Drug Index

Triamcinolone

 
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Mechanism :

Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that are readily absorbed from the gastrointestinal tract. Naturally occurring glucocorticoids have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their anti-inflammatory effects in disorders of many organ systems. When injected intra-lesionally or sub-lesionally, triamcinolone hexacetonide can be expected to be absorbed slowly from the injection site.


Indication :

• Arthritis

• Inflammatory and allergic systemic conditions

• Asthma

• Topical inflammatory dermatoses.

• Allergic rhinitis


Contraindications :

Contraindicated in patients who are hypersensitive to any components of this product. Intramuscular corticosteroid preparations are contraindicated for idiopathic thrombocytopenic purpura. Although active, latent or questionably healed tuberculosis, ocular herpes simplex, and acute psychoses are generally considered to be absolute contra-indications to corticosteroid therapy, the minimal systemic activity of triamcinolone hexacetonide following local injection might permit cautious use when indicated. Not to be injected directly into tendons.


Dosing :

Rheumatoid/arthritic disorders:

Intra-articular: 2 years and older:

Small joints: 2.5-5 mg intra-articular. Max: 10 mg/site upto 80 mg/total dose.

Large joints: 5-15 mg intra-articular. Max: 40 mg/site upto 80 mg/total dose.

Intramuscular:

6-12 years: 0.03-0.2 mg/kg IM every 1-7 days.

>12 years: 60 mg IM every 6 weeks. Can give additional 20-100 mg as needed.

Topical: Available as 0.025%, 0.1%, 0.5% cream, lotion.

Apply cream/ointment 2-3 times daily. Use smallest effective amount.

Asthma:

Available as 55 mcg or 100 mcg inhaler.

6-12 years: 1-2 puffs (75-150 mcg), 3-4 times a day. Not more than 12 puffs a day.

Allergic rhinitis:

Intranasal (available as 55 mcg/spray)

2-6 years: 1 spray/nostril/every alternate day. May increase as required. Max: 110 mcg/day.

6-12 years: 1 spray/nostril/every alternate day. May increase as required. Max: 220 mcg/day.

>12 years: 2 sprays/nostril/every alternate day. May increase as required. Max: 220 mcg/day.


Adverse Effect :

An exacerbation or flare-up of symptoms can occur. Local atrophy, burning, flushing, pain and swelling may occur. Other local effects include abscess, erythema, skin discoloration or depigmentation and necrosis at injection site. Absorption of triamcinolone following intra-articular injection is rare, so systemic side-effects are not to be expected when this route of administration is used.

Most systemic adverse effects are caused by the drug mineralocorticoid activity and include hypertension, edema, cardiac enlargement, congestive heart failure, potassium loss, and hypokalemic alkalosis.

Others: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones and spontaneous fractures, peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention and ulcerative esophagitis, impaired wound healing, thin fragile skin, bruising, petechiae and ecchymosis, facial erythema, increased sweating, subcutaneous fat atrophy, purpura, striae, hyperpigmentation of the skin and nails, hirsutism, reactions to skin tests may be suppressed, convulsions, increased intracranial pressure with papilledema, vertigo, headache and severe mental disturbances, menstrual irregularities, development of the cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, and increased requirements for insulin or oral hypoglycemic agents in diabetics, posterior subcapsular cataracts, increased intraocular pressure, glaucoma and exophthalmos, hyperglycemia, glycosuria, and negative nitrogen balance due to protein catabolism.


Interaction :

Amphotericin B or Potassium-Depleting Diuretics: Hypokalemia. Check serum potassium levels at frequent intervals and use potassium supplements if necessary.
Digitalis glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oral Anticoagulants: Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.
Antidiabetic drugs: Diminished antidiabetic effect. Monitor for symptoms of hyperglycemia
Aspirin: increased ulcerogenic effect, decreased pharmacologic effect of aspirin.
Barbiturates, Phenytoin, or Rifampin: Increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.
Anabolic Steroids such as Oxymetholone, Methandrostenolone, Norethandrolone: Enhanced tendency toward edema.
Vaccines: Neurological complications and lack of antibody response.


08/10/2019 20:44:27 Triamcinolone
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