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| Trade names | Kenalog, Nasacort, Adcortyl, others |
| Other names | Clickshow to see (8S,9R,10S,11S,13S,14S,16R,17S)-9-fluoro-11,16,17-trihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-6,7,8,9,10,11,12,13,14,15,16,17-dodecahydro-3H-cyclopenta[a]phenanthren-3-one; (1R,2S,10S,11S,13R,14S,15S,17S)-1-fluoro-13,14,17-trihydroxy-14-(2-hydroxyacetyl)-2,15-dimethyltetracyclo[8.7.0.02,7.011,15]heptadeca-3,6-dien-5-one |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a601122 |
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| Routes of administration | By mouth,topical,intranasal,intramuscular,intra-articular, intra-synovial |
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| Pharmacokinetic data | |
| Bioavailability | >90%[4] |
| Protein binding | 68%[citation needed] |
| Metabolism | Liver[4] |
| Onset of action | (2–)24(–48) hours[4][5] |
| Eliminationhalf-life | 200–300 minutes (plasma), up to 36 hours (total)[4] |
| Excretion | Urine (75%) and faeces (25%)[5] |
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| ECHA InfoCard | 100.004.290 |
| Chemical and physical data | |
| Formula | C21H27FO6 |
| Molar mass | 394.439 g·mol−1 |
| 3D model (JSmol) | |
| Specific rotation | +65° to +72° |
| Melting point | 260 to 271 °C (500 to 520 °F) |
| Solubility in water | 2 |
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Triamcinolone is aglucocorticoid used to treat certainskin diseases, allergies, andrheumatic disorders among others.[6] It is also used to prevent worsening ofasthma andchronic obstructive pulmonary disease (COPD).[6] It can be taken in various ways includingby mouth,injection into a muscle, andinhalation.[6]
Common side effects with long-term use includeosteoporosis,cataracts,thrush, andmuscle weakness.[6] Serious side effects may includepsychosis, increased risk of infections,adrenal suppression, andbronchospasm.[6] Use inpregnancy is generally safe.[7] It works by decreasinginflammation andimmune system activity.[6]
Triamcinolone was patented in 1956 and came into medical use in 1958.[8] It is available as ageneric medication.[9] In 2023, it was the 108th most commonly prescribed medication in the United States, with more than 6 million prescriptions.[10][11]
Triamcinolone is used to treat various medical conditions, such aseczema,alopecia areata,lichen sclerosus,psoriasis,arthritis,allergies,ulcerative colitis,lupus,sympathetic ophthalmia,temporal arteritis,uveitis,ocularinflammation,keloids,urushiol-induced contact dermatitis,aphthous ulcers (usually astriamcinolone acetonide),central retinal vein occlusion, visualization duringvitrectomy and the prevention ofasthma attacks.[12][13][14]
Thederivativetriamcinolone 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 toeczema[15] anddermatitis.[16]
Contraindications forsystemic triamcinolone are similar to those of other corticoids. They include systemicmycoses (fungal infections) andparasitic diseases, as well as eight weeks before and two weeks after application oflive vaccines. For long-term treatment, the drug is also contraindicated in people withpeptic ulcers, severeosteoporosis, severemyopathy, certainviral infections,glaucoma, andmetastasizing tumours.[17]
There are no contraindications for use inemergency medicine.[4]
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, sometimesgastrointestinal bleeding is seen, as well as acute infections (mainlyviral) and impairedglucose tolerance.[4]
Side effects of triamcinolone long-term treatment may include coughing (up tobronchospasms),sinusitis,metabolic syndrome–like symptoms such ashigh blood sugar andcholesterol,weight gain due towater retention, andelectrolyte imbalance, as well ascataract,thrush,osteoporosis,reduced muscle mass, andpsychosis.[5][6][17] Triamcinolone injections can cause bruising and joint swelling.[5] Symptoms of anallergic reaction includerash,itch,swelling, severedizziness,trouble breathing,[18] andanaphylaxis.[17]
No acuteoverdosing of triamcinolone has been described.[17]
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:[4][17]
Triamcinolone and other drugs can also influence each other's concentrations in the body, amounting to pharmacokinetic interactions such as:[4][17]
Triamcinolone is a glucocorticoid that is about five times as potent ascortisol but has very fewmineralocorticoid effects.[4]
When taken by mouth, the drug'sbioavailability is over 90%. It reaches its highest concentrations in theblood plasma after one to two hours and is bound toplasma proteins to about 80%. Thebiological half-life from the plasma is 200 to 300 minutes; due to stable complexes of triamcinolone andits receptor in theintracellular fluid, the total half-life is significantly longer at about 36 hours.[4][5]
A small fraction of the substance is metabolized to 6-hydroxy- and 20-dihydro-triamcinolone; most of it probably undergoesglucuronidation, and a smaller partsulfation. Three-quarters are excreted via the urine, and the rest via the faeces.[4][17]
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.[4][5]
Triamcinolone is asyntheticpregnanecorticosteroid andderivative ofcortisol (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.[20][21]
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'spolymorphism: 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.[4]
Solubility is 1:500 in water and 1:240 inethanol; it is slightly soluble inmethanol, very slightly soluble inchloroform anddiethylether, and practically insoluble indichloromethane. Thespecific rotation is +65° to +72° cm3/dm·g (1% indimethylformamide).[4]
In 2010,Teva andPerrigo launched the first generic inhalable triamcinolone.[22]
According to Chang et al. (2014), "Triamcinolone acetonide (TA) is classified as an S9glucocorticoid in the 2014 Prohibited List published by theWorld Anti-Doping Agency, which caused it to be prohibited in international athletic competition when administered orally, intravenously, intramuscularly or rectally".[23]
Topical corticosteroids (TCS) are used in the management of AD in both adults and children and are the mainstay of anti-inflammatory therapy.
