Appendix A

Rx Triamcinolone Acetonide

Triamcinolone is a corticosteroid anti-inflammatory agent. It suppresses migration of polymorphonuclear leukocytes and reverses the capillary permeability associated with inflammation. It also suppresses the immune system by reducing activity and volume of the lymphatic system.

Indications: Treatment of mild to moderate lichen planus.

Contraindications: Allergy to the drug or any of its components. Fungal, viral or bacterial infections of the oral cavity or throat.

Warnings/Precautions: Use with caution in patients with heart failure, diabetes, GI diseases, hepatic impairment, myasthenia gravis, MI, patients at risk for osteoporosis, seizure disorders, or thyroid disease. Use with caution in patients with glaucoma, cataracts, latent TB, psychiatric disturbances, or secondary infection. May induce hypothalamic-pituitary-adrenal (HPA) axis suppression, particularly in patients receiving supraphysiological doses for prolonged periods. If present, withdrawal and discontinuation of prednisone should be done slowly and carefully.

Drug interactions: Barbiturates, phenytoin, and rifampin increase metabolism of triamcinolone. Salicylates may increase risk of gastric ulceration.

Administration:
Dosage form – 0.1% cream, 0.1% ointment, 0.1% dental paste; 10mg / mL or 40mg/mL suspension.
Topical – Apply thin coating of cream or ointment to lesion after meals and at bedtime. Do not eat or drink for 30 minutes.
Injection – Inject 0.2mL – 0.4mL directly into lesion.

Monitor efficacy: Improved oral comfort, lesion resolution.

Monitor toxicity: Mucosal thinning, burning, candida superinfection, perioral dermatitis, Cushing’s syndrome (hypertension, obesity, facial plethora, muscle weakness, back pain, striae, bruising, and psychological symptoms).

Length of treatment: As may be required to manage painful exacerbations of OLP.

Cessation of treatment: Topical regimens may be discontinued without tapering.

Instructions to the patient: Use only as instructed. Do not swallow.

For additional information see DailyMed