triamcinolone acetonide extended-release injectable suspension

Action and Spectrum

Actions and Spectrum: 

triamcinolone acetonide is a synthetic corticosteroid medication that has anti-inflammatory and immunosuppressive properties. The extended-release injectable suspension formulation of triamcinolone acetonide is designed to provide a prolonged duration of action and sustained release of the medication over an extended period. 

When triamcinolone acetonide is administered as an extended-release injectable suspension, it is typically injected directly into the affected joint or soft tissue. The medication is slowly released from the suspension into the surrounding tissues, providing a localized and prolonged anti-inflammatory effect. 

The main action of triamcinolone acetonide is to reduce inflammation by suppressing the immune response and inhibiting the production of inflammatory mediators like the prostaglandins and leukotrienes. This can help to decrease symptoms associated with various inflammatory conditions, such as arthritis, bursitis, tendinitis, and other inflammatory joint or soft tissue disorders. 

The extended-release formulation of triamcinolone acetonide allows for a slower medication release than immediate-release formulations. This prolonged release helps maintain therapeutic levels of the drug in the target tissues for an extended period, thereby reducing the frequency of injections required and providing a more sustained and consistent anti-inflammatory effect. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10% 

Sinusitis (2%) 

Joint swelling (3%) 

Cough (2%) 

Contusions (2%) 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• Hypersensitivity: triamcinolone acetonide should not be used in individuals with known hypersensitivity or allergy to triamcinolone acetonide or other formulation components. Allergic reactions can range from mild skin reactions to severe systemic reactions, including anaphylaxis, a life-threatening allergic response. 
• Systemic Fungal Infections: The use of triamcinolone acetonide is contraindicated in individuals with systemic fungal infections unless the infection is being treated concomitantly with appropriate antifungal therapy. Corticosteroids like triamcinolone acetonide can suppress the immune system, making it harder for the body to fight fungal infections. 
• Live Vaccines: triamcinolone acetonide can interfere with the effectiveness of live vaccines. Therefore, administration of live vaccines is generally contraindicated in individuals receiving triamcinolone acetonide. It is key to consult a healthcare professional regarding appropriate vaccination schedules and considerations while using this medication. 
• Infection at the Injection Site: triamcinolone acetonide extended-release injectable suspension should not be administered if there is an existing infection at or near the injection site. The injection could introduce the medication directly into the infection, potentially worsening the condition or causing the spread of infection. 
• Joint Instability: The use of triamcinolone acetonide in joints with unstable or infected joint structures is contraindicated. This is because corticosteroids can weaken tissues and mask signs of infection or instability, potentially leading to further joint damage or complications. 
• Pediatric Patients: The safety and effectiveness of triamcinolone acetonide extended-release injectable suspension have not been established in pediatric patients, so its use in children is generally not recommended. 

Caution 

• Infection: Corticosteroids, including triamcinolone acetonide, can mask the signs and symptoms of infection or exacerbate existing infections. Close monitoring is necessary if there is a risk of a current infection, and appropriate anti-infective therapy should be administered. 
• Immunocompromised Patients: triamcinolone acetonide can suppress the immune system, which may increase the risk of infections in individuals with compromised immune function. Particular caution is needed when using triamcinolone acetonide extended-release injectable suspension in patients with conditions such as HIV/AIDS or those receiving immunosuppressive therapy. 
• Diabetes: triamcinolone acetonide can affect blood glucose levels, potentially leading to hyperglycemia (high blood sugar) or worsening glycemic control in patients with diabetes. Regular monitoring of blood glucose levels is recommended in diabetic patients receiving this medication, and adjustments to diabetes management may be necessary. 
• Ocular Herpes Simplex: The use of corticosteroids, including triamcinolone acetonide, in patients with ocular herpes simplex requires caution due to the potential for corneal perforation. Close monitoring is necessary, and if signs of herpes infection appear, appropriate therapy should be initiated. 
• Osteoporosis: Prolonged and high-dose corticosteroid therapy, including triamcinolone acetonide, can contribute to bone loss and increase the risk of osteoporosis. Caution should be exercised in patients with a history of osteoporosis or those at risk for developing it. Adequate calcium, vitamin D intake, and regular weight-bearing exercise should be encouraged. 
• Pregnancy and Breastfeeding: The use of triamcinolone acetonide during pregnancy condition and breastfeeding should be carefully considered. Corticosteroids may have the potential to cross the placenta and affect fetal development or be excreted in breast milk. The benefits and risks should be assessed in consultation with a healthcare professional. 
• Adrenal Insufficiency: Prolonged corticosteroids can suppress the adrenal glands, leading to adrenal insufficiency. Abrupt discontinuation of triamcinolone acetonide therapy after long-term use may cause an adrenal crisis. A gradual tapering of the medication should be considered when discontinuing treatment. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned. 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• <b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

triamcinolone acetonide extended-release injectable suspension is a synthetic corticosteroid with potent anti-inflammatory and immunosuppressive properties. When administered via injection, the suspension provides a prolonged and sustained release of triamcinolone acetonide into the targeted joint or soft tissue. triamcinolone acetonide binds to intracellular glucocorticoid receptors, regulating gene expression and subsequent modulation of inflammatory mediators.

