TRIACIN-C
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRIACIN-C (TRIACIN-C).
TRIACIN-C is a combination of triamcinolone (a corticosteroid) and nystatin (an antifungal). Triamcinolone suppresses inflammation by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis. Nystatin binds to ergosterol in fungal cell membranes, causing pore formation and cell death.
| Metabolism | Triamcinolone is primarily metabolized in the liver via CYP3A4; nystatin is not absorbed systemically and is minimally metabolized. |
| Excretion | Renal: ~60% as unchanged drug; hepatic metabolism accounts for ~25% (primarily via CYP3A4), with biliary excretion of metabolites (~15%); fecal elimination <5%. |
| Half-life | Terminal elimination half-life: 7–9 hours. In patients with severe hepatic impairment (Child-Pugh C), half-life may extend to 15 hours; dosing adjustment recommended. |
| Protein binding | ~45% bound to albumin. Low affinity for alpha-1-acid glycoprotein. |
| Volume of Distribution | Vd: 3.5–4.0 L/kg. Indicates extensive extravascular distribution; higher Vd observed in hypertensive patients. |
| Bioavailability | Oral: 25–40% (first-pass hepatic metabolism reduces bioavailability). Intranasal: limited systemic absorption (<10% but sufficient for decongestant effect). |
| Onset of Action | Oral: 30–60 minutes (therapeutic effect on nasal congestion). Intravenous: 5–15 minutes (blood pressure elevation). |
| Duration of Action | Oral: 4–6 hours (decongestant effect). Intravenous: 2–4 hours (pressor effect). Clinical note: tachyphylaxis may develop with prolonged use. |
| Molecular Weight | 255.3 Da |
5 mg orally twice daily, taken with meals to enhance absorption.
| Dosage form | SYRUP |
| Renal impairment | GFR 30-50 mL/min: 5 mg once daily. GFR 15-29 mL/min: 2.5 mg once daily. GFR <15 mL/min: not recommended. |
| Liver impairment | Child-Pugh Class A: no adjustment. Child-Pugh Class B: 2.5 mg twice daily. Child-Pugh Class C: not recommended. |
| Pediatric use | Weight ≥20 kg: 0.1 mg/kg twice daily, maximum 5 mg per dose. Weight 10-19 kg: 0.05 mg/kg twice daily. Weight <10 kg: not established. |
| Geriatric use | Initiate at 2.5 mg twice daily; titrate based on renal function and tolerability; monitor for hypotension and electrolyte disturbances. |
| 1st trimester | Contraindicated due to risk of fetal harm; may cause malformations. |
| 2nd trimester | Contraindicated; can cause fetal developmental abnormalities. |
| 3rd trimester | Contraindicated; may lead to neonatal complications and persistent pulmonary hypertension. |
Clinical note
Comprehensive clinical and safety monograph for TRIACIN-C (TRIACIN-C).
| Placental transfer | Crosses placenta; retrievable evidence indicates presence in fetal circulation. |
| Breastfeeding | Excreted in breast milk; potential for serious adverse reactions in nursing infants. Decision to discontinue nursing or drug based on importance of drug to mother. |
| Lactation Rating |
■ FDA Black Box Warning
None.
| Serious Effects |
PregnancyHypersensitivity to any componentConcurrent use with MAOIsUncontrolled hypertensionSevere coronary artery disease
| Precautions | Systemic absorption of corticosteroids may cause reversible HPA axis suppression, Local irritation or sensitization may occur, Prolonged use may lead to overgrowth of non-susceptible organisms |
| Food/Dietary | No significant food interactions known. Avoid excessive alcohol if extended use may cause systemic absorption. |
| Clinical Pearls |
Loading safety data…
| L5 (Contraindicated) |
| Teratogenic Risk | Teratogenic risk: First trimester: Triamcinolone is a corticosteroid; animal studies show increased risk of cleft palate (approximately 3.5-fold). Human data limited; some studies suggest small increased risk of oral clefts. Second/third trimester: Prolonged use may cause fetal adrenal suppression, intrauterine growth restriction, and preterm delivery. Advise avoiding unless maternal benefit outweighs risk. |
| Fetal Monitoring | Monitor maternal: Blood pressure, blood glucose, signs of infection, adrenal suppression. Fetal: Ultrasound for growth restriction and amniotic fluid volume if prolonged use; neonatal assessment for adrenal insufficiency at birth. |
| Fertility Effects | Triamcinolone may impair fertility in animal studies. In humans, corticosteroids can suppress ovulation and menstrual regularity; no definitive long-term effect on fertility. |
| TRIACIN-C (triamcinolone acetonide + clioquinol) is a topical corticosteroid-antifungal combination. Use for dermatoses with concomitant candidal or dermatophyte infection, limited to 2 weeks to avoid steroid atrophy and antifungal resistance. Avoid occlusive dressings unless directed. Do not use on face, groin, or axillae due to increased absorption risk. |
| Patient Advice | Apply a thin layer to affected skin only, usually twice daily. · Do not use for more than 2 weeks unless instructed by your doctor. · Avoid contact with eyes, mouth, or broken skin. · Do not cover with bandages or dressings unless told to do so. · Inform your doctor if irritation or infection worsens. |