Triamcinolone - description of the drug, instructions for use, reviews

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Triamcinolone

When used simultaneously with anabolic steroids and androgens, the risk of developing peripheral edema and acne increases.

When used simultaneously with antithyroid drugs and thyroid hormones, changes in thyroid function may occur.

When used simultaneously with histamine H1 receptor blockers, the effect of triamcinolone is reduced; with hormonal contraceptives - the effect of triamcinolone is potentiated.

Hypocalcemia associated with the use of triamcinolone may lead to an increase in the duration of neuromuscular blockade caused by the action of depolarizing muscle relaxants when used concomitantly.

When used simultaneously with immunosuppressants, the risk of developing bacterial and viral infections increases.

When used simultaneously with potassium-sparing diuretics, hypokalemia is possible.

With simultaneous use, it is possible to reduce the effectiveness of indirect anticoagulants, heparin, streptokinase, urokinase, and increase the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract.

When used simultaneously with NSAIDs (including acetylsalicylic acid), the risk of erosive and ulcerative lesions and bleeding from the gastrointestinal tract increases.

With simultaneous use, the effect of oral hypoglycemic agents and insulin is weakened; with laxatives - hypokalemia is possible; with cardiac glycosides - the risk of developing heart rhythm disturbances and other toxic effects of glycosides increases.

When used simultaneously with tricyclic antidepressants, an increase in mental disorders associated with triamcinolone may be possible.

When used simultaneously with m-anticholinergics (including atropine), intraocular pressure may increase.

When used simultaneously with amphotericin B and carbonic anhydrase inhibitors, there is a risk of developing hypokalemia, left ventricular myocardial hypertrophy and circulatory failure.

When used simultaneously with isoniazid, a decrease in the concentration of isoniazid in the blood plasma is possible, mainly in individuals with rapid acetylation.

With simultaneous use, it is possible to accelerate biotransformation and reduce the concentration of mexiletine in the blood plasma.

When used simultaneously with paracetamol, the risk of developing hypernatremia, peripheral edema, increased calcium excretion, hypocalcemia, osteoporosis, and hepatotoxicity of paracetamol increases.

When used simultaneously with rifampicin, phenytoin, carbamazepine, barbiturates, the metabolism of triamcinolone is accelerated due to the induction of microsomal liver enzymes, and its effect is reduced.

When used simultaneously with ephedrine, the metabolism of triamcinolone is accelerated.

Indications for use of the drug Triamcinolone

Systemic use - rheumatoid arthritis, rheumatism, systemic lupus erythematosus and other collagenoses, acute allergic and severe skin-allergic reactions, severe forms of asthma, hemorrhagic diathesis, lymphoproliferative processes; intra-articular injection - an inflammatory process in one of several joints during chronic diseases, exudative arthritis, gout, an active form of arthrosis; injection into the affected area - periostitis, bursitis, exostosis, tendovaginitis, lateral brachial epicondylitis ("tennis elbow"), limited nodular skin lesions, isolated psoriatic plaques, etc. Externally - vasculitis, pemphigus, neurodermatitis, eczema, exfoliative dermatitis, diaper rash, psoriasis , prurigo, insect bites.

Indications and contraindications

List of indications

, for which the use of topical steroid drugs (GCS) is advisable, is quite extensive. The most common indications for their use are:

• psoriasis;
• atopic dermatitis;
• eczema;
• seborrheic dermatitis;
• contact dermatitis.

The choice of a specific drug depends, first of all, on the disease and the location of the lesion. Depending on the type of pathology and the area that needs to be treated, the active component, dosage form, and concentration are selected.

For example, high-strength topical corticosteroids are used to treat exacerbations of alopecia areata, resistant atopic dermatitis, hyperkeratotic eczema, lichen planus, severe contact dermatitis and severe hand eczema [5].

Topical corticosteroids of medium strength are used for severe anal inflammation, dry eczema, atopic eczema in children, atopic dermatitis, seborrheic dermatitis and a number of other diseases [5].

Topical corticosteroids classified as “weak” are indicated for diaper dermatitis (severe), as well as eyelid dermatitis and intertrigo (dermatitis in skin folds) [5].

Topical steroids can be prescribed both for exacerbations of dermatological diseases before the onset of a period of remission, and for the treatment of chronic inflammatory process.

Contraindications

for the use of topical corticosteroids are:

• · Acute infectious skin lesions - topical corticosteroids, having immunosuppressive properties, inhibit the healing process [2];
• · Strong and super-strong steroid drugs should not be used on the face, groin and axillary areas. Their use under a bandage is contraindicated to avoid the development of an occlusive effect. As a rule, drugs of these groups are used for a short period [5].

