Volon (Volon)

Instructions for use: Volon A (Volon A)

Brief reference information compiled from official German sources (Gelbe Liste, Fachinfo, Apotheken Umschau). It does not replace a doctor’s consultation or the package insert. This is a prescription medicine — use it only as directed by a doctor.

Active substance

Triamcinolone acetonide (Triamcinolonacetonid) is a synthetic glucocorticoid with pronounced anti-inflammatory, anti-allergic and membrane-stabilising action. Volon A 40: 1 ml of the crystalline suspension contains 40 mg of triamcinolone acetonide. It also contains benzyl alcohol and polysorbate 80 as excipients.

Available forms

A crystalline (depot) suspension for injection. Volon A 10 — 10 mg/ml (for smaller doses, small lesions, small joints, tendons), Volon A 40 — 40 mg/ml, as well as Volon A 40-5 ml — a 5 ml vial (40 mg/ml). A milky-white suspension with an average crystal size of about 10 µm. Intended for intramuscular (i.m.), intra-articular, intralesional (intrafocal) and sublesional administration. NOT for intravenous, intrathecal, epidural or intravitreal use.

Indications

• Systemically (i.m., as a depot): allergic rhinitis in severe cases and when local treatment is ineffective (for example, hay fever/pollinosis)
• Intra-articularly: residual inflammation in one or more joints in chronic inflammatory joint diseases
• Intra-articularly: exudative arthritis in gout and pseudogout, activated osteoarthritis, intermittent hydrops of the joint (Hydrops articulorum intermittens), acute forms of humeroscapular periarthritis
• Intralesionally: bursitis, perineuritis
• Intralesionally (paravertebrally): cervical, thoracic and lumbar periarthritis in spondyloarthropathy; cervical, thoracic and lumbar radiculopathy
• Sublesionally (into the skin): individual psoriasis lesions, lichen planus, lichen simplex chronicus (localised neurodermatitis), chronic discoid lupus erythematosus, alopecia areata, keloids

How to take

Administered only by a doctor/medical staff by injection; self-administration is not permitted. The dose, route and frequency are determined by the doctor individually according to the disease and the response to treatment. I.m. (depot): 1 ml of Volon A 40 (40 mg) slowly and deeply into the buttock (NOT i.v. and NOT subcutaneously); in severe forms — up to 80 mg. In pollinosis, 1 ampoule (40 mg) per year during the pollination period is usually sufficient; if repeated injections are necessary, the interval should be at least 4 weeks. Intra-articularly: the dose depends on the size of the joint (small — up to 10 mg, medium — 20 mg, large — 20–40 mg; with several joints, up to 80 mg in total); a single injection is usually sufficient, repeated no earlier than after 3–4 weeks, no more than 3–4 injections per joint per year. Paravertebrally: usually 1 ml (40 mg) per injection, if necessary repeated up to 3 times at an interval of 4–21 days (increasing to 3 weeks), a maximum of 8 injections in total; if there is no improvement after the 3rd injection, treatment is discontinued. The suspension must always be shaken before drawing up. Strict asepsis.

Contraindications

• Hypersensitivity to triamcinolone or to the excipients
• For long-term therapy: gastric and duodenal ulcers, severe osteoporosis, a psychiatric history
• Acute viral infections (herpes zoster, herpes simplex, chickenpox), amoebiasis, HBsAg-positive chronic active hepatitis, systemic mycoses, tuberculous or syphilitic skin lesions, poliomyelitis
• The period approximately 8 weeks before and 2 weeks after vaccination (immunisations)
• Narrow- and wide-angle glaucoma, myasthenia, seizure disorders, perioral dermatitis, rosacea, abscesses and purulent infections
• For intra-articular administration and infiltration: infection in the joint area, bacterial arthritis, joint instability, a tendency to bleeding (including on anticoagulants), tendon rupture, Charcot joint, a psoriasis lesion in the injection area
• Must not be administered intravenously (crystalline suspension), intrathecally/epidurally (benzyl alcohol) or intravitreally; do not use in children under 12 years, and intramuscularly — not in adolescents under 16 years

Possible side effects

• Local reactions at the injection site: sensation of heat, skin irritation, persistent long-lasting pain
• Atrophy of the skin and subcutaneous tissue at the injection site (depigmentation and loss of vellus hair are possible)
• Hypersensitivity reactions: rash (exanthema), redness, skin blisters, up to anaphylactic and cardiovascular reactions
• Damage to tendons and/or their rupture (after infiltration injection); risk of damage to vessels and nerves during puncture
• With prolonged/systemic action: suppression of adrenal function, Cushingoid syndrome (moon face, truncal obesity), sodium retention with oedema, potassium loss, increased blood pressure
• Increased blood glucose levels, diabetes mellitus, osteoporosis, muscle atrophy, aseptic bone necrosis
• Mental disturbances (insomnia, depression, euphoria, irritability), increased risk of infections, delayed wound healing; from the eyes — cataract, glaucoma, blurred vision

Special precautions

Prescription medicine (rezeptpflichtig). Administered exclusively by a doctor or medical staff — this is not a medicine for independent use at home. A depot form with prolonged action: after an intramuscular injection, triamcinolone is gradually released from the depot over approximately 2–3 weeks, so the medicine is not suitable for acute conditions. Before drawing it up, shake the suspension evenly; do not use it if lumps/crystal agglomerates are present. Strict asepsis with every injection. During long-term therapy, regular medical examinations are required, including ophthalmological monitoring every 3 months and monitoring of potassium and blood pressure. Do not stop long-term use abruptly (risk of adrenal insufficiency, withdrawal syndrome). Contraindicated in children under 12 years; intramuscularly — in adolescents under 16 years. Pregnancy and lactation — only under strict indications and under a doctor’s supervision.

Sources: www.fachinfo.de, www.fachinfo.de, www.gelbe-liste.de, www.rote-liste.de, www.apotheken-umschau.de