Chemical formula: C₂₁H₂₇FO₆ Molecular mass: 394.434 g/mol PubChem compound: 31307
Triamcinolone interacts in the following cases:
Extreme caution is required in cases of concomitant administration of triamcinolone with phenothiazines, tricyclic antidepressants, terfenadine, astemizole and vincamine.
Triamcinolone should be used with caution in patients suffering from the following conditions:
Protease inhibitors (including ritonavir) or ketoconazole may decrease corticosteroid clearance via CYP3A4 inhibition resulting in increased effects such as Cushing’s syndrome and adrenal suppression. Co-administration of triamcinolone hexacetonide with CYP3A inhibitors (including cobicistat-containing products) is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects. If the potential benefit of co-administration outweighs the increased risk of systemic corticosteroid side-effects, patients should be monitored for these effects.
Corticosteroids may increase the levels of glucose in the blood. Diabetic patients should be monitored, especially on instigation and discontinuation of treatment of corticosteroids and if the dosage is changed.
Corticosteroids may potentiate or decrease anticoagulant effect. For this reason, patients receiving oral anticoagulants and corticosteroids should be closely monitored.
Concomitant administration of triamcinolone with digitalis glycosides may increase the likelihood of digitalis toxicity.
Concomitant treatment with triamcinolone and class Ia antiarrhythmic agents such as disopyramide, quinidine and procainamide, or other class III antiarrhythmic drugs such as amiodarone, bepridil and sotalol, is not recommended.
The reduction in arterial blood pressure may be diminished in in coadministration of triamcinolone with antihypertensives.
Corticosteroid half-life and concentration may be increased and clearance decreased in coadministration with oestrogens.
Neurological complications and a diminished antibody response may occur when patients taking corticosteroids are vaccinated.
Hepatic Enzyme Inducers (e.g. barbiturates, phenytoin, carbamazepine, rifampicin, primidone, aminogluthetimide): There may be increased metabolic clearance of triamcinolone. Patients should be carefully observed for possible reduced effect of triamcinolone, and the dosage should be adjusted accordingly.
The effect of anticholinesterase agent may be antagonised by triamcinolone.
Corticosteroids may increase the incidence and/or severity of gastrointestinal bleeding and ulceration associated with NSAIDs. Corticosteroids may also reduce serum salicylate levels and therefore decrease their efficacy. Conversely, discontinuing corticosteroids during high-dose salicylate therapy may result in salicylate toxicity. Caution must be exercised during concomitant use of acetylsalicylic acid and corticosteroids in patients with hypoprothrombinaemia.
Additional increase of intraocular pressure is possible in coadministration of triamcinolone with anticholinergics.
Corticosteroids may decrease or enhance the neuromuscular blocking action of non-depolarising muscle relaxants.
Patients should be monitored for additive hypokalaemia in coadministration of triamcinolone with amphotericin B.
When triamcinolone and ciclosporin used concomitantly, an increase may produce in both ciclosporin and corticosteroid activity.
Extreme caution is required in cases of concomitant administration of triamcinolone with erythromycin i.v., halofantrine, pentamidine and sultopride.
In coadministration of triamcinolone with isoniazid, serum concentrations of isoniazid may be decreased.
The growth-promoting effect of somatropin may be inhibited during long-term therapy with triamcinolone.
Metabolic clearance of adrenocorticoids is increased in hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustments to the dosage of adrenocorticoids.
Metabolic clearance of adrenocorticoids is decreased in hypothyroid patients. Changes in thyroid status of the patient may necessitate adjustments to the dosage of adrenocorticoids.
Triamcinolone should be used with caution in patients suffering from the following
conditions:
Triamcinolone should be used with caution in patients suffering from the following conditions:
Triamcinolone crosses the placenta. Corticosteroids are teratogenic in animal experiments. The significance of this fact for humans is not exactly known, but so far the use of corticosteroids has not been shown to increase the incidence of malformations. Long-term use of corticosteroids in humans and animals has led to a decrease in weight of the placenta and the newborn.
