triamcinolone acetonide
Azmacort
Pregnancy Risk Category C
How supplied
Inhalation aerosol: 100 mcg/metered spray
Action
Unknown. May decrease inflammation through inhibitory activities against such cell types as mast cells and macrophages and mediators such as leukotrienes.
Indications & dosage
Persistent asthma--
Adults: 2 inhalations t.i.d. to q.i.d. Maximum dose is 16 inhalations daily. In some patients, maintenance can be accomplished when total daily dose is given b.i.d.
Children ages 6 to 12: 1 to 2 inhalations t.i.d. to q.i.d. Maximum dose is 12 inhalations daily.
Adverse reactions
EENT: dry or irritated nose or throat, hoarseness, pharyngitis, oral candidiasis, dry or irritated tongue or mouth.
Metabolic: hypothalamic-pituitary-
adrenal function suppression, adrenal insufficiency.
Respiratory: cough, wheezing.
Other: facial edema.
Interactions
None significant.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug or its ingredients and in those with status asthmaticus.
Nursing considerations
- Use with extreme caution, if at all, in patients with tuberculosis of the respiratory tract; untreated fungal, bacterial, or systemic viral infections; or ocular herpes simplex.
- Unlike other available corticosteroids, drug has a spacer built into the drug-delivery device.
- Use cautiously in patients receiving systemic corticosteroids.
- Most adverse reactions to corticosteroids are dose- or duration-dependent.
- Patients who have recently been switched from systemic administration of steroids to oral inhaled steroids may need to resume systemic steroid therapy during periods of stress or severe asthma attacks.
- Taper oral therapy slowly, as ordered.
- Store drug between 59° and 86° F (15° and 30° C).
- It isn't known whether drug appears in breast milk. Because of risk of severe adverse effects, breast-feeding isn't recommended during therapy.
- Alert:
Don't confuse triamcinolone with Triaminicin or Triaminicol.
Patient teaching
- Inform patient that inhaled corticosteroids don't provide relief for emergency asthma attacks.
- Advise patient to warm canister to room temperature before using. Some patients carry canister in a pocket to keep it warm.
- Tell patient requiring a bronchodilator to use it several minutes before triamcinolone. Tell patient to allow 1 minute to elapse before repeat inhalations and to hold breath for a few seconds to enhance drug action.
- Teach patient to check mucous membranes frequently for signs of fungal infection.
- Tell patient to prevent oral fungal infections by gargling or rinsing mouth with water after each use of the inhaler, but not to swallow the water.
- Tell patient to keep inhaler clean and unobstructed and to wash it with warm water and dry it thoroughly after use.
- Instruct patient to contact doctor if response to therapy decreases; dosage may need adjustment. Tell him not to exceed recommended dosage on his own.
- Instruct patient to carry a card indicating his need for supplemental systemic glucocorticoids during periods of stress.
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING