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Triamcinolone
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<h2 id="medical-uses">Medical uses</h2> <p>Triamcinolone is used to treat various medical conditions, such as <a href="/facts/Eczema/JwlyQBa2">eczema</a>, <a href="/facts/Alopecia_areata/UeYKJwsz">alopecia areata</a>, <a href="/facts/Lichen_sclerosus/3PuJ7V6l">lichen sclerosus</a>, <a href="/facts/Psoriasis/WW1k1LsH">psoriasis</a>, <a href="/facts/Arthritis/IQ1wyf21">arthritis</a>, <a href="/facts/Allergies/dYAVosh8">allergies</a>, <a href="/facts/Ulcerative_colitis/BIkyFzRj">ulcerative colitis</a>, <a href="/facts/Lupus/kfHYawre">lupus</a>, <a href="/facts/Sympathetic_ophthalmia/tfKhE9TG">sympathetic ophthalmia</a>, <a href="/facts/Temporal_arteritis/3X1GdNRR">temporal arteritis</a>, <a href="/facts/Uveitis/le0Ns1eE">uveitis</a>, <a href="/facts/Human_eye/a24ua4fy">ocular</a> <a href="/facts/Inflammation/Ura86MIy">inflammation</a>, <a href="/facts/Keloid/nY3pACyg">keloids</a>, <a href="/facts/Urushiol-induced_contact_dermatitis/M8lw810J">urushiol-induced contact dermatitis</a>, <a href="/facts/Aphthous_ulcers/Guhg6h4E">aphthous ulcers</a> (usually as <a href="/facts/Triamcinolone_acetonide/8oe3CSR5">triamcinolone acetonide</a>), <a href="/facts/Central_retinal_vein_occlusion/RFmzMHJL">central retinal vein occlusion</a>, visualization during <a href="/facts/Vitrectomy/2PImvuVA">vitrectomy</a> and the prevention of <a href="/facts/Asthma/7GkJvxn3">asthma</a> attacks.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a><a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> </p><p>The <a href="/facts/Derivative_(chemistry)/JYcbLkbm">derivative</a> <a href="/facts/Triamcinolone_acetonide/8oe3CSR5">triamcinolone acetonide</a> 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 <a href="/facts/Eczema/JwlyQBa2">eczema</a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> and <a href="/facts/Dermatitis/JwlyQBa2">dermatitis</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> </p> <h2 id="contraindications">Contraindications</h2> <p>Contraindications for <a href="/facts/Systemic_administration/yxye1dtm">systemic</a> triamcinolone are similar to those of other corticoids. They include systemic <a href="/facts/Mycoses/YVK551qC">mycoses</a> (fungal infections) and <a href="/facts/Parasitic_disease/DU94HYrL">parasitic diseases</a>, as well as eight weeks before and two weeks after application of <a href="/facts/Live_vaccine/Gabb4afu">live vaccines</a>. For long-term treatment, the drug is also contraindicated in people with <a href="/facts/Peptic_ulcer/peMGnYCd">peptic ulcers</a>, severe <a href="/facts/Osteoporosis/xa1W00Tj">osteoporosis</a>, severe <a href="/facts/Myopathy/eklaDeY6">myopathy</a>, certain <a href="/facts/Viral_infection/F1Tth6qP">viral infections</a>, <a href="/facts/Glaucoma/MWqWVNz3">glaucoma</a>, and <a href="/facts/Metastasizing/4dadbm6z">metastasizing</a> tumours.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> </p><p>There are no contraindications for use in <a href="/facts/Emergency_medicine/HmVeC5R9">emergency medicine</a>.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> </p> <h2 id="side-effects">Side effects</h2> <p class="note">Further information: <a href="/facts/Glucocorticoid/2P91Aj3S">Glucocorticoid § Side effects</a></p> <p>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 <a href="/facts/Gastrointestinal_bleeding/ynYL5PXm">gastrointestinal bleeding</a> is seen, as well as acute infections (mainly <a href="/facts/Viral_infection/F1Tth6qP">viral</a>) and impaired <a href="/facts/Glucose_tolerance/MqWAdWQU">glucose tolerance</a>.