What is the recommended dosage and administration of triamcinolone (corticosteroid) for various medical conditions?

Triamcinolone Acetonide Prescription Guidelines

For prescribing triamcinolone acetonide, select the appropriate formulation and dosage based on the condition being treated, with intramuscular triamcinolone acetonide 60 mg being recommended for acute gout attacks, followed by oral prednisone as needed. 1

Formulations and Routes of Administration

Triamcinolone acetonide is available in multiple formulations for different routes of administration:

Topical Formulations

• Cream/Ointment: 0.025%, 0.1%, and 0.5% strengths
  • Apply to affected areas 2-4 times daily for 0.025% cream
  • Apply to affected areas 2-3 times daily for 0.1% or 0.5% cream 2

Injectable Formulations

• Intralesional:

  • 10 mg/mL for nodular acne and acne keloidalis
  • 40 mg/mL for hypertrophic scars and keloids 2

• Intra-articular:

  • Dose varies depending on joint size
  • For acute gout: Single injection of 10 mg has shown pain relief within 48 hours 1

• Intramuscular:

  • For acute gout: 60 mg, followed by oral prednisone 1
  • For severe asthma: 360 mg over three days (higher doses for severe cases) 3

Nasal Spray

• 55 μg per spray
• 1-2 sprays per nostril daily for allergic rhinitis 2, 4

Oral Inhaler

• 400 μg twice daily for mild-to-moderate asthma 5

Condition-Specific Dosing Guidelines

1. Acute Gout

• Intramuscular injection: Triamcinolone acetonide 60 mg as a single dose, followed by oral prednisone 1
• Intra-articular injection: 10 mg for affected joint (for 1-2 joints only) 1
• Duration: 5-10 days at full dose then stop OR 2-5 days at full dose then taper for 7-10 days 1

2. Dermatological Conditions

• Cream/Ointment: Select potency based on condition severity and location
  • 0.025% for mild conditions and sensitive areas
  • 0.1% for moderate conditions
  • 0.5% for severe conditions and thicker skin areas 2

3. Allergic Rhinitis

• Nasal spray: 55 μg per spray, 1-2 sprays per nostril daily 2, 4

4. Asthma

• Oral inhaler: 400 μg twice daily 5
• Intramuscular: For severe, life-threatening asthma: 360 mg over three days 3

5. Allergic Bronchopulmonary Aspergillosis

• Systemic glucocorticoids are first-line therapy for acute ABPA 1
• Oral prednisolone 0.5 mg/kg/day for 2 weeks, followed by alternate-day dosing for 8 weeks, then taper 1

Prescription Writing Format

For a complete prescription, include:

1. Patient information: Full name, date of birth, address
2. Prescriber information: Name, address, phone, DEA number
3. Medication details:
   • Drug name: Triamcinolone acetonide
   • Strength/concentration
   • Dosage form
   • Amount to dispense
   • Directions for use
4. Refills: Specify number or write "no refills"
5. Signature and date

Sample Prescription for Intramuscular Injection (Acute Gout)

Rx: Triamcinolone acetonide 60 mg/mL
Disp: 1 mL
Sig: Inject 60 mg intramuscularly once as directed
Refills: 0

Sample Prescription for Topical Use (Dermatitis)

Rx: Triamcinolone acetonide cream 0.1%
Disp: 30 g
Sig: Apply to affected areas twice daily
Refills: 1

Important Considerations and Precautions

• Monitor for side effects: Skin atrophy with topical use, hyperglycemia, hypertension, and cushingoid features with systemic use 2
• Contraindications: Hypersensitivity to triamcinolone, active infections, and certain skin conditions 2
• Special populations: Monitor growth in pediatric patients on long-term therapy 2
• Drug interactions: Be aware of cytochrome P450 3A4 inhibitors that may increase systemic effects 2

Monitoring

• For short-term use (<2 weeks), minimal monitoring is required
• For longer-term use, monitor for:
  • Blood pressure
  • Blood glucose
  • Signs of infection
  • HPA axis suppression
  • Local side effects (skin atrophy, pigmentary changes) with topical use 2

Remember that dosing should be adjusted based on clinical response and the development of any adverse effects.