Version May 2024
Macular edema: Suprachoroidal injection (Xipere): 4 mg as a single dose.
Ocular disease: Intravitreal (Triesence): Initial: 4 mg as a single dose; additional doses may be given as needed.
Visualization during vitrectomy: Intravitreal (Triesence): 1 to 4 mg.
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Triamcinolone (ophthalmic): Pediatric drug information")
Ocular disease: Infants, Children, and Adolescents: Triesence: Intravitreal: Initial: 4 mg as a single dose; additional doses may be given as needed over the course of treatment.
Visualization during vitrectomy: Infants, Children, and Adolescents: Triesence: Intravitreal: Initial: 1 to 4 mg.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Ophthalmic: Eye pain (12%; acute eye pain: 3%), increased intraocular pressure (acute and non-acute: 6% to 60%), progression of cataract (20% to 60%)
1% to 10%:
Local: Injection site reaction (≤2%; including eye discomfort [transient]), pain at injection site (4%)
Nervous system: Headache (5%)
Ophthalmic: Anterior chamber fibrin deposition (anterior capsule contraction: 2%), blepharoptosis (2%), blurred vision (≤2%), cataract (7%), chalazion (2%), conjunctival edema (2%), conjunctival hemorrhage (≤4%), conjunctival hyperemia (2%), decreased visual acuity (≤4%), eye irritation (2%), eye pruritus (2%), endophthalmitis (infectious and non-infectious: ≤2%), glaucoma (≤2%), hypopyon (≤2%), meibomianitis (2%), ophthalmic inflammation (≤2%), optic disc disorder (vascular disorder: ≤2%), photophobia (3%), photopsia (2%), punctate keratitis (2%), retinal detachment (≤2%), uveitis (2%), vitreous detachment (5%), vitreous opacity (≤3%), xerophthalmia (3%)
Postmarketing: Ophthalmic: Exophthalmos
Hypersensitivity to triamcinolone or any component of the formulation.
Triesence: Systemic fungal infections.
Canadian labeling: Additional contraindications (not in US labeling): Active or suspected ocular or periocular infections.
Xipere: Active or suspected ocular or periocular infections, including most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella; mycobacterial infections; fungal diseases.
Concerns related to adverse effects:
• Adrenal suppression: Prolonged use 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.
• Hypersensitivity: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.
• Immunosuppression: May enhance development of secondary bacterial, fungal, or viral infection; use with caution in patients with a history of ocular herpes simplex (potential for reactivation). Prolonged use may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to killed or inactivated vaccines. Exposure to chickenpox or measles should be avoided. Close observation is required in patients with tuberculosis (TB) infection (latent TB) and/or TB reactivity; restrict use in TB disease (active TB) (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to initiation of corticosteroids. Use with caution in patients with threadworm infection; may cause serious hyperinfection. Use with extreme caution in patients with Strongyloides infections; hyperinfection, dissemination and fatalities have occurred.
• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).
• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles.
• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including euphoria, insomnia, mood swings, and personality changes, and severe depression to psychotic manifestations. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with HF and/or hypertension; corticosteroids have been associated with fluid retention, electrolyte disturbances, and hypertension. Use with caution following acute MI; corticosteroids have been associated with myocardial rupture.
• Diabetes: Use corticosteroids with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.
• GI disease: Use with caution in patients with GI diseases (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, abscess or other pyogenic infection) due to perforation risk.
• Myasthenia gravis: Use may cause transient worsening of myasthenia gravis (MG) (eg, within first 2 weeks of treatment); monitor for worsening MG (AAN [Narayanaswami 2021]).
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; elevated intraocular pressure may occur with effects lasting up to 6 months following injection. Use has also been associated with endophthalmitis and cataracts, particularly posterior subcapsular cataracts. Consider routine eye exams in chronic users.
• Osteoporosis: Use with caution in patients with osteoporosis; corticosteroids have been associated with increased bone loss and osteoporotic fractures.
• Renal impairment: Use with caution in patients with renal impairment.
