Version May 2024
Note: For patients with mucous crusting, rinsing with saline nasal spray before triamcinolone administration can remove mucous crusting and improve nasal coating (Ref). If nasal obstruction is so severe that sprays cannot penetrate, consider concomitant use of an intranasal decongestant for up to 5 days (Ref).
Acute bacterial rhinosinusitis, adjunct to antibiotics (empiric treatment) (off-label use): Note: Dosing recommendations based on general dosing range in manufacturer's labeling. Intranasal: Two sprays (110 mcg) in each nostril once daily.
A llergic r hinitis : Intranasal: Two sprays (110 mcg) in each nostril once daily; once symptoms are controlled, reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if adequate symptomatic relief is not observed within 3 weeks (Ref).
N onallergic r hinitis (off-label use): Intranasal: 2 sprays (110 mcg) in each nostril once daily (Ref).
Rhinosinusitis, c hronic (off-label use): Note: Dosing recommendations based on general dosing range in manufacturer's labeling. Intranasal: Two sprays (110 mcg) in each nostril once daily.
Upper respiratory allergies (OTC): Intranasal: Two sprays (110 mcg) in each nostril once daily; once symptoms are controlled, reduce to 1 spray (55 mcg) in each nostril once daily (maximum: 2 sprays [110 mcg] in each nostril once daily). Discontinue therapy if adequate symptomatic relief is not observed within 1 week.
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).
Refer to adult dosing.
(For additional information see "Triamcinolone (nasal): Pediatric drug information")
Allergic r hinitis (seasonal and perennial): Discontinue treatment and contact health care provider if adequate control of symptoms has not occurred after 3 weeks of use (1 week if OTC use): Intranasal: 55 mcg/spray:
Children 2 to <6 years: One spray per nostril once daily. (Total daily dose 110 mcg/day). Maximum daily dose: 1 spray per nostril/day (110 mcg/day)
Children 6 to <12 years: Initial: One spray per nostril once daily (Total daily dose: 110 mcg/day); may increase to 2 sprays per nostril once daily if response not adequate (Total daily dose 220 mcg/day); once symptoms are controlled, reduce to 1 spray per nostril once daily (Total daily dose 110 mcg/day). Maximum daily dose: 2 sprays per nostril/day (220 mcg/day)
Children ≥12 years and Adolescents: Initial: Two sprays per nostril once daily (Total daily dose: 220 mcg/day); once symptoms are controlled, reduce dose to 1 spray per nostril once daily (total daily dose: 110 mcg/day). Maximum daily dose: 2 sprays per nostril/day (220 mcg/day)
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Reported adverse reactions are for children, adolescents, and adults.
Postmarketing:
Dermatologic: Excoriation of skin (Weinstein 2009), skin rash (Weinstein 2009)
Endocrine & metabolic: Weight gain (Bernstein 1996)
Gastrointestinal: Diarrhea (Weinstein 2009), nausea (Gross 2002), oral candidiasis (Settipane 1995), upper abdominal pain (Weinstein 2009), vomiting (Weinstein 2009)
Infection: Fungal infection (nasal) (Chang 2013), viral infection (Weinstein 2009)
Local: Application-site reaction (including application-site pain, blood in nasal mucosa, burning sensation of the nose, epistaxis, nasal mucosa irritation, sneezing, and stinging sensation of the nose) (Berger 2003; Gross 2002; Karaulov 2019)
Nervous system: Bitter taste (Baccioglu Kavut 2012), headache (Gross 2002), insomnia (Gross 2002)
Ophthalmic: Retinopathy (central serous chorioretinopathy) (Nakatsuka 2019)
Respiratory: Asthma (Weinstein 2009), cough (Weinstein 2009), dry nose (Gross 2002), nasal cavity pain (Chang 2013), nasal discomfort (Karaulov 2019), nasopharyngitis (Weinstein 2009), pharyngitis (Gross 2002), pharyngolaryngeal pain (Weinstein 2009), rhinitis (Gross 2002), sinusitis (Weinstein 2009), upper respiratory tract infection (Bernstein 1996)
Hypersensitivity to triamcinolone or any component of the formulation
OTC labeling: When used for self-medication, do not use in children <2 years of age.
Canadian labeling: Additional contraindications (not in US labeling): Tuberculosis (TB) disease or infection (active or latent TB), or untreated fungal, bacterial, and viral infection.
Concerns related to adverse effects:
• Adrenal suppression: When used at excessive doses, may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms.
• Delayed wound healing: Avoid use in patients with recent nasal septal ulcers, nasal surgery, or nasal trauma until healing has occurred.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox and/or measles should be avoided.
• Local nasal effects: Nasal septal perforation, nasal ulceration, epistaxis, and localized Candida albicans infections of the nose and/or pharynx may occur. Monitor patients periodically for adverse nasal effects.
Disease-related concerns:
• Infections: Use caution or avoid in patients with ocular herpes simplex, tuberculosis (TB) infection (latent TB), and/or TB reactivity, or in patients with untreated fungal, viral, or bacterial infections.
