Marcaine, Lidocaine, Kenalog, Povidone Iodine

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed to antibiotics.

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

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

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Increased risk of methemoglobinemia when concurrently exposed to antimalarials.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone acetonide, leading to adverse reactions.

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 when used concurrently. Convulsions have been reported.

Increased risk of methemoglobinemia when concurrently exposed to antibiotics.

Patients on digitalis glycosides may be at increased risk of arrhythmias due to corticosteroid-induced hypokalemia.

Serious dose-related cardiac arrhythmias may occur with potent inhalation anesthetics. Severe, prolonged hypertension with monoamine oxidase inhibitors or tricyclic antidepressants.

Concurrent administration with vasopressor drugs may cause severe, persistent hypertension or cerebrovascular accidents.

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 to antineoplastic agents.

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 plasma concentration of triamcinolone leading to adverse reactions.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Ketoconazole decreases the metabolism of corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects.

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.

Administration of local anesthetic solutions containing epinephrine or norepinephrine to patients receiving MAOIs may produce severe, prolonged hypertension.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Increased risk of methemoglobinemia when concurrently exposed to nitrates/nitrites.

Increased risk of methemoglobinemia when concurrently exposed to antibiotics.

Increased risk of methemoglobinemia when concurrently exposed to nitrates/nitrites.

Increased risk of methemoglobinemia when concurrently exposed to nitrates/nitrites.

Increased risk of methemoglobinemia when concurrently exposed to nitrates/nitrites.

Administration to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension.

Increased risk of methemoglobinemia when concurrently exposed to antibiotics.

Increased risk of methemoglobinemia when concurrently exposed to anticonvulsants.

Increased risk of methemoglobinemia when concurrently exposed to anticonvulsants.

Increased risk of methemoglobinemia when concurrently exposed to local anesthetics. Monitor for signs of methemoglobinemia.

Increased risk of methemoglobinemia when concurrently exposed to antimalarials.

Increased risk of methemoglobinemia when concurrently exposed.

Increased risk of methemoglobinemia when concurrently exposed to antineoplastic agents.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

Increased risk of methemoglobinemia when concurrently exposed.

Strong CYP3A4 inhibitor may increase plasma concentration of triamcinolone leading to adverse reactions.

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

Increased risk of methemoglobinemia when concurrently exposed to anticonvulsants.

Corticosteroids may increase blood glucose concentrations, requiring dosage adjustments of antidiabetic agents.

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

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

Hepatic enzyme inducers may increase corticosteroid clearance.

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

Butyrophenones may reduce or reverse the pressor effect of epinephrine. Concurrent use should generally be avoided.

Hepatic enzyme inducer may increase corticosteroid clearance.

Cholestyramine may increase the clearance of corticosteroids.

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 coadministered.

Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance.

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

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

Phenothiazines may reduce or reverse the pressor effect of epinephrine. Concurrent use should generally be avoided.

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

Hepatic enzyme inducer may increase corticosteroid clearance.

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 when additional local anesthetics are administered.

Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin. Coagulation indices should be monitored frequently.

CYP 3A4 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 triamcinolone acetonide injectable suspension may cause increased plasma concentration of triamcinolone leading to adverse reactions (see 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) (see WARNINGS, Endocrine and PRECAUTIONS, Endocrine ).