Corticosteroids triamcinolone acetonide

Inhaled corticosteroids Triamcinolone acetonide Azmacort Inhalation... 

An implant may be rod-shaped and may include the corticosteroid triamcinolone acetonide in a PCL pol5mier matrix. The implant may be fabricated by (61) ... 

If I detect induration during the postoperative exam, I immediately institute treatment with class 1 topical steroids. I will often provide samples of these agents to patients to limit their use and ensure the patient will return. When hypertrophic scarring does occur, intrale-sional corticosteroids [triamcinolone acetonide 2.5-10 mg per mL) and Cordran tape used nightly are employed. It is interesting to note that dermabrasions and lasers produce scars in the same anatomical areas as deeper chemical peels (Figs 15.21 and 15.22). 

HOUGHTON, G. MATTHEWS, R. A. (1990) Immunosuppression in juvenile carp, Cyp-rinus carpio L. the effects of the corticosteroids triamcinolone acetonide and hydrocortisone 21-hemisuccinate (cortisol) on acquired immunity and the humoral antibody response to Ichthyophthirius multifiliis Fonqaet. Journal of Fish Diseases. 13,269-280. 

Mometasone Triamcinolone acetonide for oral corticosteroid growth suppression... 

Topical preparations usually contain relatively insoluble steroids, such as clobetasol propionate, triamcinolone acetonide, or triamcinolone diacetate. Side effects of this mode of drug application are usually milder and more transient than those seen after systemically administered steroids. However, potent topical corticosteroids, such as clobetasol propionate (Temovate), can suppress adrenal function when used in large amounts for a long time, especially when the skin surface is denuded or when occlusive dressings are employed. Since the high potency topical preparations carry a higher risk of local side effects, their use should be held in reserve. 

Corticosteroids are sometimes used in the treatment of severe symptomatic gout, by intra-articular, systemic, or subcutaneous routes, depending on the degree of pain and inflammation. The most commonly used oral corticosteroid is prednisone. The recommended dose is 30-50 mg/d for 1-2 days, tapered over 7-10 days. Intra-articular injection of 10 mg (small joints), 30 mg (wrist, ankle, elbow), and 40 mg (knee) of triamcinolone acetonide can be given if the patient is unable to take oral medications. 

The limited penetration of topical corticosteroids can be overcome in certain clinical circumstances by the intralesional injection of relatively insoluble corticosteroids, eg, triamcinolone acetonide, triamcinolone diacetate, triamcinolone hexacetonide, and betamethasone acetate-phosphate. When these agents are injected into the lesion, measurable amounts remain in place and are gradually released for 3-4 weeks. This form of therapy is often effective for the lesions listed in Table 61-2 that are generally unresponsive to topical corticosteroids. The dosage of the triamcinolone salts should be limited to 1 mg per treatment site, ie, 0.1 mL of 10 mg/mL suspension, to decrease the incidence of local atrophy (see below). 

Corticosteroids administered intravitreally bypass the blood-ocular barrier to achieve therapeutic levels in the eye while minimizing systemic side effects. Initial studies of intravitreal corticosteroids combined dexamethasone and gentamicin in the treatment of inflammation associated with experimentally reduced endophthalmitis.As of late, interest has shifted to triamcinolone acetonide because of the longer half-life in the vitreous and its use in treatment of proliferative vitreoretinopathies. 

Intralesional injection of steroid can lead to adrenal suppression. Infents and small children are especially susceptible, because a given amoimt of steroid is distributed in a smaller volume of fluid and tissue compartments. Infents injected with mixtiu es of triamcinolone acetonide and betamethasone or dexamethasone fiar periocular hemangiomas exhibited depressed serum cortisol and adrenocorticotropic hormone levels. The adrenal suppression can last up to 5 months and can result in weight loss and growth retardation. It is not known whether other corticosteroid preparations would produce similar effects or which other fectors might influence these results. In general, topical and periocular use of steroids produces minimal systemic effects. Withdrawal of topical or periocular steroids does not generally cause adrenal crisis. 

Deeper or more severe forms of uveitis may not respond to topical therapy hence, injectable and/or oral routes of administration may be required. Periocular corticosteroids may be used occasionally for anterior uveitis however, this therapy is more often used in cases of intermediate uveitis or, less commonly, unilateral posterior uveitis.A small amount of depot corticosteroid (e.g., 1 ml of 40 mg/ml triamcinolone acetonide injected superiorly or inferiorly in the orbit) is considered acceptable and appropriate treatment in such situations. In cases of chronic posterior uveitis or uveitis associated with CME, intravitreal triamcinolone has also been used with some success. A retrospective study in 2005 demonstrated that intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide can effectively reduce CME and improve visual acuity and, in some eyes, allow for the reduction of immimosuppressive therapy. 

Another example for the importance of the solubility of the drug is corticosteroids. The different photosensitivities of three marketed hydrocortisone oil-in-water creams as shown in Figure 19, is due to the drug concentration as well as the composition of the preparation. Similar degradation rates were found for creams with triamcinolone-acetonid and betamethasone esters (47). 

The therapeutic effectiveness of topically applied corticosteroids is attributed primarily to their antiinflammatory activity. The relative efficacy of topical corticosteroids appears to be in the following order hydrocortisone, prednisolone, betamethasone < hydrocortisone valerate or butyrate, betamethasone valerate, triamcinolone acetonide, flucinolone acetonide < betamethasone dipropionate, fluocino-nide. In addition to the nature of the corticosteroid, its solubility, and, to a lesser extent, the concentration used, clinical efficacy is influenced by the formulation of the preparation. Glucocorticoids appear to have greater efficacy when formulated in ointment bases than in cream or lotion vehicles. This could be attributed to the occlusive effect provided by ointments. The application of an occlusive dressing further enhances penetration and persistence of the steroid (reservoir effect) in the stratum corneum. " ... 