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> </p><p>Side effects of triamcinolone long-term treatment may include coughing (up to <a href="/facts/Bronchospasm/E61Q1mGD">bronchospasms</a>), <a href="/facts/Sinusitis/czg09cPT">sinusitis</a>, <a href="/facts/Metabolic_syndrome/jI70tRBv">metabolic syndrome</a>–like symptoms such as <a href="/facts/High_blood_sugar/HM8eNqfX">high blood sugar</a> and <a href="/facts/Hypercholesterolemia/UlIDdQuT">cholesterol</a>, <a href="/facts/Weight_gain/jVbY8Eao">weight gain</a> due to <a href="/facts/Edema/Q6MI3KdH">water retention</a>, and <a href="/facts/Electrolyte_imbalance/mmb7W3A0">electrolyte imbalance</a>, as well as <a href="/facts/Cataract/RzN7k7K2">cataract</a>, <a href="/facts/Oral_candidiasis/joetTDM8">thrush</a>, <a href="/facts/Osteoporosis/xa1W00Tj">osteoporosis</a>, <a href="/facts/Reduced_muscle_mass/WgJ9jhKw">reduced muscle mass</a>, and <a href="/facts/Psychosis/cVGd7MKK">psychosis</a>.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> Triamcinolone injections can cause bruising and joint swelling.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> Symptoms of an <a href="/facts/Allergic_reaction/dYAVosh8">allergic reaction</a> include <a href="/facts/Rash/W97qGpq6">rash</a>, <a href="/facts/Itch/MBWq6SPc">itch</a>, <a href="/facts/Edema/Q6MI3KdH">swelling</a>, severe <a href="/facts/Dizziness/eI8UvmS5">dizziness</a>, <a href="/facts/Shortness_of_breath/1jBfFzxU">trouble breathing</a>,<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> and <a href="/facts/Anaphylaxis/F9IDQxeL">anaphylaxis</a>.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> </p> <h2 id="overdose">Overdose</h2> <p>No acute <a href="/facts/Overdosing/Jlo2AX3Y">overdosing</a> of triamcinolone has been described.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> </p> <h2 id="interactions">Interactions</h2> <p><a href="/facts/Drug_interactions/T5VcSVGd">Drug interactions</a> 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:<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a><a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p> <ul><li><a href="/facts/Atropine/cJQ0gL4o">Atropine</a> and other <a href="/facts/Anticholinergic/9mDjo23r">anticholinergics</a> can substantially <a href="/facts/Ocular_hypertension/PgzT17Tw">increase pressure in the eyes</a>.</li> <li><a href="/facts/Antidiabetic_drug/KIRV1BHj">Antidiabetic drugs</a> can become less effective because triamcinolone causes diabetes-like symptoms.</li> <li><a href="/facts/Aspirin/opMK4qLk">Aspirin</a> and other <a href="/facts/NSAID/coIkzl4s">NSAIDs</a>, as well as <a href="/facts/Anticoagulants/cARpjm0G">anticoagulants</a> such as <a href="/facts/Warfarin/kMnH6tb0">warfarin</a>, add to the risk of gastrointestinal bleeding.</li> <li><a href="/facts/Diuretic/x3j4I1Tg">Diuretics</a> that excrete <a href="/facts/Potassium/FWPwS7Rj">potassium</a> (such as <a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a> and <a href="/facts/Thiazide/y0xU4l4F">thiazides</a>) can increase the risk of <a href="/facts/Hypokalemia/XvS1S7s6">hypokalemia</a> and thus lead to <a href="/facts/Arrhythmia/ooEpr46Q">abnormal heart rhythm</a>.</li> <li><a href="/facts/Cardiac_glycoside/Ws7Uvv9B">Cardiac glycosides</a> may have more adverse effects due to reduced potassium levels in the blood.</li> <li>The risk for <a href="/facts/Blood_count/NF9lNJL3">blood count</a> changes is increased when combining triamcinolone with <a href="/facts/ACE_inhibitor/cHT1Yxub">ACE inhibitors</a>.</li></ul> <p>Triamcinolone and other drugs can also influence each other's concentrations in the body, amounting to pharmacokinetic interactions such as:<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <ul><li><a href="/facts/Rifampicin/9naa8C5l">Rifampicin</a>, <a href="/facts/Phenytoin/uFvxbwf2">phenytoin</a>, <a href="/facts/Carbamazepine/Hd1By1Mj">carbamazepine</a> and other inducers of the liver enzyme <a href="/facts/CYP3A4/MqD09gEj">CYP3A4</a><a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> speed up metabolization of triamcinolone and can therefore reduce its effectiveness.