local treatment with recommended doses (microgram) of any available topical corticosteroids are not as effective as treatment with larger doses (milligram) of oral or parenteral formulations. When corticosteroids are prematurely discontinued symptoms may not recur for several days.

Based upon intravenous dosing of triamcinolone acetonide phosphate ester, the half-life of triamcinolone acetonide was reported to be 88 minutes. The volume of distribution (Vd) reported was 99.5 L (SD ± 27.5) and clearance was 45.2 L/hour (SD ± 9.1) for triamcinolone acetonide. The plasma half-life of corticosteroids does not correlate well with the biologic half-life.

Pharmacokinetic characterization of the triamcinolone acetonide AQ Nasacort nasal spray formulation was determined in both normal subjects and in patients with allergic rhinitis. Single dose intranasal administration of 220 mcg of the AQ nasal spray in normal subjects and patients demonstrated minimal absorption of triamcinolone acetonide. The mean peak plasma concentration was approximately 0.5ng/mL (range: 0.1 to 1.0 ng/mL) and occurred at 1.5 hours post dose. THe mean plasma drug concentration was less than 0.06 ng/mL at 12 hours, and below the assay detection limit at 24 hours. The average terminal half-life was 3.1 hours. The range of mean AUC 0 -∞ values was 1.4 ng•hr/mL between doses of 110 mcg to 440 mcg in both patients and healthy volunteers. Dose proportionality was demonstrated in both normal subjects and in allergic rhinitis patients following single intranasal doses of 110 mcg or 220 mcg triamcinolone acetonide AQ nasal spray. The Cmax and AUC of the 440 mcg dose increased less than proportionally when compared to 110 and 220 mcg doses.

When administered intranasally to humans at 440 mcg/day dose, the peak plasma concentration was <1 ng/ml and occurred on average at 3.4 hours (range 0.5 - 8.0 hours) post dosing. The apparent half-life was 4.0 hours (range 1.0 - 7.0 hours); however, this value probably reflects lingering absorption. Intranasal doses below 440 mcg/day gave sparse data and did not allow for the calibration of meaningful pharmacokinetic parameters.

In animal studies using rats and dogs, three metabolites of triamcinolone acetonide, the active ingredient in Nasacort, have been identified. They are 6b-hydroxytriamcinolone acetonide, 21-carboxytriamcinolone acetonide and 21-carboxy-6b-triamcinolone acetonide. All three metabolites are expected to be substantially less active than the parent compound due to (a) the dependence of anti-inflammatory activity on the presence of 21-hydroxyl group, (b) the decreased activity observed upon hydroxylation, and (c) the markedly increased water solublity favoring rapid elimination. There appeared to be some quantitative differences in the metabolites among species. No differences were detected in metabolic pattern as a function of route of adminstration.

How To Take Nasacort and Nasacort Dosage and Administration

Nasacort Oral Inhaler

All patients should be instructed that the triamcinolone acetonide Oral Inhaler must be used on a regular daily basis rather than prn. Reliable dosage delivery cannot be assured after 240 actuations and patients should be cautioned against longer use of individual canisters.

Good oral hygiene including rinsing of the mouth after inhalation is recommended.

Adults: The usual dosage is two inhalations (approximately 200 mcg) given three to four times a day. The maximum daily intake should not exceed 16 inhalations (1600 mcg) in adults. Higher initial doses (12 to 16 inhalations per day) may be advisable in patients with more severe asthma, the dosage then being adjusted downward according to the response of the patient. In some patients maintenance can be accomplished when the total daily dose is given on a twice a day schedule.

Children 6 to 12 years of age: The usual dosage is two inhalations (100 to 200 mcg) given three or four times a day according to the response of the patient. The maximal daily intake should not exceed 12 inhalations (1200 mcg) in children 6 to 12 years of age. Insufficient clinical data exist with respect to the administration of triamcinolone acetonide Oral Inhaler in children below the age of 6. The long-term effects of inhaled steroids on growth are still under evaluation.

