Products
Triamcinolone acetonide nasal sprays have been approved in many countries since 1996 and are commercially available as propellant-free metered-dose sprays (Nasacort, Nasacort Allergo, Suspension).
Structure and properties
Triamcinolone acetonide (C24H31FO6, Mr = 434.5 g/mol) is a white crystalline powder that is practically insoluble in water. It is a lipophilic and potent derivative of triamcinolone.
Effects
Triamcinolone acetonide (ATC R01AD11) is a glucocorticoid with anti-inflammatory, antiallergic, and immunosuppressive effects. The nasal spray is effective against the symptoms of allergic rhinitis such as inflammation, runny nose, nasal congestion, itching and sneezing. Glucocorticoid nasal sprays are more effective against nasal congestion than antihistamine nasal sprays and are more reliable against nasal symptoms. They can additionally relieve symptoms of allergic conjunctivitis.
Indications
For self-medication (dispensing at the pharmacy), the drug is approved for the treatment of hay fever (seasonal allergic rhinitis) in adults. When prescribed by a physician, the spray can also be used in children and adolescents and for allergic rhinitis that occurs throughout the year. Other indications are mentioned in the literature (e.g., nasal polyps, vasomotor rhinitis), but many countries currently lack appropriate approval.
Dosage
Detailed instructions can be found in the patient information leaflet. An effect may be seen on the first day. However, the spray should be used regularly, because the full effectiveness is achieved only after 3-4 days. Conversely, the effect lasts for several days after discontinuation. Without a doctor’s prescription, the maximum duration of therapy is 3 months. Directions for administration:
- Remove protective cap and safety clip.
- Before first use, operate the pumping device 5 times.
- Blow the nose.
- The nasal spray contains a suspension and must therefore be shaken before use.
- The application is once a day. Adults administer 2 sprays per nostril. When symptoms are controlled, should be reduced to 1 spray puff per nostril.
- Squeeze one nostril with a finger.
- With mouth closed, inhale through the nose and release the nasal spray.
- Exhale through the mouth.
- Clean nasal spray with a cloth after use (eg paper tissue).
- Put the protective cap back on.
When using glucocorticoid nasal sprays, it is recommended that the spray nozzle be directed outward away from the nasal septum, as this may prevent septal perforation.
Contraindications
The drug is contraindicated hypersensitivity. Refer to the drug label for complete precautions.
Interactions
Interactions with other drugs are not known to date.
Adverse effects
The most common adverse effects include headache, nosebleed, cough, bronchitis, dyspepsia, infection, parasitic disease, inflamed nasal mucosa, dry nose, pharyngitis, flu, and dental problems. For nasal discomfort, dose reduction and the use of moistening saline sprays or nasal ointments may help. Nasal irritation may also possibly be due to the preservative benzalkonium chloride. Rarely, perforation of the nasal septum is observed. Compared with oral glucocorticoids, significantly fewer adverse effects occur overall. Other possible side effects of unknown frequency are: Hypersensitivity reactions, sleep disturbances, odor and taste disturbances, dizziness, cataracts, glaucoma, high intraocular pressure, nausea, candidamycosis, and fatigue.