• Thyroid disease: Use with caution in patients with thyroid disease; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid patients.
Special populations:
• Pediatric: May affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate use: For ophthalmic use only; do not administer IV.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Suspension, Intraocular, as acetonide:
Triesence: 40 mg/mL (1 mL) [contains polysorbate 80]
Xipere: 40 mg/mL (0.9 mL [DSC]) [contains polysorbate 80]
Suspension, Intraocular, as acetonide [preservative free]:
Xipere: 40 mg/mL (0.9 mL) [contains polysorbate 80]
No
Suspension (Triesence Intraocular)
40 mg/mL (per mL): $193.31
Suspension (Xipere Intraocular)
40 mg/mL (per 0.9 mL): $1,980.00
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.
Suspension, Intraocular, as acetonide:
Triesence: 40 mg/mL (1 mL) [contains polysorbate 80]
Intravitreal : Triesence: For intravitreal administration only; do not administer IV. Administer under controlled aseptic conditions (eg, sterile gloves, sterile drape, sterile eyelid speculum). Shake vial vigorously for 10 seconds before withdrawing dose; do not use if agglomerated (clumpy or granular appearance); inject immediately after suspension is withdrawn from the vial. Adequate anesthesia and a broad-spectrum bactericidal agent should be administered prior to injection. If administration is required in the second eye, a new vial/syringe should be used.
Suprachoroidal injection: Xipere: For suprachoroidal injection only via the SCS Microinjector. Administer under controlled aseptic conditions (eg, sterile gloves, sterile drape, sterile eyelid speculum, sterile cotton swab). Shake vial vigorously for 10 seconds before withdrawing dose; do not use if agglomerated (clumpy or granular appearance); inject immediately after suspension is withdrawn from the vial. Consult detailed prescribing information for additional assembly and administration instructions. Adequate anesthesia and a broad-spectrum bactericidal agent should be administered prior to injection.
Intravitreal: Triesence: For intravitreal administration only; do not administer IV. Shake vial vigorously for 10 seconds prior to use; do not use if agglomerated (clumpy or granular appearance); inject immediately after suspension is withdrawn from the vial. Administer under controlled aseptic conditions (eg, sterile gloves, sterile drape, sterile eyelid speculum). Adequate anesthesia and a broad-spectrum bactericidal agent should be administered prior to injection. If administration is required in the second eye, a new vial should be used.
Macular edema (Xipere): Treatment of macular edema associated with uveitis.
Ocular disease (Triesence): Treatment of sympathetic ophthalmia, temporal arteritis, uveitis, ocular inflammatory conditions unresponsive to topical corticosteroids.
Vitrectomy visualization (Triesence): Visualization during vitrectomy.
TAC (occasional abbreviation for triamcinolone) is an error-prone abbreviation (mistaken as tetracaine-adrenaline-cocaine)
None known.
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 (Ophthalmic). Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Corticosteroids (Ophthalmic). Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Risk C: Monitor therapy
Adverse events were have been observed in animal reproduction studies. Some studies have shown an association between first trimester corticosteroid use and oral clefts, intrauterine growth restriction, and decreased birth weight. The amount of triamcinolone absorbed systemically following ophthalmic administration is not known. Use of intravitreal triamcinolone in pregnancy has been noted in case reports (Errera 2013; Fazelat 2011).
Corticosteroids are excreted in breast milk; information specific to triamcinolone has not been located. The amount of triamcinolone absorbed systemically following ophthalmic administration is not known. According to the manufacturer, the decision to breast-feed during therapy should take into account the risk of exposure to the infant and the benefits of treatment to the mother.
Following injection, monitor for increased intraocular pressure and endophthalmitis; check for perfusion of optic nerve head immediately after injection, tonometry within 30 minutes, biomicroscopy between 2 to 7 days after injection.
Suppresses the immune system by reducing activity and volume of the lymphatic system
Half-life elimination: Intravitreal: Nonvitrectomized patients: 18.7 ± 5.7 days; Vitrectomized patients: ~3.2 days (based upon 1 patient)
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