Triamcinolone#Side effects

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.{{Cite web|url=https://www.drugs.com/triamcinolone.html|title=Triamcinolone: Uses, Dosage, Side Effects, Warnings|website=Drugs.com}}{{Cite web|url=https://www.drugs.com/azmacort.html|title=Azmacort Inhaler: Side Effects, Dosage & Uses|website=Drugs.com}}{{Cite web|url=https://www.drugs.com/newdrugs/alcon-receives-fda-approval-triesence-injectable-triamcinolone-suspension-eye-surgery-731.html|title=Alcon Receives FDA Approval of Triesence Injectable Triamcinolone Suspension for Use in Eye Surgery|website=Drugs.com}}

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{{cite journal | vauthors = Chong M, Fonacier L | title = Treatment of Eczema: Corticosteroids and Beyond | journal = Clinical Reviews in Allergy & Immunology | volume = 51 | issue = 3 | pages = 249–262 | date = December 2016 | pmid = 25869743 | doi = 10.1007/s12016-015-8486-7 | s2cid = 44337035 }} and dermatitis.{{cite journal | vauthors = Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, Bergman JN, Chamlin SL, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Feldman SR, Hanifin JM, Margolis DJ, Silverman RA, Simpson EL, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R | display-authors = 6 | title = Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies | journal = Journal of the American Academy of Dermatology | volume = 71 | issue = 1 | pages = 116–132 | date = July 2014 | pmid = 24813302 | pmc = 4326095 | doi = 10.1016/j.jaad.2014.03.023 | quote = Topical corticosteroids (TCS) are used in the management of AD in both adults and children and are the mainstay of anti-inflammatory therapy. }}

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.{{cite book|title=Austria-Codex| veditors = Haberfeld H |at=Volon 4 mg-Tabletten|publisher=Österreichischer Apothekerverlag|location=Vienna|year=2020|language=German}}

There are no contraindications for use in emergency medicine.

{{see|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.

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.Triamcinolone (systemic) {{drugs.com|PPA|triamcinolone-systemic}}. Accessed 19 August 2020. Triamcinolone injections can cause bruising and joint swelling. Symptoms of an allergic reaction include rash, itch, swelling, severe dizziness, trouble breathing,{{cite web| title = Drugs and Treatments – Nasacort AQ Nasl – Patient Handout| publisher = WebMD| url = http://www.webmd.com/drugs/drug-16244-Nasacort+AQ.aspx?drugid=16244&drugname=Nasacort%20AQ| access-date = 24 March 2008}} and anaphylaxis.

No acute overdosing of triamcinolone has been described.

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:

• 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:

• Rifampicin, phenytoin, carbamazepine and other inducers of the liver enzyme CYP3A4{{cite journal | vauthors = Moore CD, Roberts JK, Orton CR, Murai T, Fidler TP, Reilly CA, Ward RM, Yost GS | display-authors = 6 | title = Metabolic pathways of inhaled glucocorticoids by the CYP3A enzymes | journal = Drug Metabolism and Disposition | volume = 41 | issue = 2 | pages = 379–389 | date = February 2013 | pmid = 23143891 | pmc = 3558858 | doi = 10.1124/dmd.112.046318 }} 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.

{{main|Glucocorticoid#Pharmacology}}

{{see|Glucocorticoid#Mechanism of action}}

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

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.

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.

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.

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.{{cite book| vauthors = Elks J |title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA1228|date=14 November 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=1228–}}{{cite book|title=Index Nominum 2000: International Drug Directory|url=https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA1054|date=January 2000|publisher=Taylor & Francis|isbn=978-3-88763-075-1|pages=1054–}}

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: {{convert|260 to 263|C|F}}, {{convert|264 to 268|C|F}}, or {{convert|269 to 271|C|F}} can be found in the literature.

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 $[\backslash alpha]\_D^\{20\}$ +65° to +72° cm³/dm·g (1% in dimethylformamide).

In 2010, Teva and Perrigo launched the first generic inhalable triamcinolone.{{Cite web|url=https://detroit.cbslocal.com/2011/06/15/perrigo-announces-launch-of-generic-version-of-nasacort-aq/|title=Perrigo Announces Launch Of Generic Version Of Nasacort AQ|date=15 June 2011}}

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".{{cite journal | vauthors = Chang CW, Huang TY, Tseng YC, Chang-Chien GP, Lin SF, Hsu MC | title = Positive doping results caused by the single-dose local injection of triamcinolone acetonide | journal = Forensic Science International | volume = 244 | pages = 1–6 | date = November 2014 | pmid = 25126738 | doi = 10.1016/j.forsciint.2014.07.024 | doi-access = free }}

{{Reflist}}

• {{cite web | title=Triamcinolone Topical | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a601124.html }}
• {{cite web | title=Triamcinolone Nasal Spray | website=MedlinePlus | url=https://medlineplus.gov/druginfo/meds/a682791.html }}

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