Triamcinolone Acetonide

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Concomitant use increases risk of gastrointestinal side effects. Should be used cautiously with corticosteroids in hypoprothrombinemia.

Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression.

Concomitant use may cause hypokalemia and has been associated with cardiac enlargement and congestive heart failure.

Concomitant use may produce severe weakness in patients with myasthenia gravis.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Hepatic enzyme inducers that increase corticosteroid clearance, reducing their effect.

Hepatic enzyme inducer that increases corticosteroid clearance, reducing their effect.

Increased risk of methemoglobinemia when concurrently exposed.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Strong CYP3A4 inhibitor in cobicistat-containing products may increase triamcinolone plasma concentration.

Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor such as epinephrine are used in patients during or following the administration of potent inhalation anesthetics.

Increased activity of both cyclosporine and corticosteroids may occur; convulsions have been reported.

Increased risk of methemoglobinemia when concurrently exposed.

Patients may be at increased risk of arrhythmias due to hypokalemia induced by corticosteroids.

Serious dose-related cardiac arrhythmias may occur if preparations containing epinephrine are used during or following potent inhalation anesthetics.

Severe, persistent hypertension or cerebrovascular accidents may occur with concurrent vasopressor drugs used for obstetric blocks.

Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor such as epinephrine are used in patients during or following the administration of potent inhalation anesthetics.

Increased risk of methemoglobinemia when concurrently exposed.

Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor such as epinephrine are used in patients during or following the administration of potent inhalation anesthetics.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Ketoconazole decreases metabolism of corticosteroids by up to 60%, leading to increased risk of adverse effects.

Macrolide antibiotics cause significant decrease in corticosteroid clearance, increasing corticosteroid levels.

Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine 7.6 Potent Inhalation Anesthetics Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor such as epinephrine are used in patients during or following the administration of potent inhalation anesthetics.

Severe, prolonged hypertension may occur with local anesthetic solutions containing epinephrine.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Severe, prolonged hypertension may occur with local anesthetic solutions containing norepinephrine in patients receiving monoamine oxidase inhibitors or tricyclic antidepressants.

Concomitant use with corticosteroids increases risk of gastrointestinal side effects.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed. Local anesthetic with potential for methemoglobin formation.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed.

Hepatic enzyme inducer that increases corticosteroid clearance, reducing their effect.

Strong CYP3A4 inhibitor causing increased triamcinolone plasma concentration and adverse reactions.

Concomitant use with corticosteroids increases risk of gastrointestinal side effects. Clearance of salicylates may be increased.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Increased risk of methemoglobinemia when concurrently exposed.

Strong CYP3A4 inhibitor may increase triamcinolone plasma concentration and adverse reactions.

Serious dose-related cardiac arrhythmias may occur if preparations containing vasoconstrictor are used during or following potent inhalation anesthetics.

Increased risk of methemoglobinemia when concurrently exposed.

Corticosteroids may increase blood glucose; dosage adjustments of antidiabetics may be required.

Increased risk of methemoglobinemia when concurrently exposed to anticonvulsants.

Increased risk of methemoglobinemia when concurrently exposed to antimalarials.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

May reduce or reverse the pressor effect of epinephrine in local anesthetic solutions. Concurrent use should generally be avoided.

Cholestyramine may increase the clearance of corticosteroids, reducing their effect.

Potassium-depleting agents; patients should be monitored closely for development of hypokalemia when used with corticosteroids.

Induces hepatic microsomal drug metabolizing enzyme activity, enhancing corticosteroid metabolism and requiring increased dosage.

Estrogens may decrease hepatic metabolism of corticosteroids, increasing their effect.

Serum concentrations of isoniazid may be decreased by corticosteroids.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects when additional local anesthetics are administered.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

Oral contraceptive estrogens may decrease hepatic metabolism of corticosteroids, increasing their effect.

May reduce or reverse the pressor effect of epinephrine in local anesthetic solutions. Concurrent use should generally be avoided.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

Toxic effects of local anesthetics are additive. Monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.

Corticosteroids usually inhibit response to warfarin; coagulation indices should be monitored frequently.

CYP3A4 inhibitors: Triamcinolone acetonide is a substrate of CYP3A4. Co-administration of other strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin, cobicistat-containing products) with Kenalog-40 Injection may cause increased plasma concentration of triamcinolone leading to adverse reactions. ) During postmarketing use, there have been reports of clinically significant drug interactions in patients receiving triamcinolone acetonide and strong CYP3A4 inhibitors (e.g., ritonavir).