It inhibits the synthesis of prostaglandins, leukotrienes, and other inflammatory cytokines, thereby reducing inflammation and suppressing the immune response. The extended-release formulation allows for a more prolonged duration of action, reducing the frequency of injections needed and providing sustained relief for inflammatory conditions such as osteoarthritis, rheumatoid arthritis, bursitis, tendinitis, and synovitis. 

Pharmacodynamics: 

Mechanism of action: The mechanism of action of triamcinolone acetonide extended-release injectable suspension is attributed to its properties as a synthetic corticosteroid. triamcinolone acetonide exerts its effects by binding to intracellular glucocorticoid receptors. Once bound, the drug-receptor complex translocates to the nucleus and modulates gene expression, leading to various pharmacological effects. 

triamcinolone acetonide has potent anti-inflammatory properties. It inhibits the synthesis and release of pro-inflammatory mediators, such as prostaglandins and leukotrienes. By suppressing the activity of phospholipase A2, triamcinolone acetonide reduces the production of arachidonic acid, the precursor of these inflammatory mediators. Consequently, the drug helps to dampen the inflammatory response and decrease the recruitment and activation of inflammatory cells. 

It also exhibits immunosuppressive actions. It inhibits the functions of immune cells, including lymphocytes, monocytes, and macrophages. By suppressing the immune response, the drug reduces the release of cytokines and chemokines, which play crucial roles in inflammation and immune-mediated processes. 

The extended-release formulation of triamcinolone acetonide allows for a slow and the sustained release of the drug, providing a longer action duration than immediate-release formulations. This sustained release maintains therapeutic drug levels in the target tissues for an extended period, reducing the frequency of the required injections. 

Pharmacokinetics: 

Absorption 

The absorption of triamcinolone acetonide from the injection site into the systemic circulation is minimal. 

Distribution 

Regarding distribution, triamcinolone acetonide is extensively bound to plasma proteins, primarily albumin. It has a relatively large volume of distribution due to its protein binding. 

Metabolism 

Metabolism of triamcinolone acetonide primarily occurs in the liver, undergoing extensive biotransformation. It is metabolized mainly by hepatic enzymes, including cytochrome P450 enzymes, into inactive metabolites. 

Elimination and Excretion 

The excretion of triamcinolone acetonide and its metabolites primarily occurs via the kidneys. The exact mechanisms and routes of excretion are not extensively documented, but the drug and its metabolites are likely eliminated in urine. 

Adminstartion

Administration: 

triamcinolone acetonide extended-release injectable suspension is typically administered by a healthcare professional, such as a physician or a nurse, who has experience in joint or soft tissue injections. The specific administration technique may vary depending on the target area and the condition being treated.  

• Preparation: The healthcare professional will prepare the extended-release injectable suspension syringe. The suspension should be inspected visually for any particulate matter or discoloration. If any abnormalities are noticed, the suspension should not be used. 
• Site Preparation: The injection site should be cleaned thoroughly with an antiseptic solution to reduce the risk of infection. Sterile techniques should be followed throughout the procedure. 
• Injection Technique: triamcinolone acetonide extended-release injectable suspension is typically administered directly into the affected joint or soft tissue. The healthcare professional will deliver the medication with a sterile needle and syringe. The needle size and injection technique may vary depending on the specific situation. 
• Aspiration: Before injecting the suspension, the healthcare professional may perform an aspiration to ensure the needle is not within a blood vessel. This helps to minimize the risk of inadvertent intravascular injection. 
• Injection: Once proper needle placement is confirmed, the healthcare professional will slowly inject the triamcinolone acetonide extended-release injectable suspension into the target area. The medication is designed to provide a prolonged release, so the injection process may take some time to ensure the proper delivery of the suspension. 
• Post-Injection Care: The healthcare professional may apply a sterile bandage or dressing to the injection site as needed. Patients may be instructed to rest or limit movement of the treated joint or area as advised by the healthcare professional. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: triamcinolone acetonide extended-release injectable suspension 

Why do we use triamcinolone acetonide extended-release injectable suspension? 

triamcinolone acetonide extended-release injectable suspension manages various inflammatory conditions involving joints or soft tissues. 

• Osteoarthritis: triamcinolone acetonide extended-release injectable suspension can provide symptomatic relief in patients with osteoarthritis. It helps reduce joint inflammation and alleviate pain and stiffness associated with the condition. 
• Rheumatoid Arthritis: In patients with rheumatoid arthritis, triamcinolone acetonide extended-release injectable suspension may be used to manage joint inflammation and relieve pain and swelling. 
• Bursitis: It is the inflammation of the fluid-filled sacs (bursae) that cushion the joints. triamcinolone acetonide extended-release injectable suspension can be administered directly into the affected bursa to reduce inflammation and relieve pain. 
• Tendinitis: It is the inflammation of a tendon, usually caused by repetitive movements or injury. triamcinolone acetonide extended-release injectable suspension may alleviate the inflammation and discomfort associated with tendinitis. 
• Synovitis: Synovitis is the synovial membrane inflammation, which lines the joints. triamcinolone acetonide extended-release injectable suspension can help reduce inflammation and associated symptoms. 
• Soft Tissue Inflammation: triamcinolone acetonide extended-release injectable suspension may manage inflammation in various soft tissues, such as ligaments and muscles. It can relieve pain, swelling, and limited mobility caused by soft tissue inflammation.