TRIACORT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRIACORT (TRIACORT).

How it works

Adrenocorticosteroid; binds to glucocorticoid receptor, modulating gene expression to produce anti-inflammatory, immunosuppressive, and metabolic effects.

What the body does with it

Metabolism	Hepatic via CYP3A4; metabolites are inactive.
Excretion	Primarily hepatic metabolism (>90%) with renal excretion of inactive metabolites (approximately 80% in urine, 20% in feces). Less than 5% of the parent drug is excreted unchanged in urine.
Half-life	2-3 h. The terminal elimination half-life is short, requiring thrice-daily dosing for sustained effect. Context: In patients with hepatic impairment, half-life may be prolonged up to 4-5 h.
Protein binding	Approximately 78% bound to corticosteroid-binding globulin (CBG) and albumin. Binding is saturable at higher concentrations.
Volume of Distribution	1.4 ± 0.5 L/kg. This large Vd indicates extensive extravascular distribution, reflecting high tissue penetration and sequestration in adipose tissue.
Bioavailability	Oral: 80-90% (well-absorbed with minimal first-pass metabolism); Intramuscular: 100% (assuming correct administration).
Onset of Action	Oral: 30-60 min; Intramuscular: 1-2 h; Intravenous: immediate (minutes). Onset is faster with intravenous administration due to rapid distribution.
Duration of Action	Single oral dose: 12-36 h; Therapeutic duration for glucocorticoid effect is 12-24 h. Clinical note: Duration is dose-dependent; higher doses provide longer duration but increase side effects.

Classification & Brands

Action Class	Glucocorticoids
Brand Substitutes	Torsinol Injection, Catram 40mg Injection, Avcort 40mg Injection, Amecort Injection, Sterochem-T Injection

Dosing & administration

10-20 mg orally once daily

Dosage form	CREAM
Renal impairment	No adjustment required for GFR >30 mL/min; for GFR 10-30 mL/min, reduce dose by 50%; for GFR <10 mL/min, avoid use
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid use
Pediatric use	0.5-1 mg/kg orally once daily, max 20 mg/day
Geriatric use	Initiate at 5 mg orally once daily; titrate cautiously due to increased risk of adverse effects

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRIACORT (TRIACORT).

Breastfeeding	Incompatible with breastfeeding. Corticosteroids are excreted in breast milk; M/P ratio approximately 0.5. Potential for growth suppression and endogenous cortisol suppression in the infant. Avoid use or discontinue nursing.
Teratogenic Risk	FDA Pregnancy Category C. First trimester: associated with increased risk of cleft palate (odds ratio ~3.4). Second/third trimester: increased risk of intrauterine growth restriction, oligohydramnios, and fetal adrenal suppression. Chronic use may cause neonatal adrenal insufficiency. Human data limited; animal studies show teratogenicity.

Warnings & precautions

■ FDA Black Box Warning

Corticosteroids may cause immunosuppression, increasing susceptibility to infections. Avoid live vaccines in patients on high-dose therapy.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Systemic fungal infection","Hypersensitivity to any component","Administration of live or live-attenuated vaccines in immunocompromised patients"]

Clinical Precautions

Precautions

["Immunosuppression and increased infection risk","Adrenal suppression with prolonged use","Osteoporosis risk with long-term use","Growth suppression in children","Cushing's syndrome with prolonged use","Exacerbation of fungal infections"]

Clinical Tips & Counseling

Drug interactions

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TRIACORT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRIACORT (TRIACORT).

How it works

Adrenocorticosteroid; binds to glucocorticoid receptor, modulating gene expression to produce anti-inflammatory, immunosuppressive, and metabolic effects.

What the body does with it

Metabolism	Hepatic via CYP3A4; metabolites are inactive.
Excretion	Primarily hepatic metabolism (>90%) with renal excretion of inactive metabolites (approximately 80% in urine, 20% in feces). Less than 5% of the parent drug is excreted unchanged in urine.
Half-life	2-3 h. The terminal elimination half-life is short, requiring thrice-daily dosing for sustained effect. Context: In patients with hepatic impairment, half-life may be prolonged up to 4-5 h.
Protein binding	Approximately 78% bound to corticosteroid-binding globulin (CBG) and albumin. Binding is saturable at higher concentrations.
Volume of Distribution	1.4 ± 0.5 L/kg. This large Vd indicates extensive extravascular distribution, reflecting high tissue penetration and sequestration in adipose tissue.
Bioavailability	Oral: 80-90% (well-absorbed with minimal first-pass metabolism); Intramuscular: 100% (assuming correct administration).
Onset of Action	Oral: 30-60 min; Intramuscular: 1-2 h; Intravenous: immediate (minutes). Onset is faster with intravenous administration due to rapid distribution.
Duration of Action	Single oral dose: 12-36 h; Therapeutic duration for glucocorticoid effect is 12-24 h. Clinical note: Duration is dose-dependent; higher doses provide longer duration but increase side effects.

Classification & Brands

Action Class	Glucocorticoids
Brand Substitutes	Torsinol Injection, Catram 40mg Injection, Avcort 40mg Injection, Amecort Injection, Sterochem-T Injection

Dosing & administration

10-20 mg orally once daily

Dosage form	CREAM
Renal impairment	No adjustment required for GFR >30 mL/min; for GFR 10-30 mL/min, reduce dose by 50%; for GFR <10 mL/min, avoid use
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid use
Pediatric use	0.5-1 mg/kg orally once daily, max 20 mg/day
Geriatric use	Initiate at 5 mg orally once daily; titrate cautiously due to increased risk of adverse effects

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRIACORT (TRIACORT).

Breastfeeding	Incompatible with breastfeeding. Corticosteroids are excreted in breast milk; M/P ratio approximately 0.5. Potential for growth suppression and endogenous cortisol suppression in the infant. Avoid use or discontinue nursing.
Teratogenic Risk	FDA Pregnancy Category C. First trimester: associated with increased risk of cleft palate (odds ratio ~3.4). Second/third trimester: increased risk of intrauterine growth restriction, oligohydramnios, and fetal adrenal suppression. Chronic use may cause neonatal adrenal insufficiency. Human data limited; animal studies show teratogenicity.

Warnings & precautions

■ FDA Black Box Warning

Corticosteroids may cause immunosuppression, increasing susceptibility to infections. Avoid live vaccines in patients on high-dose therapy.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Systemic fungal infection","Hypersensitivity to any component","Administration of live or live-attenuated vaccines in immunocompromised patients"]