Dosing and uses of Trivaris Intravitreal, Triesence (triamcinolone intravitreal)
Adult dosage forms and strengths
injectable suspension, intravitreal (as acetonide salt)
- 4mg/0.05mL
- 4mg/0.1mL
Ophthalmic Disease
Indicated for sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to ophthalmic corticosteroids
Initial: 4 mg intravitreaL
Visualization During Vitrectomy (Triesence)
1-4 mg intravitreaL
Intravitreal Preparation
Trivaris IntravitreaL
- Available without an attached needle, therefore, it is necessary to firmly attach a desired needle to the syringe (27 gauge, 0.5-inch needle suggested)
- Prepare the proper volume to be injected by advancing the plunger to the single line marked on the prefilled glass syringe shaft; hold the syringe and the needle at an angle and express excess gel suspension over a sterile surface
- The plunger is correctly positioned when white compound is no longer visible between the plunger and the fill line on the syringe
- This will provide the recommended dose of 4 mg/0.05 mL
- Always check the needle to ensure it is firmly attached to the syringe before injecting the patient
Triesence
- The vial should be vigorously shaken for 10 seconds before use to ensure a uniform suspension
- Prior to withdrawal, the suspension should be inspected for clumping or granular appearance (agglomeration)
- An agglomerated product results from exposure to freezing temperatures and should not be used
- After withdrawal, inject without delay to prevent settling in the syringe
Intravitreal Administration
The intravitreal injection procedure should be carried out under controlled aseptic conditions which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent)
Adequate anesthesia and a broad-spectrum antimicrobial should be administered prior to the injection
Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis
Each syringe should only be used for the treatment of a single eye
If the contralateral eye requires treatment, a new syringe should be used and the sterile field, syringe, gloves, drapes, and eyelid speculum and injection needles should be changed before administered to the other eye
Storage
Keep refrigerated 36-46 degrees F (2- 8 degrees C) until use
Avoid freezing and protect from light
Pediatric dosage forms and strengths
Safety and efficacy not established
Trivaris Intravitreal, Triesence (triamcinolone intravitreal) adverse (side) effects
Frequency not defined
Abnormal sensation in eye
Anterior chamber cells
Anterior chamber flare
Cataract
Cataract corticaL
Cataract nuclear
Cataract subcapsular
Conjunctival hemorrhage
Exophthalmos
Eye irritation
Eye pain
Eye pruritus
Foreign body sensation in eyes
Glaucoma
Intraocular pressure increased
Injection site hemorrhage
Lacrimation increased
Vitreous detachment
Vitreous floaters
Rare instances of blindness associated with intravitreal or periocular injections
Warnings
Contraindications
Hypersensitivity
Not for intravenous administration
Cautions
Prolonged use may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses
The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes
Intraocular pressure may become elevated in some individuals; if steroid therapy is continued for more than 6 weeks, IOP should be monitored
Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex because of possible corneal perforation; do NOT use in active ocular herpes simplex
Endophthalmitis: rate of infectious culture positive endophthalmitis is 0.5%; proper aseptic techniques should always be used when administering triamcinolone acetonide
In addition, patients should be monitored following the injection to permit early treatment should an infection occur
Children who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity
Pregnancy and lactation
Pregnancy category: d
Lactation: Distributed in breast milk; caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Trivaris Intravitreal, Triesence (triamcinolone intravitreal)
Peak aqueous humor concentration: 2151-7202 ng/mL
AUC: 231-1911 ng•h/mL
Half-Life: 18.7 ± 5.7 days
Mechanism of action
Glucocorticoid
Elicits anti-inflammatory effects; edema, fibrin deposition, capillary dilatation, migration of leukocytes and phagocytosis and the later stages of wound healing (capillary proliferation, deposition of collagen, cicatrization) are inhibited
Depresses the production of eosinophils and lymphocytes
