Table Of Contents
- Nasacort AQ Price Comparison Table
- Nasacort AQ Information
- Nasacort AQ Ingredients and Composition
- How Does Nasacort AQ Work?
- How To Take Nasacort AQ and Nasacort AQ Dosage and Administration
- If you suspect a Nasacort AQ Overdose
- Nasacort AQ Side Effects
- Nasacort AQ Warnings
- Contraindications to Nasacort AQ
- Nasacort AQ Clinical Trials and Studies
- Nasacort AQ Pill Identification / ID and Appearance
- Storing Nasacort AQ
- Credits for Nasacort AQ Information
Brand names: Nasacort, Nasacort AQ, Azmacort, Aristocort, Aristocort A
Nasacort AQ Price Comparison Table
| Product | Qty | Medical Fees & Shipping | Price/ Qty | Price | Click to Order |
|---|---|---|---|---|---|
| Nasacort AQ 55mcg 16.5gm | 1 | $15.00 | $140.00ea | $140.00 | Buy from RxPayouts |
| Nasacort AQ 55mcg 16.5gm | 2 | $15.00 | $104.00ea | $208.00 | Buy from RxPayouts |
| Nasacort AQ 55mcg 16.5gm | 3 | $15.00 | $96.33ea | $289.00 | Buy from RxPayouts |
| Product | Qty | Medical Fees & Shipping | Price/ Qty | Price | Click to Order |
|---|---|---|---|---|---|
| Nasacort AQ Nasal Spray | 1 | $18.00 | $99.00ea | $99.00 | Buy from IntegraRx |
| Nasacort AQ Nasal Spray | 2 | $18.00 | $84.50ea | $169.00 | Buy from IntegraRx |
| Product | Qty | Medical Fees & Shipping | Price/ Qty | Price | Click to Order |
|---|---|---|---|---|---|
| Nasacort Aq | 1 | $18.00 | $115.00ea | $115.00 | Buy from Billing-md |
| Nasacort Aq | 2 | $18.00 | $100.00ea | $200.00 | Buy from Billing-md |
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Nasacort AQ 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:
- For relief of asthma which can be controlled by bronchodilators and other non-steroid medications.
- In patients who require systemic corticosteroid treatment infrequently.
- 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 AQ Ingredients and Composition
Nasacort Nasal and Oral Inhalers and AQ Nasal Spray: Triamcinolone acetonide, USP, Nasal Inhaler, is a glucocorticosteroid with a molecular weight of 434.51 and with the chemical designation 9-Fluoro-11b, 16a, 17,21-tetrahydroxypregna-1, 4-diene-3,20-dione cyclic 16,17-acetal with acetone. (C24H31FO6).
Oral Inhaler
Nasacort Oral Inhaler is a metered-dose aerosol unit containing a microcrystalline suspension of triamcinolone acetonide in the propellant dichlorodifluoromethane and dehydrated alcohol USP 1% w/w. Each canister contains 60 mg triamcinolone acetonide. Each actuation releases approximately 200 mcg triamcinolone acetonide, of which approximately 100 mcg are delivered from the unit (in vitro testing). There are at least 240 actuations in one triamcinolone acetonide aerosol canister. After 240 actuations, the amount delivered per actuation may not be consistent and the unit should be discarded.
AQ Nasacort Nasal Spray
Triamcinolone Acetonide AQ Nasal Spray is an unscented, thixotropic, water-based metered-dose pump spray formulation unit containing a microcrystalline suspension of triamconolone acetonide in an aqueous medium. Microcrystalline cellulose, carboxymethylcellulose sodium, polysorbate 80, dextrose, benzalkonium chloride, and edetate disodium are contained in this aqueous medium; hydrochloric acid or sodium hydroxide may be added to adjust the pH to a target of 5.0 within a range of 4.5 and 6.0.
Each bottle contains 9.075 mg triamcinolone acetonide. Each actuation delivers 55 mcg triamcinolone acetonide from the nasal actuator to the patient (estimated from in vitro testing) after an initial priming of 5 sprays. It will remain adequately primed for 2 weeks. If the product is not used for more than 2 weeks, then it can be adequately reprimed with one spray. There are at least 120 actuations in one triamcinolone acetonide AQ nasal spray bottle. After 120 actuations, the amount of triamcinolone acetonide delivered per actuation may not be consistent and the unit should be discarded. In the manufacturer's original package insert, patients are provided with a check-off form to track usage in the Information for Patients tear-off sheet.
Nasal Inhaler
Nasacort Nasal Inhaler is a metered-dose aerosol unit containing a microcrystalline suspension of triamcinolone acetonide in dichlorodifluoromethane and dehydrated alcohol USP 0.7% w/w. Each canister contains 15 mg triamcinolone acetonide. Each actuation releases approximately 55 mcg triamcinolone acetonide from the nasal actuator to the patient (estimated from in vitro testing). There are at least 100 actuations in one triamcinolone acetonide Nasal Inhaler canister. After 100 actuations, the amount delivered per actuation may not be consistent and the unit should be discarded. Patients are provided with a check-off card to track usage as party of the Information for Patients tear-off sheet.
How Does Nasacort AQ 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 AQ and Nasacort AQ 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 AQ 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 AQ Side Effects
Nasacort Oral Inhaler: A few cases of oral candidiasis have been reported. In addition, some patients receiving triamcinolone acetonide Nasacort Oral Inhaler have experienced hoarseness, dry throat, irritated throat and dry mouth. Increased wheezing and cough have been reported infrequently as has facial edema. These Nasacort side effects have generally been mild and transient.
