TRIAMCINOLONE ACETONIDE
Clinical safety rating: avoid
CYP3A4 inducers (eg phenytoin) may decrease efficacy and inhibitors may increase effects Can cause hyperglycemia and adrenal suppression with prolonged use.
Corticosteroid that binds to glucocorticoid receptors, leading to inhibition of phospholipase A2, decreased prostaglandin and leukotriene synthesis, and suppression of inflammatory cytokines.
| Metabolism | Primarily hepatic; metabolized by CYP3A4 to inactive metabolites. |
| Excretion | Renal (primarily as metabolites, <5% unchanged); biliary/fecal (minor). |
| Half-life | Terminal elimination half-life approximately 2-5 hours; but suppression of adrenal function (HPA axis) can persist for 7-30 days depending on dose and duration. |
| Protein binding | 68-71% bound to corticosteroid-binding globulin (CBG) and albumin. |
| Volume of Distribution | Approximately 1.4 L/kg; indicates extensive tissue distribution. |
| Bioavailability | Intranasal: ~50%; Inhaled: ~25% (deposition and absorption dependent); Oral: ~23% (first-pass metabolism); Topical: low systemic absorption (depends on site, occlusion). |
| Onset of Action | Intra-articular: 24-72 hours; Topical: varies by formulation (hours to days); Inhalation: 24-48 hours for asthma control. |
| Duration of Action | Intra-articular: 1-4 weeks after single injection; Topical: varies by vehicle and site; Inhalation: 12-24 hours for bronchodilator effect. |
Intramuscular: 40-80 mg every 4 weeks. Intra-articular: 5-40 mg depending on joint size. Topical: Apply thin film to affected area 2-4 times daily.
| Dosage form | OINTMENT |
| Renal impairment | No adjustment required for any GFR level. |
| Liver impairment | No specific guidelines; caution in severe hepatic impairment (Child-Pugh C) due to potential for increased systemic exposure. |
| Pediatric use | Intramuscular: 0.03-0.2 mg/kg every 4 weeks (max 40 mg). Topical: Apply sparingly; avoid prolonged use. |
| Geriatric use | Use lowest effective dose; monitor for hyperglycemia, hypertension, and osteoporosis with prolonged use. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
CYP3A4 inducers (eg phenytoin) may decrease efficacy and inhibitors may increase effects Can cause hyperglycemia and adrenal suppression with prolonged use.
| FDA category | Positive |
| Breastfeeding | Enters breast milk; M/P ratio unknown. Systemic bioavailability to infant is low with maternal doses ≤40 mg/day. Avoid high-dose or prolonged therapy. Use lowest effective dose for shortest duration. |
| Teratogenic Risk | First trimester: Increased risk of orofacial clefts (odds ratio ~1.3-3.4) based on observational studies. Second trimester: Possible growth restriction with chronic use. Third trimester: Risk of fetal hypothalamic-pituitary-adrenal suppression, transient neonatal adrenal insufficiency. Avoid high-dose systemic use. |
■ FDA Black Box Warning
None
| Common Effects | Hyperglycemia |
| Serious Effects |
["Hypersensitivity to triamcinolone acetonide","Systemic fungal infections","Intrathecal administration","Live or attenuated vaccines"]
| Precautions | ["Immunosuppression and increased susceptibility to infections","HPA axis suppression with prolonged use","Osteoporosis with long-term use","Cataracts and glaucoma with ocular use","Growth retardation in children"] |
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| Fetal Monitoring | Monitor maternal blood pressure, blood glucose, and signs of infection. Fetal growth ultrasound if chronic use. Neonatal observation for adrenal suppression if maternal therapy continued until delivery. |
| Fertility Effects | No evidence of impaired fertility in humans; animal studies show dose-dependent effects at high doses. Reversible menstrual irregularities possible with chronic use. |