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Triamcinolone
Chemical compound

Triamcinolone is a glucocorticoid used to treat various conditions such as skin diseases, allergies, and rheumatic disorders. It also helps prevent worsening of asthma and COPD. Administration methods include oral, intramuscular injection, and inhalation. Long-term use may cause side effects like osteoporosis, cataracts, and muscle weakness, while serious risks include psychosis and adrenal suppression. It reduces inflammation and suppresses the immune system. Patented in 1956, it is available as a generic medication and was among the top 150 prescribed drugs in the US in 2022.

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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.121314

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 eczema15 and dermatitis.16

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.17

There are no contraindications for use in emergency medicine.18

Side effects

Further information: Glucocorticoid § Side effects

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.19

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.202122 Triamcinolone injections can cause bruising and joint swelling.23 Symptoms of an allergic reaction include rash, itch, swelling, severe dizziness, trouble breathing,24 and anaphylaxis.25

Overdose

No acute overdosing of triamcinolone has been described.26

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:2728

Triamcinolone and other drugs can also influence each other's concentrations in the body, amounting to pharmacokinetic interactions such as:2930

Pharmacology

Main article: Glucocorticoid § Pharmacology

Mechanism of action

Further information: Glucocorticoid § Mechanism of action

Triamcinolone is a glucocorticoid that is about five times as potent as cortisol but has very few mineralocorticoid effects.32

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.3334

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.3536

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.3738

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.3940

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: 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.41

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 [ α ] D 20 {\displaystyle [\alpha ]_{D}^{20}} +65° to +72° cm3/dm·g (1% in dimethylformamide).42

Society and culture

In 2010, Teva and Perrigo launched the first generic inhalable triamcinolone.43

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".44

References

  1. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  2. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  3. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  4. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  5. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  6. "Triamcinolone Use During Pregnancy". Drugs.com. Retrieved 3 March 2019. https://www.drugs.com/pregnancy/triamcinolone.html ↩

  7. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  8. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 486. ISBN 978-3-527-60749-5. 978-3-527-60749-5 ↩

  9. Vallerand AH (2018). Davis's Drug Guide for Nurses. F.A. Davis. p. 365. ISBN 978-0-8036-7000-6. 978-0-8036-7000-6 ↩

  10. "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024. https://clincalc.com/DrugStats/Top300Drugs.aspx ↩

  11. "Triamcinolone Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024. https://clincalc.com/DrugStats/Drugs/Triamcinolone ↩

  12. "Triamcinolone: Uses, Dosage, Side Effects, Warnings". Drugs.com. https://www.drugs.com/triamcinolone.html ↩

  13. "Azmacort Inhaler: Side Effects, Dosage & Uses". Drugs.com. https://www.drugs.com/azmacort.html ↩

  14. "Alcon Receives FDA Approval of Triesence Injectable Triamcinolone Suspension for Use in Eye Surgery". Drugs.com. https://www.drugs.com/newdrugs/alcon-receives-fda-approval-triesence-injectable-triamcinolone-suspension-eye-surgery-731.html ↩

  15. 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. /wiki/Doi_(identifier) ↩

  16. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326095 ↩

  17. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  18. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  19. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  20. Triamcinolone (systemic) Professional Drug Facts. Accessed 19 August 2020. https://www.drugs.com/ppa/triamcinolone-systemic.html ↩

  21. "Triamcinolone Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019. https://www.drugs.com/monograph/triamcinolone.html ↩

  22. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  23. Triamcinolone (systemic) Professional Drug Facts. Accessed 19 August 2020. https://www.drugs.com/ppa/triamcinolone-systemic.html ↩

  24. "Drugs and Treatments – Nasacort AQ Nasl – Patient Handout". WebMD. Retrieved 24 March 2008. http://www.webmd.com/drugs/drug-16244-Nasacort+AQ.aspx?drugid=16244&drugname=Nasacort%20AQ ↩

  25. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  26. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  27. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  28. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  29. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  30. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  31. Moore CD, Roberts JK, Orton CR, Murai T, Fidler TP, Reilly CA, et al. (February 2013). "Metabolic pathways of inhaled glucocorticoids by the CYP3A enzymes". Drug Metabolism and Disposition. 41 (2): 379–389. doi:10.1124/dmd.112.046318. PMC 3558858. PMID 23143891. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558858 ↩

  32. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  33. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  34. Triamcinolone (systemic) Professional Drug Facts. Accessed 19 August 2020. https://www.drugs.com/ppa/triamcinolone-systemic.html ↩

  35. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  36. Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Volon 4 mg-Tabletten. ↩

  37. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  38. Triamcinolone (systemic) Professional Drug Facts. Accessed 19 August 2020. https://www.drugs.com/ppa/triamcinolone-systemic.html ↩

  39. Elks J (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. pp. 1228–. ISBN 978-1-4757-2085-3. 978-1-4757-2085-3 ↩

  40. Index Nominum 2000: International Drug Directory. Taylor & Francis. January 2000. pp. 1054–. ISBN 978-3-88763-075-1. 978-3-88763-075-1 ↩

  41. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  42. Dinnendahl V, Fricke U, eds. (2004). Arzneistoff-Profile (in German). Vol. 10 (19 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. Triamcinolon. ISBN 978-3-7741-9846-3. 978-3-7741-9846-3 ↩

  43. "Perrigo Announces Launch Of Generic Version Of Nasacort AQ". 15 June 2011. https://detroit.cbslocal.com/2011/06/15/perrigo-announces-launch-of-generic-version-of-nasacort-aq/ ↩

  44. Chang CW, Huang TY, Tseng YC, Chang-Chien GP, Lin SF, Hsu MC (November 2014). "Positive doping results caused by the single-dose local injection of triamcinolone acetonide". Forensic Science International. 244: 1–6. doi:10.1016/j.forsciint.2014.07.024. PMID 25126738. https://doi.org/10.1016%2Fj.forsciint.2014.07.024 ↩