Patients receiving bronchodilators by inhalation should be advised to use the bronchodilator before triamcinolone acetonide Oral Inhaler in order to enhance penetration of triamcinolone acetonide into the bronchial tree. After use of an aerosol bronchodilator, several minutes should elapse before use of the triamcinolone acetonide Oral Inhaler to reduce the potential toxicity from the inhaled fluorocarbon propellants in the two aerosols.

Different considerations must be given to the following groups of patients in order to obtain the full therapeutic benefit of triamcinolone acetonide Oral Inhaler:

Patients Not Receiving Systemic Steroids: The use of Nasacort Oral Inhaler is straightforward in patients who are inadequately controlled with non-steroid medications but in whom systemic steroid therapy has been withheld because of concern over potential adverse reactions. In patients who respond to triamcinolone acetonide, an improvement in pulmonary function is usually apparent within one to two weeks after the start of triamcinolone acetonide Oral Inhaler.

Patients Receiving Systemic Steroids: In those patients dependent on systemic steroids, transfer to triamcinolone acetonide Oral Inhaler and subsequent management may be more difficult because recovery from impaired adrenal function is usually slow. Such suppression has been known to last up to 12 months or longer. Clinical studies, however, have demonstrated that triamcinolone acetonide Oral Inhaler may be effective in the management of these asthmatic patients and may permit replacement or significant reduction in the dosage of systemic corticosteroids.

The patient's asthma should be reasonably stable before treatment with Nasacort Oral Inhaler is started. Initially, the inhaler should be used concurrently with the patient's usual maintenance dose of systemic steroid. After approximately one week, gradual withdrawal of the systemic steroid is started by reducing the dose. The next reduction is made after an interval of one or two weeks, depending on the response of the patient. Generally, these decrements should not exceed 2.5 mg of prednisone or its equivalent. A rate of withdrawal cannot be overemphasized. During withdrawal, some patients may experience symptoms of systemically active steroid withdrawal, e.g., joint and/or muscular pain, lassitude and depression, despite maintenance or even improvement of respiratory function. Such patients should be encouraged to continue with the inhaler but should be watched carefully for objective signs of adrenal insufficiency, such as hypotension and weight loss. If evidence of adrenal insufficiency occurs, the systemic steroid dose should be boosted temporarily and thereafter further withdrawal should continue more slowly. No clinical studies have been conducted evaluating triamcinolone acetonide with alternate day prednisone regimens. However, based on the results of such a study with another inhaled corticosteroid, inhaled corticosteroids generally are not recommended for chronic use with alternate day prednisone regimens.

During periods of stress or a severe asthma attack, transfer patients will require supplementary treatment with systemic steroids. Exacerbations of asthma which occur during the course of treatment with triamcinolone acetonide Oral Inhaler should be treated with a short course of systemic steroid which is gradually tapered as these symptoms subside. There is no evidence that control of asthma can be achieved by administration of triamcinolone acetonide Oral Inhaler in amounts greater than the recommended doses.

Contents under pressure. Do not puncture. Do not use or store near heat or an open flame. Exposure to temperatures above 120°F may cause bursting. Never throw container into fire or incinerator. Keep out of reach of children.

Store at room temperature.

Nasacort Nasal Inhaler and AQ Nasal Spray

A decrease in symptoms may occur as soon as 12 hours after starting steroid therapy and generally can be expected to occur within a few days of initiating therapy in allergic rhinitis.

If improvement is not evident after 2-3 weeks, the patient should be re-evaluated or discontinue treatment.

Adults and Children 12 years of age and older: The recommended starting dose of Nasacort Nasal Inhaler is 220 mcg per day given as two sprays (approximately 55 mcg/spray) in each nostril once a day. If needed, the dose may be increased to 440 mcg per day (approximately 55 mcg/spray) either as once a day dosage or divided up to four times a day (i.e., twice a day [two sprays/nostril] or four times a day [one spray/nostril]). After the desired effect is obtained, some patients may be maintained on a dose of as little as one spray (approximately 55 mcg) in each nostril once a day (total daily dose 110 mcg per day).

Children 6 Through 11 Years of Age: The recommended starting dose of triamcinolone acetonide nasal ihaler is 220 mcg per day given as two sprays (55 mcg/spray) in each nostril once a day. Once the maximal effect has been achieved, it always desirable to titrate the patient to the minimum effective dose.