We say pleiotropic, we mean multiple

The mechanism of action of local corticosteroids is based on their ability to interact with corticosteroid-specific receptors, which are located in the epidermis and fibroblasts of human skin. At the same time, they exhibit a complex of different effects, exerting a pleiotropic (multiple - editor's note) effect due to the implementation of a number of mechanisms [2].

Anti-inflammatory effect

Provides the benefits of topical corticosteroids for inflammatory skin lesions.

Mechanisms:

• Inhibition of the release of phospholipase A2, the main enzyme for the formation of inflammatory mediators based on arachidonic acid (prostaglandins and leukotrienes).
• Inhibition of transcription factors that are involved in the activation of proinflammatory genes.
• Inhibition of phagocytosis and stabilization of membranes of phagocytic cells.
• Decreased release of keratinocytes and the pro-inflammatory cytokine interleukin-2 from epidermal principal cells.

Immunosuppressive effect

Provides the anti-inflammatory effect of topical corticosteroids.

Mechanisms:

• Suppression of the production of mediators involved in the inflammatory response (tumor necrosis factor, interleukins and some others).
• Inhibition of leukocyte migration to the site of inflammation.
• Interference with the function of endothelial cells, granulocytes, mast cells and fibroblasts.

Antiproliferative effect aimed at suppressing the excessive proliferation of certain cells.

Provides the effectiveness of topical glucocorticosteroids in conditions accompanied by abnormally high skin proliferation, for example, psoriasis or eczema.

Mechanism:

• Inhibition of DNA synthesis and mitosis.
• Inhibition of fibroblast activity and collagen formation.

Vasoconstrictor effect

Provides high activity of topical corticosteroids for dermatological diseases accompanied by skin redness and swelling.

The mechanism of this effect is still not fully understood. One of its stages is the inhibition of pro-inflammatory mediators that have a vasodilatory effect (histamine, bradykinin, prostaglandin, etc.). Vasoconstrictor activity has become one of the criteria for assessing the power of topical GCS.

Activity of topical corticosteroids

The activity of drugs in this group depends on at least four factors [2, 4].

Release form.

The release form of a local drug is in its own way a “vehicle” that ensures the delivery of active substances deep into the skin. Therefore, the “power” of the topical agent largely depends on its properties.

• Ointments with steroids

  are considered the most effective form of topical corticosteroids. These are water-in-oil emulsions, the high activity of which is due to the ability to form a film on the surface of the skin that is impenetrable to air and moisture and thus provides a “compress effect” - occlusion. As a result, the local concentration and effectiveness of the product increases. But occlusive preparations also have disadvantages: firstly, the skin stops “breathing”, which can contribute to the development of weeping, and secondly, they are inconvenient to apply to the skin of the scalp, chest, etc.

  It is advisable to recommend topical corticosteroids in the form of ointments for the treatment of dry skin diseases.

• Creams

  , unlike ointments, being an “oil in water” emulsion, are not fatty forms. They do not form an occlusive film on the surface of the skin and therefore lack both the disadvantages of ointments and their advantages. GCS creams are less active than steroid ointments.

  Topical corticosteroids in the form of a cream are indicated for acute and subacute inflammation without significant weeping.

• Gels

  - an oil-in-water emulsion with an alcohol base. They liquefy upon contact with skin and have a medium degree of activity.

  It is advisable to recommend gels for the treatment of areas of the body heavily covered with hair.

• Lotions
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  , which are aqueous solutions, are considered the least active form of GCS. They evaporate, providing a cooling effect.

  It is advisable to recommend topical GCS in the form of a lotion if it is necessary to treat large areas, as well as areas abundantly supplied with hair follicles.

The salt to which the steroid is bound.

For example, betamethasone exists as valerate, dipropionate, and benzoate, each of which has different potencies.

Active ingredient concentration

The higher the concentration of the active substance, the higher the activity of the drug.

For example, one of the most powerful topical corticosteroids, clobetasol propionate, in the form of an ointment, is approximately 1000 times “more powerful” than the weakest drug in this group, 1% hydrocortisone.

There are two classifications of topical corticosteroids according to the degree of activity - European, which distinguishes 4 classes, and American, in which drugs are divided into 7 classes of activity. In both the first and second, activity was assessed based on vasoconstrictor tests and according to clinical studies.

European classification of topical glucocorticosteroids [3]

American classification of topical corticosteroids [3]