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Intranasal corticosteroid Pregnancy: Use with caution; minimal systemic absorption at standard doses. Intranasal steroids generally considered acceptable in pregnancy.

Triamcinolone Acetonide 55 micrograms/actuation Nasal Spray (Nasacort)

Brand names: Nasacort

Adult dose

Dose: 2 sprays (110 micrograms) in each nostril once daily
Route: Intranasal
Frequency: Once daily
Max: 220 micrograms/day (2 sprays per nostril)
Seasonal and perennial allergic rhinitis: 2 sprays per nostril once daily. Once symptoms controlled, reduce to 1 spray per nostril (55 micrograms) once daily. Onset of action: 8–12 hours; full effect: 1–2 weeks. Use lowest effective dose for maintenance. Available OTC in some countries; prescription in UK.

Paediatric dose

Route: Intranasal
Frequency: Once daily
Max: 110 micrograms/day (children 2–11 years)
2–5 years: 1 spray per nostril once daily (55 micrograms — specialist supervision). 6–11 years: 1 spray per nostril once daily (55 micrograms). ≥12 years: adult dose. Monitor growth in children on prolonged use.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Use with caution in severe hepatic impairment — increased systemic exposure.

Clinical pearls

  • Correct technique is critical: tilt head forward slightly, aim toward outer nostril wall (not septum), breathe in gently through nose
  • Full efficacy requires consistent daily use for 1–2 weeks — patients often stop too early
  • Equivalent efficacy to other intranasal corticosteroids; mometasone (Nasonex) has the lowest bioavailability (<1%) if systemic effects concern
  • Can be used year-round for perennial allergic rhinitis at minimum effective dose
  • Combine with intranasal antihistamine (e.g., azelastine) if rhinitis not controlled — synergistic effect

Contraindications

  • Hypersensitivity to triamcinolone acetonide
  • Recent nasal surgery or trauma (until healed)
  • Active nasal infections

Side effects

  • Epistaxis (nasal bleeding — common, usually mild)
  • Nasal irritation and stinging
  • Headache
  • Pharyngitis
  • Nasal septal perforation (rare — with prolonged high-dose use or incorrect technique)
  • HPA axis suppression (rare at standard doses)

Interactions

  • Strong CYP3A4 inhibitors (ketoconazole, ritonavir) — increased systemic triamcinolone exposure

Monitoring

  • Symptom control (TNSS)
  • Height (children on prolonged treatment)
  • Nasal mucosa inspection

Reference: BNFc; BNF; ARIA 2020; BSACI Allergic Rhinitis Guidelines; Nasacort SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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