Triamcinolone

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Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others.<ref name=AHFS2019 /> It is also used to prevent worsening of asthma and chronic obstructive pulmonary disease (COPD).<ref name="AHFS2019" /> It can be taken in various ways including by mouth, injection into a muscle, and inhalation.<ref name=AHFS2019 />

Common side effects with long-term use include osteoporosis, cataracts, thrush, and muscle weakness.<ref name=AHFS2019 /> Serious side effects may include psychosis, increased risk of infections, adrenal suppression, and bronchospasm.<ref name=AHFS2019 /> Use in pregnancy is generally safe.<ref name=Preg2019>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It works by decreasing inflammation and immune system activity.<ref name=AHFS2019>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Triamcinolone was patented in 1956 and came into medical use in 1958.<ref name=Fis2006>Template:Cite book</ref> It is available as a generic medication.<ref>Template:Cite book</ref> In 2022, it was the 102nd most commonly prescribed medication in the United States, with more than 6Template:Nbspmillion prescriptions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Medical uses

Triamcinolone is used to treat various medical conditions, such as eczema, alopecia areata, lichen sclerosus, psoriasis, arthritis, allergies, ulcerative colitis, lupus, sympathetic ophthalmia, temporal arteritis, uveitis, ocular inflammation, keloids, urushiol-induced contact dermatitis, aphthous ulcers (usually as triamcinolone acetonide), central retinal vein occlusion, visualization during vitrectomy and the prevention of asthma attacks.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

The derivative triamcinolone acetonide is the active ingredient in various topical skin preparations (cream, lotion, ointment, aerosol spray) designed to treat such skin conditions as rash, inflammation, redness, or intense itching due to eczema<ref>Template:Cite journal</ref> and dermatitis.<ref>Template:Cite journal</ref>

Contraindications

Contraindications for systemic triamcinolone are similar to those of other corticoids. They include systemic mycoses (fungal infections) and parasitic diseases, as well as eight weeks before and two weeks after application of live vaccines. For long-term treatment, the drug is also contraindicated in people with peptic ulcers, severe osteoporosis, severe myopathy, certain viral infections, glaucoma, and metastasizing tumours.<ref name="AC">Template:Cite book</ref>

There are no contraindications for use in emergency medicine.<ref name="Dinnendahl" />

Side effects

Template:See The side effects of triamcinolone are similar to other corticosteroids. In short-term treatment of up to ten days, it has very few adverse effects; however, sometimes gastrointestinal bleeding is seen, as well as acute infections (mainly viral) and impaired glucose tolerance.<ref name="Dinnendahl" />

Side effects of triamcinolone long-term treatment may include coughing (up to bronchospasms), sinusitis, metabolic syndrome–like symptoms such as high blood sugar and cholesterol, weight gain due to water retention, and electrolyte imbalance, as well as cataract, thrush, osteoporosis, reduced muscle mass, and psychosis.<ref name="PPA">Triamcinolone (systemic) Template:Drugs.com. Accessed 19 August 2020.</ref><ref name=AHFS2019 /><ref name="AC" /> Triamcinolone injections can cause bruising and joint swelling.<ref name="PPA" /> Symptoms of an allergic reaction include rash, itch, swelling, severe dizziness, trouble breathing,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and anaphylaxis.<ref name="AC" />

Overdose

No acute overdosing of triamcinolone has been described.<ref name="AC" />

Interactions

Drug interactions are mainly pharmacodynamic, that is, they result from other drugs either adding to triamcinolone's corticosteroid side effects or working against its desired effects. They include:<ref name="Dinnendahl" /><ref name="AC" />

• Atropine and other anticholinergics can substantially increase pressure in the eyes.
• Antidiabetic drugs can become less effective because triamcinolone causes diabetes-like symptoms.
• Aspirin and other NSAIDs, as well as anticoagulants such as warfarin, add to the risk of gastrointestinal bleeding.
• Diuretics that excrete potassium (such as loop diuretics and thiazides) can increase the risk of hypokalemia and thus lead to abnormal heart rhythm.
• Cardiac glycosides may have more adverse effects due to reduced potassium levels in the blood.
• The risk for blood count changes is increased when combining triamcinolone with ACE inhibitors.

Triamcinolone and other drugs can also influence each other's concentrations in the body, amounting to pharmacokinetic interactions such as:<ref name="Dinnendahl" /><ref name="AC" />

• Rifampicin, phenytoin, carbamazepine and other inducers of the liver enzyme CYP3A4<ref name="pmid23143891">Template:Cite journal</ref> speed up metabolization of triamcinolone and can therefore reduce its effectiveness.
• Conversely, CYP3A4 inhibitors, such as ketoconazole and itraconazole, can increase its concentrations in the body and the risk for adverse effects.
• Blood concentrations of ciclosporin can be increased.

Pharmacology

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Mechanism of action

Template:See Triamcinolone is a glucocorticoid that is about five times as potent as cortisol but has very few mineralocorticoid effects.<ref name="Dinnendahl" />

Pharmacokinetics

When taken by mouth, the drug's bioavailability is over 90%. It reaches its highest concentrations in the blood plasma after one to two hours and is bound to plasma proteins to about 80%. The biological half-life from the plasma is 200 to 300 minutes; due to stable complexes of triamcinolone and its receptor in the intracellular fluid, the total half-life is significantly longer at about 36 hours.<ref name="Dinnendahl" /><ref name="PPA" />

A small fraction of the substance is metabolized to 6-hydroxy- and 20-dihydro-triamcinolone; most of it probably undergoes glucuronidation, and a smaller part sulfation. Three-quarters are excreted via the urine, and the rest via the faeces.<ref name="Dinnendahl" /><ref name="AC" />

Due to corticoids' mechanism of action, the effects are delayed as compared to plasma concentrations. Depending on the route of administration and the treated condition, the onset of action can be from two hours up to one or two days after application; and the drug can act much longer than its elimination half-life would suggest.<ref name="Dinnendahl" /><ref name="PPA" />

Chemistry

Triamcinolone is a synthetic pregnane corticosteroid and derivative of cortisol (hydrocortisone) and is also known as 1-dehydro-9α-fluoro-16α-hydroxyhydrocortisone or 9α-fluoro-16α-hydroxyprednisolone as well as 9α-fluoro-11β,16α,17α,21-tetrahydroxypregna-1,4-diene-3,20-dione.<ref name="Elks2014">Template:Cite book</ref><ref name="IndexNominum2000">Template:Cite book</ref>

The substance is a light-sensitive, white to off-white, crystalline powder, or has the form of colourless, matted crystals. It has no odour or is nearly odourless. Information on the melting point varies, partly due to the substance's polymorphism: Template:Convert, Template:Convert, or Template:Convert can be found in the literature.<ref name="Dinnendahl" />

Solubility is 1:500 in water and 1:240 in ethanol; it is slightly soluble in methanol, very slightly soluble in chloroform and diethylether, and practically insoluble in dichloromethane. The specific rotation is <math>[\alpha]_D^{20}</math> +65° to +72° cm³/dm·g (1% in dimethylformamide).<ref name="Dinnendahl" />

Society and culture

In 2010, Teva and Perrigo launched the first generic inhalable triamcinolone.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

According to Chang et al. (2014), "Triamcinolone acetonide (TA) is classified as an S9 glucocorticoid in the 2014 Prohibited List published by the World Anti-Doping Agency, which caused it to be prohibited in international athletic competition when administered orally, intravenously, intramuscularly or rectally".<ref>Template:Cite journal</ref>

External links

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