Each mL contains Triamcinolone Acetonide 10 mg or 40 mg.
Pharmacology: Triamcinolone is a corticosteroid with mainly glucocorticoid activity, which has potent anti-inflammatory and immunosuppressive effects, at least party through inhibition of the release of various cytokines. It also has profound metabolic affects: blood glucose concentrations are maintained or increased by a decrease in peripheral glucose utilization and an increase in gluconeogenesis; glycogen deposition, protein breakdown, and lipolysis are increased, and effects on calcium uptake and excretion lead to a decrease in body calcium stores.
Pharmacokinetics: Triamcinolone is readily absorbed from sites of local administration and is rapidly distributed to all body tissues. It crosses the placenta to varying degrees and may be excreted in small amounts in breast milk. In the circulation, it is extensively bound to plasma proteins, mainly to globulin and less so to albumin. The corticosteroid-binding globulin (transcortin) has high affinity but low binding capacity, while albumin has low affinity but large binding capacity. The plasma half-life of Triamcinolone is 1 to 2 hours.
Triamcinolone is metabolized mainly in the liver but also in other tissues, and are excreted in the urine.
The anti-inflammatory and immunosuppressant glucocorticoid properties of corticosteroids are used to suppress the clinical manifestations of disease in a wide range of disorders considered to have inflammatory or immunological components. It is used to provide symptomatic control throughout the pollen season for patients who suffer from hay fever. It is also used in the treatment of some inflammatory skin disorders such as keloids. discoid lupus erythematosus, necrobiosis, lipoidica, diabeticorum, alopecia areata and localized hypartrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulate, and lichen simplex chronicus (neurodermatitis). Triamcinolone is administered in the treatment of exacerbation in synovitis of osteoarthritis, acute nonspecific, tenospecific and posttraumatic osteoarthritis, rheumatoid arthritis, acute gouty arthritis, acute and subacute bursitis.
For parenteral administration doses of about 40 mg are usually given to provide prolonged systemic effect. A dose of 40 to100 mg of the triamcinolone may provide symptomatic control throughout the pollen season for patients who suffer from hay fever. Doses ranging from 2.5 to 40 mg can be administered by intra-articular injection depending upon the size of the pint injected. Triamcinolone is administered by intralesional or intradermal injection in the treatment of some inflammatory akin disorders at a dose of 1 to 3 mg per site with no more than 5 mg injected into any one site or not more than 30 mg in total if several sites of Injection are used. Or as prescribed by a physician.
Symptoms: Anxiety, depression and or stimulation, stomach bleeding, increased blood sugar and hypertension.
Treatment: Toxic effects should be treated symptomatically with the corticosteroid dosage reduced slowly withdrawn where possible.
Triamcinolone is contraindicated in the presence of acute infections uncontrolled by appropriate antimicrobial chemotherapy. Patients with active or doubtfully quiescent tuberculosis should not be given corticosteroids.
Adverse glucocorticoid effects lead to mobilization of calcium and phosphorus, with osteoporosis and spontaneous fractures; muscle wasting and nitrogen depletion; and hyperglycemia with accentuation or precipitation of the diabetic state. The insulin requirement of diabetic patients are increased. Increased appetite is often reported. Impaired tissue repair and immune function can lead to delayed wound healing, and increased susceptibility to infection. Increased susceptibility to all kinds of infection, including septicemia, tuberculosis, fungal infections, and viral infections, has been reported in patients on corticosteroid therapy. Infections may also be masked by anti-inflammatory, analgesic and antipyretic effects of glucocorticoids.
Other adverse effects include menstrual irregularities, amenorrhea, hyperhidrosis, skin thinning, ocular changes including development of glaucoma and cataract mental and neurological disturbances, benign intracranial hypertension, acute pancreatitis and avascular necrosis of bane. An increase in the coagulability of the blood may lead to thromboembolic complications. Peptic ulceration has been reported.
The negative feedback effects of glucocorticoids on the hypothalamic-pituitary-adrenal (HPA) axis may lead to adrenal atrophy in some cases after therapy for as little as 7 days. This produces secondary adrenocortical insufficiency which may be manifested following overly rapid withdrawal of treatment or be precipitated by some stress such as infection or trauma.
High doses of corticosteroids administered during pregnancy may cause fetal or neonatal adrenal suppression. Growth retardation may follow the administration of oven relatively small doses of corticosteroids to children.
Large doses of corticosteroids may produce Cushingoid symptoms typical of hyperactivity of the adrenal cortex with moon-face, sometimes with hirsutism, buffalo hump, flushing, increased bruising, ecchymoses striae, and acne. Rapid intravenous administration of large doses of corticosteroids may cause cardiovascular collapse. High doses of Triamcinolone may have a greater tendency to produce proximal myopathy.
Corticosteroids should only be used systemically with great caution in the presence of heart failure, recent myocardial infarction or hypertension, in patients with diabetes mellitus, epilepsy, glaucoma, hypothyroidism, hepatic failure, osteoporosis, peptic ulceration, psychoses or severe affective disorders, and renal impairment.
The risk of chickenpox and probably of severe herpes water is increased in non-immune patients receiving therapeutic doses of systemic corticosteroids, and .patients should avoid close personal contact with either infection. Passive immunization is recommended for non-immune patients who do come into contact with chickenpox. Similar precautions apply to measles. Live vaccines should not be given to patients receiving high-dose systemic corticosteroid therapy nor for at least 3 months afterwards; killed vaccines or toxoids may be given although the response may be attenuated.
During prolonged courses of corticosteroid therapy, patients should be examined regularly. Sodium Intake may need to be reduced and calcium and potassium supplements may be necessary. Monitoring of the fluid intake and output, and daily weight records may give early warning of fluid retention. Back pain may signify osteoporosis. Children are at special risk from raised intracranial pressure.
Rapid intravenous injection of massive doses of corticosteroids may sometimes cause cardiovascular collapse and injections should therefore be given slowly or by Infusion.
Concurrent use of barbiturates, carbamazepine, phenytoin, primidone or rifampicin may enhance the metabolism and reduce the effects of systemic corticosteroids. Conversely oral contraceptives or ritonavir may increase plasma concentrations of corticosteroids. Use of corticosteroids with potassium depleting diuretics, such as thiazides or furosemide, may cause excessive potassium loss. There is also an increased risk of hypokalemia with concurrent amphotericin B or bronchodilator therapy with xanthines or beta2 agonists. There may be an increased incidence of gastrointestinal bleeding and ulceration when corticosteroids are given with NSAIDS. Response to anticoagulants may be altered by corticosteroids and requirements of antidiabetic drugs and antihypertensives may be increased.
Corticosteroids may decrease serum concentrations of salicylates and may decrease the effect of antimuscarinics in myasthenia gravis. Triamcinolone may decrease or increase plasma concentrations of phenytoin. Like other enzyme inducing drugs, phenytoin also has the potential to increase the metabolism of Dexamethasone.
Store at temperatures not exceeding 30°C and protect from light.
H02AB08 - triamcinolone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.
Susp for inj (vial) 10 mg/mL x 5 mL x 1's. 40 mg/mL x 1 mL x 1's.