Triamcinolone Acetonide Nasal Inhaler is not recommended for children below 6 years of age since adequate numbers of patients have not been studied in this age group.

Directions for Use: Illustrated Patient's Instructions for use accompany each package of Triamcinolone Acetonide Nasal Inhaler.

Contents under pressure. Do not puncture. Avoid spraying in eyes. Do not use or store near heat or open flame. Exposure to temperatures above 120° F may cause bursting. Never throw container into fire or incinerator. Keep out of reach of children.

Note: The following statement is required by the Federal government's Clean Air Act for all products containing or manufactured with chlorofluorocarbons (CFC's):

WARNING: Contains CFC-12, a substance which harms public health and enviroment by destroying ozone in the upper atmosphere. A notice similar to the above WARNING has been placed in the Information for the Patient portion of this monograph pursuant to EPA regulations.

Dental Paste

Press a small dab (about 1/4 inch) to the lesion until a thin film develops. A larger quantity may be required for coverage of some lesions. For optimal results use only enough to coat the lesion with a thin film. Do not rub in. Attempting to spread this preparation may result in a granular, gritty sensation, however, a smooth slippery film develops.

The preparation should be applied at bedtime to permit steroid contact with the lesion throughout the night. Depending on the severity of symptoms, it may be necessary to apply the preparation two or three times a day, preferably after meals. If significant repair or regeneration has not occurred in seven days, further investigation is advisable.

Injection-10

Dosage: The initial dose for intra-articular or intrabursal administration and for injection into tendon sheaths may vary from 2.5 to 5 mg for smaller joints and from 5 to 15 mg for larger joints depending on the specific disease entity being treated. Single injections into several joints for multiple locus involvement, up to 20 mg or more, have been given without incident. For intradermal administration, the initial dose of triamcinolone acetonide will vary depending upon the specific disease entity being treated but should be limited to 1.0 mg (0.1 ml) per injection site, since larger volumes are more likely to produce cutaneous atrophy. Multiple sites (separated by one centimeter or more) may be injected, keeping in mind that the greater the total volume employed the more corticosteroids become available for possible systemic absorption and subsequent corticosteroid effects. Such injections may be repeated, if necessary, at weekly or less frequent intervals.

The lower dosages in the initial dosage range of Nasacort may produce the desired effect when the corticosteroid is administered to provide a localized concentration. The site of the injection and the volume of the injection should be carefully considered when triamcinolone acetonide is administered for this purpose. The initial dosage should be maintained for this purpose. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, this drug should be discontinued and the patient transferred to other appropriate therapy. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness, and the effect of the patient's individual drug responsiveness,a nd the effect of the patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of this drug for a period of time consistent with the patients's condition. If Nasacort is to be stopped after long-term therapy, it is recommended that it be withdrawn gradually rather than abruptly.

Injection-10 Administration

Shake the vial before use to insure a uniform suspension. Prior to withdraw, inspect suspension for clumping or granular appearance (agglomeration). An agglomerated product results from exposure to freezing temperatures and should not be used. After withdraw, inject without delay to prevent settling in the syringe. Careful technique should be employed to avoid the possibility of entering a blood vessel or introducing infection.

Routine laboratory studies, such as urinalysis, two-hour postprandial blood sugar, determination of blood pressure and body weight, and a chest x-ray should be made at regular intervals during prolonged therapy. Upper GI x-rays are desirable with an ulcer history or significant dyspepsia.

For treatment of joints, the usual intra-articular Injection technique as described in standard textbooks, should be followed. If excessive amount of synovial fluid is present in the joint, some but not all, should be aspirated to aid in the relief of pain and to prevent undue dilation of the steroid.

With intra-articular or intrabursal administration, and with injection of this drug into tendon sheaths, the use of a local anesthetic is used, its package insert should be read with care and all the precautions connected with its use should be observed. It should be injected into the surrounding soft tissues prior to the injection of the injection of the corticosteroid. A small amount of the anesthetic solution may be instilled into the joint.

