Triamcinolone (trye-am-sin’-oh-lone) is a corticosteroid used topically to manage certain inflammatory skin diseases and orally or by injection to treat some rheumatic disorders, acute exacerbations of multiple sclerosis and sometimes to prevent worsening of asthma and COPD. Triamcinolone is considered as being a medium to medium-high potency topical corticosteroid (hydrocortisone is considered as having low to medium potency).
Topically it is available as a cream and ointment containing 0.01%-0.05% triamcinolone acetonide.
Mechanism of action:
Topically corticosteroids produce anti-inflammatory, antipruritic and vasoconstrictor responses by binding with a steroid receptor.
The anti-inflammatory activity of 4 mg triamcinolone is about equivalent to 5 mg of prednisolone.
Pharmacokinetics:
Systemic absorption is very limited when applied topically, but is increased if used under occlusion or if there is a disruption in the stratum corneum (eg in psoriasis).
In the plasma, it binds to albumin and has a half-life of 2-5 hours.
Metabolised in the liver and excreted in the urine.
Topical indications:
Atopic dermatitis, eczematous dermatitis, nummular eczema, contact dermatitis, seborrhoeic dermatitis, eczematised psoriasis
Contraindications:
Allergy or hypersensitivity
Fungal infections and viral diseases of the skin
Critical limb ischaemia
Precautions:
Not to be used in the eye.
Fertility: no data is avialble.
Pregnancy: (in USA, Category C; Category B3 in Australia); has teratogenic effects in pregnant animals.
Lactation: Not known whether topical corticosteroids are distributed into breast milk (systemic
corticosteroids are distributed into breast milk)
Topical Dosage:
Apply small amount of cream 3 to 4 times daily.
Interactions:
There are many possible drug interactions with corticosteroids, but only tend to rarely occur with the topical preparations with prolonged or over-use.
Carbamazepine, phenytoin and rifampicin all induce hepatic enzymes and can lead to an increased metabolism of triamcinolone.
Use of diuretics may lead to hypokalaemia as they also deplete potassium ion concentration in the blood.
Corticosteroids antagonise the effects of neuromuscular blocking agents (eg vecuronium).
Oral contraceptives prolong the half-life of triamcinolon, potentiating its anti-inflammatory effects.
Adverse Effects:
Itching and irritation at the site of application. Local reactions are more likely if used with occlusion.
With prolonged use there is an increased risk for atrophy of the epidermis, subcutaneous tissue and dermal collagen; drying and cracking or tightening of the skin; epidermal thinning; telangiectasia; pupura.
Adverse effects are more likely in groin or face applications as the skin is thinner.
(Adverse effects of systemic corticosteroids)
Brand names: Kenalog, Kenacort, Trianx, Nasacort, Triderm, Oralone, Adcortyl, Aristocort and others
Chemical formula: C21H27FO6
Chemical name: (11β,16α)-9-Fluoro-11,16,17,21-tetrahydroxypregna-1,4-diene-3,20-dione
Availability: Prescription only
In Australia, triamcinolone is on the National Podiatry Scheduled Medicines List for use by authorised Podiatrists.
Other topical corticosteroids:
| Betamethasone | Methylprednisolone | Triamcinolone | Desonide | Hydrocortisone | Mometasone |
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