Triamcinolone

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Contraindications 4 Dosage 5 Adverse-effects 6 Drug-interactions 7 Mechanism-of-action 8 More General Terms 9 Internet Database 10 References

Introduction

• Systemic agent: Tradenames: Aristocort, Kenacort, Kenalog.

• Topical: Tradenames: Aristocort, Kenalog, Kenalog in Orabase Nasal preparation: Tradename: Nasocort. Asthma medication: Tradename: Azmacort.

Indications

• anti-inflammatory agent ( systemic, topical)
• inhaled steroid for chronic suppression of inflammation associated with reactive airway disease

Contraindications

• Caution: Halogenated steroids should not be used on face

• rebound worsening
• steroid-induced rosacea or atrophy
  

• pregnancy category = c
• pregnancy category = d
• safety in lactation = -
• safety in lactation = ?
• safety in lactation = ?

Dosage

• 4-48 mg PO/ IM QD
• 20 mg injected into large joints
• 5-10 mg into smaller joints
• topical: Apply TID/ QID
• nasal spray: start 2 sprays (110 ug) QD, max 4 sprays/day
• inhaler: 2 puffs TID/ QID

• Tabs: 1, 2, 4, 8 mg
• Syrup: 4 mg/5 mL.
• Injection: Kenalog, Trivaris
• Cream: 0.025%, 0.1%, 0.5%.
• Ointment: 0.025% (15 & 80 g), 0.1% (15, 60, 240 g), 0.5% (15 g).
• Lotion: 0.025% (60 mL), 0.1% (15 mL, 60 mL). Paste 0.1% (Kenalog in Orabase)
• Medium potency (0.025%). Inhaler: 100 ug/spray (20 g)

Adverse-effects

• common (> 10%)

• increased appetite, insomnia, indigestion, nervousness

• less common (1-10%)

• cataracts, hyperglycemia ( diabetes mellitus), hirsutism, joint pain, epistaxis

• uncommon (< 1%)

• seizures, mood swings, headache, skin atrophy, bruising, hyperpigmentation, acne, amenorrhea, Na+ & H20 retention, Cushing's syndrome, suppression of bone growth, abdominal distention, ulcerative esophagitis, pancreatitis, muscle wasting, hypersensitivity, delirium, hallucinations, euphoria

• short-term

• fluid & electrolyte disturbances
• hyperglycemia
• poor wound healing
• GI disturbances
• spread of infection

• long-term

• osteoporosis
• bone fractures
• pituitary adrenal axis insufficiency
• Cushing's syndrome
• acute adrenal insufficiency with rapid withdrawal of therapy
• skin atrophy
• hyperpigmentation

• Azmacort:

• dysphonia in 5-50% of patients, use of a spacer is of benefit
• oral candidiasis ( thrush)
• cough
• long-term use may result in loss of bone mineral density [7]

• Nasocort:

• irritation of nasal mucosa
• rarely nasal ulceration
  
• drug adverse effects of glucocorticoids
• drug adverse effects of immunosuppressive agents

Drug-interactions

• aminoglutethimide
• anticholinesterases
• barbiturates
• carbamazepine
• phenytoin
• rifampin
• live virus vaccines
  
• drug interaction(s) of glucocorticoids with warfarin

Mechanism-of-action

• intermediate-acting glucocorticoids
• nasal preparation ( Nasocort)

• does NOT inhibit IgE synthesis or mast cell degranulation

• inhibits cytokine production, arachidonate metabolism, inflammation & mast cell proliferation

More General Terms

• glucocorticoid
• antiasthmatic agent
• antipruritic agent

Internet Database

PubChem: 31307
PubChem: 5544
PubChem: 6216
PubChem: 6436
PubChem: 21826
PubChem: 62963
PubChem: 62964
PubChem: 633097
PubChem: 539244
PubChem: 16147
PubChem: 633091
PubChem: 5545
PubChem: 657338

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 85.
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 743
5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
6. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
7. a) Journal Watch, Mass Med Soc 20(11):88 (June) 2000 b) Wong CA et al Lancet 355:1399, 2000 c) Sambrook PN Lancet 355:1385, 2000

triamcinolone (TAC, Aristocort, Arsitospan, Kenacort, Kenalog, Nasocort, Azmacort, Trivaris)