In treating acute nonspecific tenosynovitis, care should be taken to insure that the injection of this drug is made into the tendon sheath rather than the tendon substance. Epicondylitis (tennis elbow) may be treated by infiltrating the preparation into the area of greatest tenderness.

For treatment of dermal lesions, inject Nasacort directly into the lesion, i.e, intradermally or sometimes subcutaneously. For accuracy of dosage measurement and ease of administration, it is preferable to employ a tuberculin syringe and a small-bore needle (23 to 25 gauge). Ethyl chloride spray may be used to alleviate the discomfort of the injection.

Injection-40

The initial Nasacort dose may vary from 2.5 to 60 mg per day. Depending on the specific disease entity being treated. In situations of less severity, lower doses will generally suffice while in selected patients higher initial doses may be required. Usually the parenteral dosage ranges are about 1/3 to 1/2 of the oral dose given every 12 hours. However in certain overwhelming, acute, life-threatening situations, administrations of dosages exceeding the usual dosages may be justified and may be in multiples of the usual dosages.

The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, this drug should be discontinued and the patient transferred to other appropriate therapy.

IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient's individual drug responsiveness, and the effect of the patient's individual drug responsiveness,a nd the effect of the patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of this drug for a period of time consistent with the patients's condition. If the drug is to be stopped after long-term therapy, it is recommended that it be withdrawn gradually rather than abruptly.

Injection-40 Dosage

Systemic: Although this drug may be administered for most initial therapy, most physicians's prefer to adjust the dose orally until adequate control is attained. IM administration provides a sustained or depot action which can be used to supplement or reduce initial oral therapy. With IM therapy, greater supervision of the amount of steroid used is made possible in the patient who is inconsistent in following an oral dosage schedule. In maintenance therapy, the patient-to-patient response is not uniform and, therefore, the dose must be individualized for optimal control.

For Adults And Children Over 12 Years Of Age: The suggested initial dose is 60 mg, injected deeply into the gluteal muscle. Subcutaneous fat atrophy may occur if care is not taken to inject the preparation intramuscularly. Dosage is usually adjusted within the range of 40 to 80 mg depending upon the patient response and duration of relief. However, some patients may be well controlled on dosages as low as 20 mg or less patients with hay fever or pollen asthma who are not responding to pollen administration and other conventional therapy may obtain a remission of symptoms lasting throughout the pollen season after one injection of 40 to 100 mg.

For Children From 6 To 12 Tears Of Age: The suggested initial dose is 40 mg, although dosage depends more upon the severity of symptoms than on age or weight. There is insufficient clinical experience with this drug to recommend its use in children under six years of age.

Local: For intra-articular or intra-bursal administration and for injection into tendon sheaths, the initial Nasacort dose may vary from 2.5 to 5 mg for smaller joints and from 5 to 15 mg for larger joints depending on the specific disease entity being treated, (A more dilute form of sterile triamcinolone acetonide Suspension USP is available). For adults, doses of up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient to alleviate symptoms. Single injections into several joints for multiple locus involvement, up to a total of 80 mg, have been given without undue reactions. A single local infection of triamcinolone acetonide is frequently sufficient, but several injections may be needed for adequate relief of symptoms. The lower dosages in the initial dosage range of triamcinolone acetonide may produce the desired effect when the corticosteroid is administered to provide a localized concentration. The site of injection and the volume of the injection should be carefully considered when triamcinolone acetonide is administered for this purpose.

Injection-40 Administration

General: Shake the vial before use to insure a uniform suspension. Prior to withdraw, inspect suspension for clumping or granular appearance (agglomeration). An agglomerated product results from exposure to freezing temperatures and should not be used. After withdraw, inject without delay to prevent settling in the syringe. Careful technique should be employed to avoid the possibility of entering a blood vessel or introducing infection.

Routine laboratory studies, such as urinalysis, two-hour postprandial blood sugar, determination of blood pressure and body weight, and a chest x-ray should be made at regular intervals during prolonged Nasacort therapy. Upper GI x-rays are desirable with an ulcer history or significant dyspepsia.

