NASACORT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for NASACORT (NASACORT).
Triamcinolone acetonide, a corticosteroid, exerts anti-inflammatory effects by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis, and suppressing cytokine production, thereby decreasing nasal inflammation.
| Metabolism | Primarily hepatic via CYP3A4; main metabolites are 6β-hydroxytriamcinolone acetonide and 21-carboxylic acid derivative. |
| Excretion | Primarily hepatic metabolism via CYP3A4; renal excretion accounts for <5% of unchanged drug; biliary/fecal excretion of metabolites accounts for ~60% of total clearance. |
| Half-life | Terminal elimination half-life is approximately 3-4 hours after intranasal administration; however, due to prolonged residence time in nasal mucosa, clinical effects persist beyond plasma half-life. |
| Protein binding | Approximately 99% bound to serum proteins, primarily albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Vd is approximately 2-3 L/kg, indicating extensive tissue distribution; clinical significance: large Vd suggests sequestration in tissues, potentially prolonging retention. |
| Bioavailability | Intranasal: Absolute bioavailability is approximately 3-5% due to extensive first-pass metabolism and limited absorption from nasal mucosa. |
| Onset of Action | Intranasal: Relief of nasal symptoms occurs within 12-24 hours after first dose, with significant improvement often seen by 48 hours. |
| Duration of Action | Intranasal: Duration of action is approximately 12-24 hours, supporting once-daily dosing; clinical effect maintained with regular use. |
| Molecular Weight | 434.5 |
110 mcg (2 sprays) per nostril once daily; maximum: 440 mcg (4 sprays) per nostril once daily. Intranasal administration.
| Dosage form | AEROSOL, METERED |
| Renal impairment | No dosage adjustment required for renal impairment. |
| Liver impairment | No specific dosage adjustment provided; use with caution in severe hepatic impairment, monitor for systemic effects. |
| Pediatric use | Ages 2-5: 55 mcg (1 spray) per nostril once daily, maximum 110 mcg (2 sprays) once daily. Ages 6-11: 110 mcg (2 sprays) per nostril once daily, maximum 220 mcg (4 sprays) once daily. Ages 12+: same as adult. |
| Geriatric use | No specific adjustment; use lowest effective dose due to potential increased systemic sensitivity; monitor for adverse effects. |
| 1st trimester | Limited human data; animal studies show variable adverse effects. Use only if clearly needed. |
| 2nd trimester | Minimal systemic absorption; unlikely to cause fetal harm. Considered low risk. |
| 3rd trimester | No known fetal risks from intranasal corticosteroids; avoid excessive doses. |
Clinical note
Comprehensive clinical and safety monograph for NASACORT (NASACORT).
| Placental transfer | Triamcinolone acetonide crosses the placenta to a limited extent; systemic absorption from intranasal spray is minimal (<0.5% bioavailability). |
| Breastfeeding | Triamcinolone acetonide is excreted in breast milk in low amounts. Intranasal use results in negligible systemic exposure, compatible with breastfeeding. Monitor infant for adrenal suppression if high doses used. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to triamcinolone acetonide or any componentUntreated nasal mucosal infection (e.g., herpes simplex)
| Precautions | Nasal septal perforation, Nasal irritation, Epistaxis, Candida albicans infection, Immunosuppression, Growth suppression in children, Hypothalamic-pituitary-adrenal axis suppression with prolonged use |
| Food/Dietary | No significant food interactions known. However, grapefruit juice may slightly increase systemic exposure; avoid excessive consumption. |
| Clinical Pearls |
Loading safety data…
| Lactation Rating |
| L2 (Probably Compatible) |
| Teratogenic Risk | FDA Pregnancy Category C. In animal studies, corticosteroids have been shown to be teratogenic at relatively low doses. There are no adequate and well-controlled studies in pregnant women. Nasacort should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. First trimester: Risk cannot be ruled out; avoid unless clearly needed. Second and third trimesters: Limited data; use with caution. Potential fetal risks include orofacial clefts (conflicting data), intrauterine growth restriction, and adrenal suppression in neonates with prolonged maternal use of high doses. |
| Fetal Monitoring | Monitor maternal for signs of adrenal suppression if used chronically in high doses. Monitor fetal growth via ultrasound if used long-term or at high doses. Assess neonatal adrenal function if mother received significant doses near term. |
| Fertility Effects | No specific studies on fertility in humans. In animal studies, corticosteroids may impair fertility. Based on class effects, potential reversible ovulatory dysfunction and menstrual irregularities with systemic use. Intranasal triamcinolone at recommended doses is unlikely to significantly affect fertility due to low systemic absorption. |
| For optimal efficacy, prime the nasal spray by actuating 5 times or until a fine mist appears. If not used for 7+ days, re-prime with 2 actuations. Instruct patient to blow nose gently before use and tilt head slightly forward. Avoid spraying directly onto nasal septum to reduce risk of epistaxis. May cause growth suppression in children; monitor height regularly if long-term use. Onset of action is within 12-24 hours, but maximal effect may take 2-3 weeks. |
| Patient Advice | Use regularly for best results; it may take 2-3 weeks for full effect. · Blow your nose gently before each use to clear nasal passages. · Do not spray directly onto the nasal septum (the wall between nostrils). · Clean the nozzle after each use and replace the cap tightly. · If you miss a dose, skip it and continue with the next scheduled dose; do not double the dose. · Common side effects include nosebleeds, headache, and nasal irritation. · Report persistent nosebleeds, vision changes, or signs of infection (e.g., fever) to your doctor. |