How triamcinolone works
Triamcinolone is a synthetic glucocorticoid that primarily has an anti-inflammatory effect. It penetrates body cells, binds internally to specific glucocorticoid receptors and subsequently inhibits the release of pro-inflammatory substances such as cytokines and prostaglandin.
In addition, glucocorticoids such as triamcinolone inhibit the maturation/activation of certain immune cells (T and B cells) and the migration of white blood cells (leukocytes) into a site of inflammation. Leukocytes (which include B and T cells) play an important role in inflammation and autoimmune disease.
For this reason, triamcinolone has an anti-allergic effect and, in higher doses, also an immunosuppressive effect (= suppressing the immune system).
Absorption, degradation and excretion
If triamcinolone is administered orally, i.e. taken by mouth (e.g. as a tablet), it is completely absorbed into the blood in the intestine. The highest blood levels are reached within four hours.
The glucocorticoid can also be used as an injection or external preparation (such as an ointment, spray, etc.).
When is triamcinolone used?
Triamcinolone is prescribed orally (for example, as a tablet) when the drug is to exert its effect throughout the body (systemically). This is the case, for example, in the following diseases:
- Allergic rhinitis (rhinitis)
- skin diseases (dermatoses), eczema
- @ inflammatory diseases of the musculoskeletal system
In various diseases, triamcinolone can be injected directly into the focus of the disease, such as rheumatoid arthritis, activated osteoarthritis, bursitis, periostitis, shoulder-arm syndrome and various skin diseases (such as lichen ruber verrucosus, lichen simplex chronicus, lichen sclerosus et atrophicans).
Topical application of the active ingredient (for example, as an ointment) is indicated for atopic dermatitis and allergic eczema.
How triamcinolone is used
The dosage depends on the type and severity of the disease. The age of the patient also plays a role.
As an injection, ten to 40 milligrams of triamcinolone are generally administered every three to four weeks.
An ointment containing one milligram of triamcinolone per gram is applied once or twice daily (for a maximum of four weeks).
Dosage and duration of use in individual cases are determined by the treating physician.
What are the side effects of triamcinolone?
When used systemically (tablets), triamcinolone may cause the following side effects, among others:
- Osteoporosis
- reddish stretch marks of the skin (striae rubrae)
- glaucoma and cataracts (glaucoma and cataract)
- gastric ulcer
- diabetes mellitus
- increased retention of water and sodium in the body, increased excretion of potassium
- male type of hair in women like beard growth (hirsutism)
- increased risk of infections
If triamcinolone is injected directly into a joint or a focus of disease, bone tissue may die and local infections may occur.
What should be considered when using triamcinolone?
Contraindications
Triamcinolone must not be used in certain cases. Thus, prolonged systemic use is contraindicated in:
- gastrointestinal ulcers
- pre-existing psychiatric conditions
- chronic viral liver inflammation (chronic viral hepatitis)
- fungal infections affecting the whole body or at least large parts of it (systemic mycoses)
- lymphadenitis (inflammation of the lymph nodes) after tuberculosis vaccination
In some cases, a doctor must carefully weigh the benefits and risks before using triamcinolone, such as in patients who have a history of tuberculosis.
Injections of triamcinolone are contraindicated if there is an infection in the area of application.
Topical triamcinolone preparations (such as ointments) should not be used in specific skin processes (tuberculosis, syphilis), chickenpox, fungal infections, bacterial skin infections, skin inflammation around the mouth (perioral dermatitis), rosacea, and vaccination reactions.
Interactions
For example, glucocorticoid therapy may increase the effect of cardiac glycosides and diuretics and decrease that of oral anticoagulants.
In combination with non-steroidal anti-inflammatory drugs (such as acetylsalicylic acid, diclofenac), the risk of stomach ulcers and bleeding in the digestive tract increases.
Drugs that increase the amount of xenobiotic-degrading liver enzymes (enzyme inducers) accelerate the metabolism of triamcinolone and thus reduce the effect of therapy. Such enzyme inducers include phenytoin (for epilepsy), rifampicin (antibiotic for tuberculosis) and barbiturates (for example, for epilepsy and as an anesthetic).
Oral contraceptives (the Pill) may increase the effect of glucocorticoids such as triamcinolone.
Other interactions are possible. Patients should therefore inform their doctor about all preparations (including over-the-counter) they are using.
Age restriction
Pregnancy and lactation
During pregnancy and lactation, triamcinolone should only be used if absolutely necessary for medical reasons (strict indication). This applies in particular to systemic use, for example as a tablet.
Local treatment with triamcinolone, for example in the form of an ointment or tincture, on the other hand, may be carried out in all phases of pregnancy.
More detailed information on the transfer of triamcinolone into breast milk is not available. Similarly, there are no reports of symptoms in the breastfed infant. The following applies: Triamcinolone may be used locally during breastfeeding if the breast area is avoided.
Glucocorticoids of choice for systemic therapy in pregnancy and lactation, however, are prednisolone and prednisone. If possible, these agents should be given preference over triamcinolone.
How to obtain medication with triamcinolone
The active ingredient is available on prescription in Germany, Austria and Switzerland, i.e. only on presentation of a doctor’s prescription at the pharmacy.
