Drug Action
Triamcinolone exerts predominantly glucocorticoid effects with minimal mineralcorticoid effects.
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Drug reference
Triamcinolone exerts predominantly glucocorticoid effects with minimal mineralcorticoid effects.
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Local inflammation of joints and soft-tissues (for details, consult product literature) ▶BY INTRA-ARTICULAR INJECTION ▶Adult: 2–20 mg, adjusted according to size of joint, no more than 2 joints should be treated on any one day, where appropriate, may be repeated at intervals of 3–4 weeks ▶BY PERI-ARTICULAR INJECTION ▶Adult: 10–20 mg, adjusted according to size of joint, no more than 2 joints should be treated on any one day
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Consult product literature
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Consult product literature
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Various strengths available from ’special order’ manufacturers or specialist importing companies.
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→Appendix 1: corticosteroids
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Protein catabolism
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There can be variation in the licensing of different medicines containing the same drug. Suspension for injection EXCIPIENTS: May contain Benzyl alcohol ▶Triamcinolone hexacetonide (Non-proprietary) Triamcinolone hexacetonide 20 mg per 1 ml Triamcinolone hexacetonide 20mg/1ml suspension for injection ampoules | 10 ampoule P £120.00 DT = £120.00 5.2 Soft tissue disorders Soft-tissue disorders Extravasation Local guidelines for the management of extravasation should be followed where they exist or specialist advice sought. Extravasation injury follows leakage of drugs or intravenous fluids from the veins or inadvertent administration into the subcutaneous or subdermal tissue. It must be dealt with promptly to prevent tissue necrosis. Acidic or alkaline preparations and those with an osmolarity greater than that of plasma can cause extravasation injury; excipients including alcohol and polyethylene glycol have also been implicated. Cytotoxic drugs commonly cause extravasation injury. In addition, certain patients such as the very young and the elderly are at increased risk. Those receiving anticoagulants are more likely to lose blood into surrounding tissues if extravasation occurs, while those receiving sedatives or analgesics may not notice the early signs or symptoms of extravasation. Extravasation prevention Precautions should be taken to avoid extravasation; ideally, drugs likely to cause extravasation injury should be given through a central line and patients receiving repeated doses of hazardous drugs peripherally should have the cannula resited at regular intervals. Attention should be paid to the manufacturers’ recommendations for administration. Placing a glyceryl trinitrate p. 232 patch distal to the cannula may improve the patency of the vessel in patients with small veins or in those whose veins are prone to collapse. Patients should be asked to report any pain or burning at the site of injection immediately. Extravasation management If extravasation is suspected the infusion should be stopped immediately but the cannula should not be removed until after an attempt has been made to aspirate the area (through the cannula) in order to remove as much of the drug as possible. Aspiration is sometimes possible if the extravasation presents with a raised bleb or blister at the injection site and is surrounded by hardened tissue, but it is often unsuccessful if the tissue is soft or soggy. Corticosteroids are usually given to treat inflammation, although there is little evidence to support their use in extravasation. Hydrocortisone p. 713 or dexamethasone p. 712 can be given either locally by subcutaneous injection or intravenously at a site distant from the injury. Antihistamines and analgesics may be required for symptom relief. The management of extravasation beyond these measures is not well standardised and calls for specialist advice. Treatment depends on the nature of the offending substance; one approach is to localise and neutralise the substance whereas another is to spread and dilute it. The first method may be appropriate following extravasation of vesicant drugs and involves administration of an antidote (if available) and the application of cold compresses 3–4 times a day (consult specialist literature for details of specific antidotes). Spreading and diluting the offending substance involves infiltrating the area with physiological saline, applying warm compresses, elevating the affected limb, and administering hyaluronidase p. 1219. A saline flush-out technique (involving flushing the subcutaneous tissue with physiological saline) may be effective but requires specialist advice. Hyaluronidase should not be administered following extravasation of vesicant drugs (unless it is either specifically indicated or used in the saline flush-out technique). Dexrazoxane p. 991 is licensed for the treatment of anthracycline-induced extravasation. Enzymes used in soft-tissue disorders Collagenase Collagenase below are proteolytic enzymes that are derived from the fermentation of Clostridium histolyticum and have the ability to break down collagen. A preparation containing a mixture of two collagenases is licensed for the treatment of Dupuytren’s contracture; the preparation should be injected into a palpable cord with a contracture of a metacarpophalangeal joint or proximal interphalangeal joint. Hyaluronidase Hyaluronidase is used to render the tissues more readily permeable to injected fluids, e.g. for introduction of fluids by subcutaneous infusion (termed hypodermoclysis). Rubefacients Rubefacients act by counter-irritation. Pain, whether superficial or deep-seated, is relieved by any method that itself produces irritation of the skin. Topical rubefacient preparations may contain nicotinate and salicylate compounds, essential oils, capsicum, and camphor. Topical NSAIDs The use of a NSAID by mouth is effective for relieving musculoskeletal pain. Topical NSAIDs (e.g. felbinac p. 1202, ibuprofen p. 1203, ketoprofen p. 1207, and piroxicam p. 1212) may provide some relief of pain in musculoskeletal conditions; they can be considered as an adjunctive treatment in knee or hand osteoarthritis. ENZYMES
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2–20 mg, adjusted according to size of joint, no
First-line fragment. Read the complete Indications and Dose section above.
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10–20 mg, adjusted according to size of joint, no
First-line fragment. Read the complete Indications and Dose section above.
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