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Consider routine eye exams in chronic users.
Special populations:
• Pediatric: Avoid using higher than recommended dosages; suppression of linear growth (ie, reduction of growth velocity), reduced bone mineral density, or hypercortisolism (Cushing syndrome) may occur; titrate to lowest effective dose. Reduction in growth velocity may occur when corticosteroids are administered to pediatric patients, even at recommended doses via intranasal route (monitor growth).
Other warnings/precautions:
• Self-medication (OTC use): Consult a health care provider before use if you have had recent nose ulcers or nose surgery; have a nose injury that has not healed; or are using a steroid for asthma, allergies or skin rash. Discontinue use and consult a health care provider if symptoms do not improve after 1 week, or if infection (eg, persistent fever), changes in vision, or frequent nosebleeds occur. Do not use for the common cold.
Nasacort Allergy 24HR 10.8 mL bottles contain 60 sprays, and the 16.9 mL bottles contain 120 sprays.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol, Nasal, as acetonide:
Nasacort Allergy 24HR: 55 mcg/actuation (6.8 mL, 10.8 mL, 16.9 mL) [alcohol free; contains benzalkonium chloride, edetate (edta) disodium, polysorbate 80]
Nasacort Allergy 24HR Children: 55 mcg/actuation (10.8 mL [DSC]) [contains benzalkonium chloride, edetate (edta) disodium, polysorbate 80]
Generic: 55 mcg/actuation (16.9 mL)
Yes
Aerosol (Nasacort Allergy 24HR Nasal)
55 mcg/ACT (per mL): $1.26
Aerosol (Triamcinolone Acetonide Nasal)
55 mcg/ACT (per mL): $1.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, Nasal, as acetonide:
Nasacort AQ: 55 mcg/actuation (16.5 g) [contains benzalkonium chloride, edetate (edta) disodium, polysorbate 80]
Generic: 55 mcg/actuation (1 ea)
Shake well prior to use. Gently blow nose to clear nostrils. Avoid spraying into mouth or eyes and do not blow nose for 15 minutes after use. Prime prior to first use by shaking contents well and releasing 5 sprays into the air. If product is not used for more than 2 weeks, reprime with 1 spray. Consider use of a nasal vasoconstrictor for 2 to 3 days before initiating therapy in patients with excessive nasal mucous secretion or nasal mucosa edema.
For intranasal use only. Shake container well before each use. Before first use, prime by releasing 5 sprays into the air away from the face. Repeat priming with 1 spray if ≥14 days between use. Blow nose to clear nostrils. Insert applicator into nostril, keeping bottle upright, and close off the other nostril. Breathe in through nose. While inhaling, press pump to release spray. Avoid blowing nose for 15 minutes after use. Do not spray into eyes or mouth. Discard after labeled number of doses has been used, even if bottle is not completely empty.
Allergic rhinitis (Nasacort AQ [Canadian product]): Management of seasonal and perennial allergic rhinitis in children 4 to 12 years of age.
Upper respiratory allergies (OTC products): Relief of hay fever and other upper respiratory allergies (eg, nasal congestion, runny nose, sneezing, itchy nose) in adults and children 2 years of age and older.
Acute bacterial rhinosinusitis, adjunct to antibiotics (empiric treatment); Chronic rhinosinusitis; Nonallergic rhinitis
Nasacort may be confused with NasalCrom
TAC (occasional abbreviation for triamcinolone) is an error-prone abbreviation (mistaken as tetracaine-adrenaline-cocaine)
Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Triamcinolone (Nasal). Risk C: Monitor therapy
Esketamine: Corticosteroids (Nasal) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal corticosteroid on an esketamine dosing day should administer the nasal corticosteroid at least 1 hour before esketamine. Risk D: Consider therapy modification
Nirmatrelvir and Ritonavir: May increase the serum concentration of Corticosteroids (Nasal). Risk C: Monitor therapy
Information related to the use of intranasal triamcinolone in pregnant women is limited (Bérard 2016).
Maternal use of intranasal corticosteroids in usual doses are generally not associated with an increased risk of fetal malformations or preterm birth (ERS/TSANZ [Middleton 2020]). However, intranasal triamcinolone has a high systemic bioavailability, and adverse fetal events have been reported. Agents other than intranasal triamcinolone may be preferred for the treatment of allergic rhinitis during pregnancy (Alhussien 2018; BSACI [Scadding 2017]).
Growth (adolescents and children); signs/symptoms of HPA axis suppression/adrenal insufficiency or hypercortisolism; ocular changes, including glaucoma and cataracts; signs/symptoms of Candida infection (long-term therapy); nasal effects (eg, epistaxis, nasal discomfort, nasal septal perforation, nasal ulcerations).
Controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes and fibroblasts, reverses capillary permeability, and stabilizes lysosomal membranes at the cellular level to prevent or control inflammation
Absorption: Systemic absorption may occur following intranasal administration.
Half-life elimination: Biologic: 18-36 hours; Terminal (intranasal): 3.1 hours
Excretion: Urine (~40%); feces (~60%)
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