TRIESENCE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRIESENCE (TRIESENCE).
Corticosteroid that suppresses inflammation by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis, and modulating cytokine production.
| Metabolism | Hepatic via CYP3A4; primary metabolites include 6β-hydroxycorticosteroids. |
| Excretion | Primarily hepatic metabolism; renal excretion of metabolites (<5% unchanged). Biliary/fecal elimination accounts for minimal clearance. |
| Half-life | Approximately 3.3 hours for triamcinolone acetonide; with intravitreal administration, detectable levels persist for weeks to months. |
| Protein binding | 68% bound to corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | 0.57 L/kg; indicates distribution into total body water and peripheral tissues. |
| Bioavailability | Intravitreal: 100% (local); intramuscular: ~70-100% after absorption; oral: ~23% (due to first-pass metabolism); topical: minimal systemic absorption. |
| Onset of Action | Intravitreal: 1-2 days; intramuscular: 24-48 hours; intra-articular: 12-24 hours; topical: variable (hours to days). |
| Duration of Action | Intravitreal: weeks to months (sustained release); intramuscular: 2-3 weeks; intra-articular: 1-2 weeks; topical: days. |
1 to 4 mg (0.025 to 0.1 mL of 40 mg/mL suspension) intravitreal injection once.
| Dosage form | INJECTABLE |
| Renal impairment | No dosage adjustment required for renal impairment. |
| Liver impairment | No specific guidelines; use with caution in severe hepatic impairment. |
| Pediatric use | Not established; safety and efficacy in pediatric patients have not been determined. |
| Geriatric use | No specific dose adjustments; use with caution due to potential increased sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for TRIESENCE (TRIESENCE).
| Breastfeeding | Distributed into breast milk. M/P ratio not established. Use caution; monitor infant for adrenal suppression and growth retardation. Consider alternative therapy. |
| Teratogenic Risk | Category C. First trimester: potential for cleft palate and cardiac defects based on animal studies; avoid use. Second and third trimesters: risk of intrauterine growth restriction, premature birth, and hypothalamic-pituitary-adrenal suppression in neonate. Use only if benefit outweighs risk. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypersensitivity to triamcinolone or any component","Active ocular herpes simplex infection","Active ocular fungal infections","Ocular tuberculosis"]
| Precautions | ["Increased intraocular pressure, glaucoma, optic nerve damage, posterior subcapsular cataract formation","Exacerbation of ocular fungal, viral, or bacterial infections","Systemic corticosteroid effects with prolonged use","Adrenal suppression with high doses or prolonged therapy"] |
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| Monitor maternal blood pressure, blood glucose, and signs of infection. Fetal monitoring for growth restriction and adrenal insufficiency via ultrasound and nonstress testing. |
| Fertility Effects | May impair fertility by disrupting ovulation and menstrual cycle. Reversible upon discontinuation. |