Maximum Dose of Nasacort Allergy (Triamcinolone Acetonide)
For adults and children 12 years and older, the maximum dose of Nasacort Allergy (triamcinolone acetonide) is 2 sprays per nostril 1 or 2 times per day, which equals a total maximum daily dose of 220-440 mcg. 1
Age-Specific Dosing Guidelines
- Ages 2-5 years: 1 spray per nostril once daily (55 mcg per nostril, 110 mcg total daily) 1
- Ages 6-11 years: 2 sprays per nostril once daily (110 mcg per nostril, 220 mcg total daily) 1
- Ages 12 years and older: 2 sprays per nostril once or twice daily (110-220 mcg per nostril, 220-440 mcg total daily) 1
Efficacy and Dosing Considerations
- Clinical trials have shown that once-daily triamcinolone acetonide 110 to 220 mcg reduces symptoms of allergic rhinitis within the first day of administration 2
- The 220 mcg dose has demonstrated significant improvement over placebo in reducing nasal symptoms by week 1 of treatment 3
- For adults with more severe symptoms, the 440 mcg dose (maximum dose) has shown the greatest improvement in symptom relief 3
- Once symptoms are under control, the dosage may be reduced from 220 to 110 mcg/day without loss of effect 2
Safety Profile
- Nasacort Allergy 24HR is the only intranasal steroid preparation available over-the-counter 1
- Common side effects include pharyngitis, epistaxis (nosebleeds), and cough 1
- At therapeutic dosages, nasally administered triamcinolone acetonide is not significantly absorbed into the systemic circulation and does not suppress hypothalamic-pituitary-adrenal (HPA) axis function 2
- Standard dosages (110 or 220 mcg once or twice a day) do not appear to suppress adrenal gland function 4
Clinical Pearls and Precautions
- Contraindicated in patients with a history of hypersensitivity to the medication or its components 1
- For optimal results, use regularly rather than as-needed to maintain symptom control 5
- Onset of action may be delayed (12 hours) with maximal efficacy reached in days to weeks 5
- If treating perennial allergic rhinitis long-term, consider reducing to the lowest effective dose with monitoring every 3 months 4
- Rare complications to watch for include nasal bleeding, septal perforation, and nasal candidiasis 4
Comparison to Other Intranasal Steroids
- Triamcinolone acetonide 220 mcg/day has shown similar efficacy to beclomethasone 84-168 mcg twice daily, fluticasone 200 mcg once daily, and flunisolide 100 mcg twice daily in reducing nasal symptoms of allergic rhinitis 2
- Triamcinolone acetonide has been shown to be more effective at reducing nasal symptoms than oral antihistamines like loratadine and astemizole 2
- The combination of intranasal triamcinolone acetonide with oral antihistamines does not provide additional benefits over triamcinolone acetonide alone 2