Systemic: For systemic therapy, injection should be made deeply into the gluteal muscles to insure IM delivery. For adults, a minimum needle length of 1 1/2 inches is recommended. In obese patients, a longer needle may be required. Use alternate sites for subsequent injections.

Local: For treatment of joints, the usual intra-articular Injection technique as described in standard textbooks, should be followed. If excessive amount of synovial fluid is present in the joint, some but not all, should be aspirated to aid in the relief of pain and to prevent undue dilation of the corticosteroid.

With intra-articular or intrabursal administration, and with injection of this drug into tendon sheaths, the use of a local anesthetic is used, its package insert should be read with care and all the precautions connected with its use should be observed. It should be injected into the surrounding soft tissues prior to the injection of the injection of the corticosteroid. A small amount of the anesthetic solution may be instilled into the joint.

In treating acute nonspecific tenosynovitis, care should be taken to insure that the injection of this drug is made into the tendon sheath rather than the tendon substance. Epicondylitis (tennis elbow) may be treated by infiltrating the preparation into the area of greatest tenderness.

Aerosol Spray

Directions for use of the spray can are provided on the label. The preparation may be applied to any surface area of the body, but when it is sprayed about the face, care should be taken to see that the eyes are covered, and that inhalation of the spray is avoided.

Three or four applications daily of Nasacort aerosol spray are generally adequate.

Occlusive Dressing Technique

Occlusive dressings may be used for the management of psoriasis or other recalcitrant conditions. Spray a small amount of Nasacort onto the lesion, cover a small amount of the preparation onto the lesion, cover with pliable nonporous film, and seal the edges. If needed, additional moisture may be provided by covering the lesion with a dampened clean cotton cloth before the nonporous film is applied or by briefly wetting the affected the area with water immediately prior to applying the medication. The frequency of changing dressings is best determined on an individual basis. It may be convenient to apply the spray under an occlusive dressing in the evening and to remove the dressing in the morning (i.e., 12-hour occlusion). When utilizing the 12-hour occlusion regimen, additional spray should be applied, without occlusion, during the day. Reapplication is essential at each dressing change.

Apply a thin film of the 0.1% or the 0.5% triamcinolone acetonide ointment as appropriate, to the affected areas two or three times daily. Rub gently.

Cream: (All Strengths) Apply a thin film of triamcinolone acetonide cream, 0.025% to the affected area two to four times daily. Rub in gently.

If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.

If you suspect a Nasacort Overdose

Nasacort Nasal Inhaler: Acute overdosage with this dosage form is unlikely. The acute topical application of the entire 15 mg of the canister would most likely cause nasal irritation and headache. It would be unlikely to see acute systemic adverse effects if the nasal application of the 15 mg of triamcinolone acetonide was administered all at once.

AQ Nasacort Nasal Spray: Like any other nasally administered corticosteroid acute overdosing is unlikely in view of the total amount of active ingredient present. In the event that the entire contents of the bottle were administered all at once, via either oral or nasal application, clinically significant systemic adverse events would most likely not result. The patient may experience some gastrointestinal upset.

Aerosol Spray, Cream and Ointment: Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects.

Nasacort Side Effects

Nasacort Warnings

Contraindications to Nasacort

Nasacort Oral Inhaler: Triamcinolone acetonide Oral Inhaler is contraindicated in the primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required.

Oral and Nasal Inhalers and AQ Nasacort Nasal Spray: Hypersensitivity to any of the ingredients of this preparation contraindicates its use.

Aerosol Spray, Cream and Ointment: Topical corticosteroids are contraindicated in those patients with a history of hypersensitivity to any of the components of the preparations.

Nasacort Clinical Trials and Studies

Nasacort Pill Identification / ID and Appearance

AQ Nasal Spray

Nasacort (Triamcinolone Acetonide AQ Nasal Spray is a nonchlorofluorocarbon (CFC) containing metered-dose pump spray which will provide 120 actuations. Net weight of the bottle contents is 16.5 grams.

It is supplied in a high-density polyethylene container with a metered-dose pump unit, nasal adapter, and patient instructions

Storing Nasacort

Store Nasacort at controlled room temperature, 15-30°C (59-86°F). Protect from light; freezing, and heat.

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