</li> <li>Conversely, CYP3A4 inhibitors, such as <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a> and <a href="/facts/Itraconazole/x7IeB92o">itraconazole</a>, can increase its concentrations in the body and the risk for adverse effects.</li> <li>Blood concentrations of <a href="/facts/Ciclosporin/tcIToHvK">ciclosporin</a> can be increased.</li></ul> <h2 id="pharmacology">Pharmacology</h2> <p class="note">Main article: <a href="/facts/Glucocorticoid/2P91Aj3S">Glucocorticoid § Pharmacology</a></p> <h3>Mechanism of action</h3> <p class="note">Further information: <a href="/facts/Glucocorticoid/2P91Aj3S">Glucocorticoid § Mechanism of action</a></p> <p>Triamcinolone is a glucocorticoid that is about five times as potent as <a href="/facts/Cortisol/5IvRV0cm">cortisol</a> but has very few <a href="/facts/Mineralocorticoid/Ruj1B1Mv">mineralocorticoid</a> effects.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> </p> <h3>Pharmacokinetics</h3> <p>When taken by mouth, the drug's <a href="/facts/Bioavailability/9l6na9MV">bioavailability</a> is over 90%. It reaches its highest concentrations in the <a href="/facts/Blood_plasma/oHuwwugG">blood plasma</a> after one to two hours and is bound to <a href="/facts/Plasma_protein/C87ptzI0">plasma proteins</a> to about 80%. The <a href="/facts/Biological_half-life/7nB2JtMr">biological half-life</a> from the plasma is 200 to 300 minutes; due to stable complexes of triamcinolone and <a href="/facts/Glucocorticoid_receptor/NUsGokjq">its receptor</a> in the <a href="/facts/Intracellular_fluid/CYV4l60r">intracellular fluid</a>, the total half-life is significantly longer at about 36 hours.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p><p>A small fraction of the substance is metabolized to 6-hydroxy- and 20-dihydro-triamcinolone; most of it probably undergoes <a href="/facts/Glucuronidation/G5qfwsFb">glucuronidation</a>, and a smaller part <a href="/facts/Sulfation/lI6B3Y1M">sulfation</a>. Three-quarters are excreted via the urine, and the rest via the faeces.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> </p><p>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.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> </p> <h2 id="chemistry">Chemistry</h2> <p>Triamcinolone is a <a href="/facts/Synthetic_compound/gqCNaN45">synthetic</a> <a href="/facts/Pregnane/tbXV6N95">pregnane</a> <a href="/facts/Corticosteroid/jeL2QeIL">corticosteroid</a> and <a href="/facts/Chemical_derivative/JYcbLkbm">derivative</a> of <a href="/facts/Cortisol/5IvRV0cm">cortisol</a> (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.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p><p>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 <a href="/facts/Polymorphism_(materials_science)/bu2tqsB9">polymorphism</a>: 260 to 263 °C (500 to 505 °F), 264 to 268 °C (507 to 514 °F), or 269 to 271 °C (516 to 520 °F) can be found in the literature.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> </p><p><a href="/facts/Solubility/kLE9h3Jb">Solubility</a> is 1:500 in water and 1:240 in <a href="/facts/Ethanol/3lCLfBSP">ethanol</a>; it is slightly soluble in <a href="/facts/Methanol/EIfpoNCg">methanol</a>, very slightly soluble in <a href="/facts/Chloroform/gvzuJMXa">chloroform</a> and <a href="/facts/Diethylether/Ep20vEdj">diethylether</a>, and practically insoluble in <a href="/facts/Dichloromethane/mHyeTD2D">dichloromethane</a>. The <a href="/facts/Specific_rotation/XGLNP7U3">specific rotation</a> is [ α ] D 20 {\displaystyle [\alpha ]_{D}^{20}} +65° to +72° cm3/dm·g (1% in <a href="/facts/Dimethylformamide/wjI8UfB4">dimethylformamide</a>).<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> </p> <h2 id="society-and-culture">Society and culture</h2> <p>In 2010, <a href="/facts/Teva_Pharmaceuticals/usfDATJp">Teva</a> and <a href="/facts/Perrigo/Ix9Pq3pC">Perrigo</a> launched the first generic inhalable triamcinolone.