AQ Nasal Spray: In placebo-controlled, double-blind and open-label clinical studies, 1483 patients received treatment with triamcinolone acetonide aqeous nasal spray. These patients were treated for an average duration of 50.7 days. In the controlled trials (2-5 weeks duration) from which the following adverse reaction data is derived, 1394 patients were treated with the Nasacort AQ Nasal Spray for an average of 18.7 days. In the long-term, open-label study, the 172 patients received treatment for an average duration of 286 days.
As with any medication, you may experience additional Nasacort side effects.
Nasacort AQ Warnings
Nasacort Oral Inhaler: Particular care is needed in patients who are transferred from systemically active corticosteroids to triamcinolone acetonide Oral Inhaler because deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to aerosolized steroids in recommended doses. After withdrawal from systemic corticosteroids, a number of months is usually required for recovery of hypothalamic-pituitary- adrenal (HPA) function. For some patients who have received large doses of oral steroids for long periods of time before therapy with triamcinolone acetonide Oral Inhaler is initiated, recovery may be delayed for one year or longer. During this period of HPA suppression, patients may exhibit signs and symptoms of adrenal insufficiency when exposed to trauma, surgery or infections, particularly gastroenteritis or other conditions with acute electrolyte loss. Although Nasacort Oral Inhaler may provide control of asthmatic symptoms during these episodes, in recommended doses it supplies only normal physiological amounts of corticosteroid systemically and does NOT provide the increased systemic steroid which is necessary for coping with these emergencies.°During periods of stress or a severe asthmatic attack, patients who have been recently withdrawn from systemic corticosteroids such as Nasacort, should be instructed to resume systemic steroids (in large doses) immediately and to contact their physician for further instruction. These patients should also be instructed to carry a warning card indicating that they may need supplementary systemic steroids during periods of stress or a severe asthma attack.
Contraindications to Nasacort AQ
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 AQ Clinical Trials and Studies
Nasacort Nasal Inhaler In double-blind, parallel, placebo-controlled clinical trials of seasonal and perennial allergic rhinitis, in adults and adolescentes in fixed total daily doses of 110, 220 and 440 mcg per day, the responses to aerosolized triamcinolone acetonide demonstrated a statistically significant improvement over placebo. In open label trials where the doses were sometimes adjusted according to patients' signs and symptoms, the daily doses and regimens varied. The most commonly used dose was 110 mcg per day.
The Nasacort Nasal Inhaler, at a dose of 220 mcg once daily, has also been studied in two double blind placebo controlled trials of two and four weeks duration in children ages 6 through 11 years with seasonal and perennial allergic rhinitis. These trials included 162 males and 91 females. The nasal inhaler, administered at a fixed dose of 220 mcg once daily resulted in consistent and statistically significant reductions of allergic rhinitis symptoms over vehicle placebo.
In attempting to determine if systemic absorption played a role in the response to Nasacort, a clinical study comparing intranasal and depot intramuscular triamcinolone acetonide was conducted. The doses used were based on bioavailability studies of each formulation. The final doses of Nasacort (triamcinolone acetonide) 440 mcg once a day and Kenalog-40, 4 mg intramuscularly once a week, were chosen to deliver comparable total amounts of weekly triamcinolone acetonide. However, the weekly injection yielded sustained plasma levels throughout the dosing interval while the daily triamcinolone acetonide application resulted in daily peak and trough concentrations, the mean of which was 3.5 times below the Kenalog plasma levels. Both topical triamcinolone acetonide and intramuscular Kenalog-40 were clinically effective. In addition, in some studies there was evidence of improvement of eye symptoms. This suggests that triamcinolone acetonide, at least to some degree is acting by a systemic mechanism.
In order to evaluate the effects of systemic absorption on the Hypothalamic-Pituitary-Adrenal (HPA) axis, triamcinolone acetonide to adults in doses of 440 mcg once a day was compared to placebo and 42 days of a single morning dose of prednisone 10 mg. Adrenal response to a six-hour cosyntropin stimulation test suggests that intranasal triamcinolone acetonide 440 mcg/day for six weeks did not measurably affect adrenal activity. Conversely, oral prednisone at 10 mg/day significantly reduced the response to ACTH.
No evidence of adrenal axis suppression was observed in 26 pediatric patients exposed for 6 weeks to systemic levels of triamcinolone acetonide higher than the systemic levels observed following administration of the maximum recommended dose of triamcinolone acetonide nasal inhaler.
AQ Nasacort Nasal Spray: The safety and efficacy of triamcinolone acetonide AQ nasal spray has been evaluated in 10 double-blind, placebo-controlled clinical trials of two to four weeks in duration in adults and children 12 years and older with seasonal or perennial allergic rhinitis. The number of patients treated with the AQ nasal spray in these studies was 1266; of these patients, 675 were male and 591 were female.
Overall, the results of these Nasacort clinical trials showed that triamcinolone acetonide AQ nasal spray 220 mcg once daily (2 sprays in each nostril) when compared to placebo provides statistically significant relief of nasal symptoms including sneezing, stuffiness, discharge, and itching.
Nasacort AQ 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 AQ
Store Nasacort at controlled room temperature, 15-30°C (59-86°F). Protect from light; freezing, and heat.
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