Indications for use of the drug Triamcinolone
Systemic use - rheumatoid arthritis, rheumatism, systemic lupus erythematosus and other collagenoses, acute allergic and severe skin-allergic reactions, severe forms of asthma, hemorrhagic diathesis, lymphoproliferative processes; intra-articular injection - an inflammatory process in one of several joints during chronic diseases, exudative arthritis, gout, an active form of arthrosis; injection into the affected area - periostitis, bursitis, exostosis, tendovaginitis, lateral brachial epicondylitis ("tennis elbow"), limited nodular skin lesions, isolated psoriatic plaques, etc. Externally - vasculitis, pemphigus, neurodermatitis, eczema, exfoliative dermatitis, diaper rash, psoriasis , prurigo, insect bites.
Triamcinolone acetonide
pharmachologic effect
GKS. Suppresses the functions of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of inflammation. It disrupts the ability of macrophages to phagocytose, as well as to form interleukin-1. Helps stabilize lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.
Inhibits the activity of phospholipase A2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.
Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; suppresses the formation of antibodies.
Suppresses the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.
When directly applied to blood vessels, it has a vasoconstrictor effect.
It has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys and increases the activity of gluconeogenesis enzymes. In the liver, it enhances the deposition of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from the products of protein metabolism. An increase in blood glucose levels activates the release of insulin.
Suppresses the uptake of glucose by fat cells, which leads to activation of lipolysis. However, due to increased insulin secretion, lipogenesis is stimulated, which promotes fat accumulation.
It has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue.
Osteoporosis and Itsenko-Cushing syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic effect, growth suppression in children is possible.
In high doses, it can increase the excitability of brain tissue and help lower the threshold for convulsive readiness. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.
When used systemically, the therapeutic activity is due to anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.
When applied externally and locally, the therapeutic activity of triamcinolone acetonide is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) effect.
In terms of anti-inflammatory activity, triamcinolone acetonide is 6 times more active than hydrocortisone. Triamcinolone acetonide has virtually no mineralocorticoid activity.
Use of the drug Triamcinolone
Orally at a dose of 4–16 mg/day in 2–4 doses. When a therapeutic effect is achieved, the dose is gradually (by 2 mg/day) reduced to a maintenance dose - usually to 1 mg/day. For systemic treatment, adults and adolescents over 16 years of age in the form of a suspension of 40 mg are administered deeply intramuscularly; in severe forms of disease, the dose can be doubled. Deep injection avoids possible tissue atrophy at the injection site. After the injection, you should press a sterile napkin tightly to the injection site for 1–2 minutes to prevent the suspension from leaking out of the injection channel. If it is necessary to perform several injections, an interval of at least 4 weeks should be maintained between them. When used intra-articularly, the dose is determined by the size of the joint and the severity of symptoms; adults and children over 12 years of age are usually prescribed in the following doses: small joints (phalanxes of the fingers of the upper and lower extremities) - 10 mg; medium-sized joints (shoulder, elbow) - 30 mg; large joints (hip, knee) - 40 mg. If multiple joints are affected, the total amount of triamcinolone administered may be 80 mg. For intralesional use for bursitis, periostitis and exostosis, adults and children over 12 years of age, depending on the size and location of the lesions, are administered: for minor lesions - up to 10 mg; for moderate and extensive - from 10 to 40 mg. Locally in the form of 0.1% ointment or cream 2-3 times a day for several days. Occlusive dressings enhance the therapeutic effect. Repeated courses of treatment can be carried out at intervals of several days.
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** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before starting to use the drug Triamcinolone, you should consult a doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.
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special instructions
If skin irritation occurs, you should stop using fluorocort ointment and continue treatment with another drug.
When using occlusive dressings and treating large surfaces of the body, a systemic effect of the drug is possible - in such cases, special caution is required.
When applying the ointment, microorganisms located on the skin (primarily pyogenic microorganisms, sometimes blastomycetes) can penetrate the loosened stratum corneum and cause various pyodermas, which are treated with disinfectants that are washed off. Fungal diseases are possible, and sometimes bruising may appear under the occlusive dressing. With prolonged use of the ointment on the same part of the body, especially in young patients, atrophy of this area of the skin may develop.
Some areas of the body, such as the armpits, groin folds (where there is a natural occlusion and the skin is more delicate and thin) are more prone to the development of stretch marks and easily noticeable atrophy of this area of the skin, which is irreversible. Therefore, the use of ointment on these areas of the skin should be short-term.