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> </p><p>According to Chang et al. (2014), "Triamcinolone acetonide (TA) is classified as an S9 <a href="/facts/Glucocorticoid/2P91Aj3S">glucocorticoid</a> in the 2014 Prohibited List published by the <a href="/facts/World_Anti-Doping_Agency/z1KV3bhB">World Anti-Doping Agency</a>, which caused it to be prohibited in international athletic competition when administered orally, intravenously, intramuscularly or rectally".<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> </p> <h2 id="external-links">External links</h2> <ul><li><a href="https://medlineplus.gov/druginfo/meds/a601124.html">"Triamcinolone Topical"</a>. <i>MedlinePlus</i>.</li> <li><a href="https://medlineplus.gov/druginfo/meds/a682791.html">"Triamcinolone Nasal Spray"</a>. <i>MedlinePlus</i>.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>"Triamcinolone Use During Pregnancy". Drugs.com. Retrieved 3 March 2019. <a href="https://www.drugs.com/pregnancy/triamcinolone.html" target="_blank">https://www.drugs.com/pregnancy/triamcinolone.html</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>"Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. <a href="https://www.drugs.com/monograph/triamcinolone.html" target="_blank">https://www.drugs.com/monograph/triamcinolone.html</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 486. ISBN 978-3-527-60749-5. <a href="978-3-527-60749-5" target="_blank">978-3-527-60749-5</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Vallerand AH (2018). Davis's Drug Guide for Nurses. F.A. Davis. p. 365. ISBN 978-0-8036-7000-6. <a href="978-0-8036-7000-6" target="_blank">978-0-8036-7000-6</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024. <a href="https://clincalc.com/DrugStats/Top300Drugs.aspx" target="_blank">https://clincalc.com/DrugStats/Top300Drugs.aspx</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>"Triamcinolone Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024. <a href="https://clincalc.com/DrugStats/Drugs/Triamcinolone" target="_blank">https://clincalc.com/DrugStats/Drugs/Triamcinolone</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>"Triamcinolone: Uses, Dosage, Side Effects, Warnings". Drugs.com. <a href="https://www.drugs.com/triamcinolone.html" target="_blank">https://www.drugs.com/triamcinolone.html</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>"Azmacort Inhaler: Side Effects, Dosage & Uses". Drugs.com. <a href="https://www.drugs.com/azmacort.html" target="_blank">https://www.drugs.com/azmacort.html</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>"Alcon Receives FDA Approval of Triesence Injectable Triamcinolone Suspension for Use in Eye Surgery". Drugs.com. <a href="https://www.drugs.com/newdrugs/alcon-receives-fda-approval-triesence-injectable-triamcinolone-suspension-eye-surgery-731.html" target="_blank">https://www.drugs.com/newdrugs/alcon-receives-fda-approval-triesence-injectable-triamcinolone-suspension-eye-surgery-731.html</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Chong M, Fonacier L (December 2016). "Treatment of Eczema: Corticosteroids and Beyond". Clinical Reviews in Allergy & Immunology. 51 (3): 249–262. doi:10.1007/s12016-015-8486-7. PMID 25869743. S2CID 44337035. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. (July 2014). "Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies". Journal of the American Academy of Dermatology. 71 (1): 116–132. doi:10.1016/j.jaad.2014.03.023. PMC 4326095. PMID 24813302. Topical corticosteroids (TCS) are used in the management of AD in both adults and children and are the mainstay of anti-inflammatory therapy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326095" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326095</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. 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