Nelson textbook of pediatrics. Bethesda, MD: National Institutes of Health; 1997 Feb.101. Patients being transferred from systemic corticosteroid to oral inhalation therapy should carry special identification (e.g., card, bracelet) indicating the need for supplementary systemic corticosteroids during periods of stress.Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.Importance of informing patients of other important precautionary information.100. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Executive summary: guidelines for the diagnosis and management of asthma. Global initiative for asthma: global strategy for asthma management and prevention NHLBI/WHO Workshop Report. Topical and inhaled preparations should be used whenever possible.Before initiating glucocorticoid therapy in postmenopausal women, consider that they are especially prone to osteoporosis.Withdraw glucocorticoids if osteoporosis develops, unless their use is life-saving.Glucocorticoid-induced bone loss can be both prevented and treated. 2014 Apr 23. National Institutes of Health, National Heart, Lung, and Blood Institute. Epidural corticosteroid injection: Drug safety communication - risk of rare but serious neurologic Problems. 02-3659. The site of the injection and the volume of the injection should be carefully considered when Aristospan is administered for this purpose.Aristospan® (triamcinolone hexacetonide injectable suspension, USP), 5 mg/mL is available as follows:Store at 20°-25°C (68°-77°F) [see USP Controlled Room Temperature]. Less frequent (e.g., annually) follow-up probably is sufficient in patients who are receiving therapy to prevent bone loss.Skeletal wasting is most rapid during the initial 6 months of therapy; trabecular bone is affected to a greater degree than is cortical bone.Calcium and vitamin D supplementation, bisphosphonate (e.g., alendronate, risedronate), and a weight-bearing exercise program that maintains muscle mass are suitable first-line therapies aimed at reducing the risk of adverse bone effects.Calcitonin may be considered as second-line therapy for patients who refuse or do not tolerate bisphosphonate therapy or in whom the drugs are contraindicated.Sodium retention with resultant edema, potassium loss, and elevation of BP may occur but is less common with triamcinolone than with average or large doses of cortisone or hydrocortisone.Dietary salt restriction and potassium supplementation may be necessary.Increased calcium excretion and possible hypocalcemia.Prolonged use may result in posterior subcapsular and nuclear cataracts (particularly in children), exophthalmos, and/or increased IOP which may result in glaucoma or may occasionally damage the optic nerve.Increased risk of ocular hypertension or open-angle glaucoma observed in patients receiving the maximum dosage of oral inhalation for 3 or more months.May enhance the establishment of secondary fungal and viral infections of the eye.Transient blindness, amblyopia, acute retinal necrosis syndrome, intraocular hemorrhage, and cortical blindness have occurred following epidural glucocorticoid injection.Administration over a prolonged period may produce various endocrine disorders including hypercorticism (cushingoid state) and amenorrhea or other menstrual difficulties.May decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus, especially in patients predisposed to diabetes mellitus.Administer by epidural injection with caution in patients with diabetes mellitus.Exaggerated glucocorticoid response in patients with hypothyroidism.Possible association between use of glucocorticoids and left ventricular free-wall rupture; use with extreme caution in patients with recent MI.Use with caution in patients with CHF or hypertension.Administer by epidural injection with caution in patients with CHF.If bronchospasm occurs, treat immediately with a short-acting bronchodilator, and discontinue treatment with triamcinolone acetonide and institute alternative therapy.Unknown long-term, systemic, and local effects of the drug in humans, particularly developmental or immunologic processes in the mouth, pharynx, trachea, and lung.Some commercially available injections of triamcinolone contain benzyl alcohol as a preservative.Anaphylactic or anaphylactoid reactions have occurred with parenteral corticosteroids.Prior to initiation of long-term glucocorticoid therapy, perform baseline ECGs, BP, chest and spinal radiographs, glucose tolerance tests, and evaluations of HPA-axis function in all patients.Perform upper GI radiographs in patients predisposed to GI disorders, including those with known or suspected peptic ulcer disease or appreciable dyspepsia.During long-term therapy, perform periodic height, weight, chest and spinal radiographs, hematopoietic, electrolyte, glucose tolerance, and ocular and BP evaluations.Because systemic absorption possible with orally inhaled corticosteroids, carefully observe patients for systemic effects.Increased or decreased motility and number of sperm in some men.Corticosteroids should be used with caution in patients with diverticulitis, nonspecific ulcerative colitis (if there is a probability of impending perforation, abscess, or other pyogenic infection), or those with recent intestinal anastomoses.Use with caution in patients with active or latent peptic ulcer.Cortisone reported rarely to increase blood coagulability and to precipitate intravascular thrombosis, thromboembolism, and thrombophlebitis; use corticosteroids with caution in patients with thromboembolic disorders.Fluoroscopy (recommended for ensuring proper needle placement for epidural injections) is contraindicated in pregnant women.Insufficient experience with triamcinolone acetonide IM injection or inhalation aerosol in children <6 years of age; use not recommended.With long-term use, may delay growth and maturation in children and adolescents.Glucocorticoid-induced osteoporosis and associated fractures are common in children and adolescents receiving long-term systemic therapy. 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