Triamcinolone
Unchecked
Triamcinolone (acetonide and other esters)
Kenalog (injectable), Nasacort (intranasal), Aristocort (topical), Trianex
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Summary
Common uses
Inflammatory dermatoses (topical)0, Intra-articular corticosteroid injection0, Allergic rhinitis (intranasal)0, Oral aphthous ulcers (dental paste)0, Intralesional keloid injection0
Pharmacy
Starting dose
Topical 0.025-0.5% cream/ointment BID; intra-articular 5-40 mg per joint q3-6 months; intranasal Nasacort 110 mcg/spray, 2 sprays/nostril daily; oral paste 0.1% to lesion 2-3×/d
Preparations
Topical creams, ointments, lotions, dental paste (0.025-0.5%); Kenalog 10 mg/mL, 40 mg/mL injection; Nasacort 55 mcg/spray intranasal; oral inhaler discontinued in US
US FDA Max
Indication-specific
Pharmacology
Routes
Topical, intra-articular, intralesional, intramuscular, intranasal, oral paste
Onset
Topical hours; intra-articular days to weeks
Duration
Intra-articular 3-6 months (depot effect of acetonide microcrystals)
Half-life
Plasma ~3-5 hours; biologic effect substantially longer (~12-36 hours for intermediate-acting glucocorticoids)[1]
Bioavailability
Topical/intranasal: high local, low systemic; intra-articular: local depot then systemic absorption[1]
Pregnancy
Topical/intranasal generally low-risk; intra-articular and high-dose injection: weigh risk individually.[citation needed]
Legal status
OTC (lowest-strength topicals) and Rx-only (higher strengths, injectable) in US
Purported mechanism
Triamcinolone is a synthetic glucocorticoid agonist with potency intermediate between hydrocortisone and the highest-potency clobetasol; the acetonide ester is the most common formulation, producing slow release from depot at injection sites.0 Like all glucocorticoids it binds the glucocorticoid receptor to remodel transcription of inflammatory, immune, and metabolic gene programs, with broad anti-inflammatory and immunosuppressive effects whose intensity depends on route, dose, and local concentration[1].
References
[edit | edit source]- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Kenalog-40 (triamcinolone acetonide), Bristol-Myers Squibb, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/014901s062lbl.pdf