Long-term corticosteroid therapy is also associated with a risk of adrenocortical suppression in the newborn. The product should be used during pregnancy only if the benefit to the mother is clearly greater than the risk to the fetus.
It is not known whether triamcinolone is excreted in human milk. Because other corticosteroids are excreted in human milk, caution should be exercised when triamcinolone is administered to nursing women; therefore, the therapeutic benefit to the mother should outweigh any potential risk to the baby.
Women: Corticosteroid therapy may cause menstrual disorders and amenorrhea.
Triamcinolone has no or negligible influence on the ability to drive and use machines.
For assessment of adverse reactions (ADRs) following terms regarding frequency are used: very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to 1</1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).
Adverse effects depend on the dose and the duration of treatment. Systemic adverse effects are rare, but may occur as a result of repeated periarticular injection. As with other intraarticular steroid treatments, transient adrenocortical suppression has been observed during the first week after injection. This effect is enhanced if corticotropin or oral steroids are used concomitantly.
Very rare: anaphylaxis-type reactions
Not known: exacerbation or masking of infections
Not known: menstrual irregularities, amenorrhoea and postmenopausal vaginal bleeding; hirsutism; development of a cushingoid state; secondary adrenocortical and pituitary unresponsiveness, particularly during periods of stress (e.g. trauma, surgery or illness); decreased carbohydrate tolerance; manifestation of latent diabetes mellitus
Not known: insomnia; exacerbation of existing psychiatric symptoms; depression (sometimes severe); euphoria; mood swings; psychotic symptoms
Rare: vertigo
Not known: increased intracranial pressure with papilloedema (pseudotumor cerebri) usually after treatment; headache
Not known: posterior subcapsular cataracts; increased intraocular pressure; glaucoma; vision, blurred
Not known: cardiac failure; arrhythmias
Very rare: thromboembolism
Not known: hypertension
Not known: peptic ulcers with possibility of subsequent perforation and haemorrhage; pancreatitis
Very rare: hyperpigmentation or hypopigmentation
Not known: impaired wound healing; thin and fragile skin; petechiae and ecchymoses; facial erythema; increased sweating; purpurea; striae; acneiform eruptions; hives; rash
Very rare: calcinosis; tendon rupture
Not known: loss of muscle mass; osteoporosis; aseptic necrosis of the heads of the humerus and femur; spontaneous fractures; Charcot-like arthropathy
Not known: negative nitrogen balance owing to protein catabolism
Common: Local reactions include sterile abscesses, post-injection erythema, pain, swelling and necrosis at the injection site.
Rare: Excess dosage or too-frequent administration of injections into the same site may cause local subcutaneous atrophy, which, due to the properties of the drug, will only return to normal after several months.
Glucocorticoids may induce growth suppression in children.
The adverse events reported in clinical trials with triamcinolone nasal spray most commonly involved the mucous membranes of the nose and throat.
The following frequency rating has been used, when applicable: Very common ≥1/10; Common ≥1/100 and <1/10; Uncommon ≥1/1,000 and <1/100; Rare ≥1/10,000 and <1/1,000; Very rare <1/10,000 and not known (cannot be estimated from the available data).
Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
The most frequent adverse reactions in adults were:
Common: flu syndrome, pharyngitis, rhinitis
Not known: hypersensitivity (including rash, urticaria, pruritus and facial oedema)
Not known: insomnia
Common: headache
Not known: dizziness and alterations of taste and smell
Not known: chorioretinopathy, cataract, glaucoma, increased ocular pressure, blurred vision
Common: bronchitis, epistaxis, cough
Rare: nasal septum perforations
Not known: nasal irritation, dry mucous membrane, nasal congestion, sneezing, dyspnoea
Common: dyspepsia, tooth disorder
Not known: nausea
Not known: fatigue
Not known: decreased blood cortisol
Systemic effects of nasal corticosteroids may occur, particularly when prescribed at high doses for prolonged periods.
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