In case of development of a fungal or bacterial skin infection, additional use of local or systemic therapy is necessary.
It is not recommended to use the ointment on the scalp.
Long-term use of the drug on the skin of the face is not recommended due to the risk of skin atrophy. Do not allow the drug to get into your eyes. In case of contact with eyes, rinse them with plenty of running water and consult a doctor.
When treating psoriasis, withdrawal syndrome, steroid dependence, the development of generalized pustular psoriasis and local or systemic toxicity due to impaired skin barrier function are possible. Treatment of patients with psoriasis with topical corticosteroids is possible only under strict medical supervision.
Prescribing ointment to children over 1 year of age is possible only in exceptional cases. The duration of use of the drug in children should not exceed 5 days. The use of occlusive dressings in children is contraindicated.
When used in children, it is necessary to take into account the possibility of signs of suppression of the hypothalamic-pituitary-adrenal system and Cushing's syndrome, which occur in children more often than in adult patients, due to a greater ratio of skin area to body weight, and, accordingly, children are more prone to systemic toxicity. In children receiving topical corticosteroids, acute adrenal insufficiency, Cushing's syndrome, and increased intracranial pressure were noted.
Use during pregnancy and lactation. The use of ointment in the first trimester of pregnancy is contraindicated. There is insufficient data confirming the safety of using the drug during pregnancy in the second and third trimesters. The question of using the drug in the second and third trimester of pregnancy and during breastfeeding is decided by the doctor in each case individually, carefully weighing the ratio of the expected effect of treatment and the potential risk of exposure of the fetus to the drug.
The absorption of GCS into the circulatory system is accompanied by their penetration into breast milk and their effect on the adrenal cortex and the growth of the baby.
Children. The use of ointment is contraindicated in children under 1 year of age.
The ability to influence reaction speed when driving vehicles or working with other mechanisms. There are no messages at the moment. However, when driving vehicles or other machinery, it is recommended to exercise special caution, given the possibility of developing undesirable reactions from the nervous system.
Contraindications
Hypersensitivity to triamcinolone acetonide or any excipient of the drug.
The drug should not be used in the eyes or on the skin around the eyes.
Use as monotherapy without specific treatment for fungal and bacterial skin infections; tuberculosis; viral skin lesions, especially with herpes simplex and chicken pox; for parasitic infections (scabies); skin manifestations of syphilis; skin reactions after vaccination; perianal and genital itching; leg ulcer; phlebeurysm; widespread plaque psoriasis; facial skin lesions (rosacea, acne vulgaris, perioral dermatitis); diaper rash caused by wet diapers; treating dry flaking skin and applying ointment to the breasts immediately before breastfeeding; children under 1 year of age.
Side effects
Glucocorticosteroid drugs, when applied topically, are characterized by local side effects, however, depending on the amount of the substance entering the systemic circulation, systemic effects are possible.
With prolonged use on large surfaces, inhibition of the function of the adrenal cortex is possible, especially in children, as well as when using occlusive dressings; a negative nitrogen balance is possible due to increased protein breakdown.
From the immune system: hypersensitivity reactions.
From the side of water and electrolyte metabolism: inhibition of adrenal cortex function (secondary adrenal insufficiency), hypokalemic alkalosis, water and sodium retention in the body, hypokalemia, hypertension.
From the central nervous system: mental disorders, convulsions, dizziness, headache, increased intracranial pressure, insomnia.
From the organ of vision: cataract, posterior subcapsular cataract, exophthalmos, glaucoma, papilledema, corneal ulcer, exophthalmos. Children are more likely to develop cataracts.
From the cardiovascular system: heart failure, hypertension.
From the digestive system: gastric bleeding, gastrointestinal bleeding, gastrointestinal perforation, esophagitis, pancreatitis, ulcer.
Skin: dermatitis, burning, folliculitis, acneiform rash, contact dermatitis, dryness and thinning of the skin, erythema, hirsutism, increased sweating, diaper rash, itching, skin atrophy, hypopigmentation, irritation, stretch marks, telangiectasia, delayed wound healing.
From the musculoskeletal system: growth retardation in children, steroid myopathy, osteoporosis, osteonecrosis, aseptic necrosis.
Laboratory abnormalities: increased intraocular pressure, negative nitrogen balance, slow reactions to skin tests.
Infections and parasitic diseases: activation of latent infections, masking the course of infections, opportunistic infections.