The ICSs beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, and triamcinolone acetonide that are currently available for use are compared and listed in Table 26-12. The ICSs have pharmacokinetic differences that result in different topical/ systemic activity. Most evidence is consistent with log-linear dose-response curves for both indirect and direct responses. The log-linear nature of the dose-response curve for corticosteroid activity raises the issue of how much of a difference in dose (or lung delivery) or potency is detectable. The dose-response curves for the ICSs are relatively flat primarily because all the measures used to assess efficacy (lung function, BHR, symptoms, and as-needed short-acting inhaled /32-agonist use) are downstream events from the anti-inflammatory activity. In general, it takes a fourfold difference in potency or dose to detect clinically significant differences. The table of comparative doses (see Table 26-12) is based on extensive comparative clinical trials. Clinical comparative doses take into consideration potency differences as well as lung delivery differences from the various devices. 

Corticosteroids also may be delivered by injection. The intramuscular route is preferable in patients with compliance problems, since a depot effect is achieved. Depot forms of corticosteroids include triamcinolone acetonide, triamcinolone hexacetonide, and methylprednisolone acetate. This provides the patient with 2 to 8 weeks of symptomatic control. The depot effect provides a physiologic taper, avoiding withdrawal reaction associated with hypothalamic-pituitary axis suppression. It should be noted that the onset of effect via this route may be delayed by several days. Intravenous corticosteroids may be used to provide the patient with large amounts of drug during a steroid burst to control severe symptoms. Intra-articular injections of depot forms of corticosteroids can be useful in treating synovitis and pain when a small number of joints are affected. The onset and duration of symptomatic relief are similar to those of intramuscular injection. The intra-articular route often is preferred because it is associated with the fewest number of systemic adverse effects. If efficacious, intra-articular injections may be repeated every 3 months. No one joint should be injected more than two to three times per year because of the risk of accelerated joint destruction and atrophy of tendons. Soft tissues such as tendons and bursae also may be injected. This may help control the pain and inflammation associated... 

NASACORT AQ Aventis (U.S.) Triamcinolone acetonide Corticosteroid, Mr= 435 BKC, MCC, NaCMC, Tw80, dex, HCI, Na2edta, (pH 4.5-6.0) HDPE bottle with metered-dose pump spray... 

The use of intravitreal corticosteroids was first popularized by Machemer in 1979 (33) in an effort to halt cellular proliferation after retinal detachment surgery, and Graham (34), McCuen (35), Tano (36), and others have studied its use in both animal models and humans. In contrast to other corticosteroids with short half-lives following intravitreal injection, triamcinolone acetonide is an effective and well-tolerated (35,37) agent for intravitreal injection in conditions such as uveitis (38,39), macular edema secondary to ocular trauma or retinal vascular disease (40), proliferative diabetic retinopathy (41), intraocular proliferation such as proliferative vitreoretinopathy (42), and choroidal neovascularization from AMD (43,44). 

Efficacy. Corticosteroids have an inhibitory effect on the growth of fibroblasts (47,48). Triamcinolone acetonide inhibits experimental intraocular proliferation in rabbits (36). Intravitreal injection of 1 mg of triamcinolone significantly reduced both retinal neovascularization and retinal detachment in an experimentally induced rabbit model (36). A 4-mg intravitreal triamcinolone injection inhibited preretinal and optic nerve head neovascularization in a pig model of iatrogenic branch vein occlusion all untreated eyes developed neovascularization by six weeks (49). Intravitreal triamcinolone is also a potent inhibitor of laser-induced CNV in a rat model however, this animal model may not be ideal since laser-induced CNV may be caused by a traumatic repair process or inflammatory response and may be more susceptible to steroids than neovascularization in human disease states (50). In addition, the intravitreal triamcinolone acetonide was administered at the time of laser treatment thus, the treatment may only inhibit new vessel formation and not existing neovascularization. 

Pharmacodynamics. After a single triamcinolone acetonide injection (0.5 mg) in rabbits, corticosteroid was undetectable ophthalmoscopically by 41 days in... 

Dexamethasone alcohol and triamcinolone acetonide have been studied in PVR animal models (30-33). These agents are particularly suited for local delivery as they are both relatively lipophilic, and therefore, may be administered as a suspension. The crystalline drug then acts as a depot, providing relatively long-term intraocular levels of steroid that can be given at high doses without apparent retinal toxicity (33). While direct delivery of corticosteroids has been demonstrated to be both safe and effective in the treatment of PVR, few studies have been performed in humans (31,32). 

As discussed previously, corticosteroids downregulate VEGF production in experimental models and possibly reduce breakdown of the blood retinal barrier (15,16). Similarly, corticosteroids have antiangiogenic properties possibly due to attenuation of the effects of VEGF (20,21). These properties of steroids are commonly used. Clinically, triamcinolone acetonide is used locally as a periocular injection to treat cystoid macular edema secondary to uveitis or as a result of intraocular surgery (22,23). In animal studies, intravitreal triamcinolone acetonide has been used to prevent proliferative vitreoretinopathy and retinal neovascularization (24—27). Intravitreal triamcinolone acetonide has been used clinically to treat proliferative vitreoretinopathy and choroidal neovascularization (28-31). 

Corticosteroids (Table 11) are synthetic adrenocortical steroids with antiinflammatory actions and effects, and are used in numerous disorders including bronchial asthma. For example, beclomethasone dipropionate (Beclovent, 85 meg 3 to 4 times daily), dexamethasone sodium phosphate (Decadron phosphate), and triamcinolone acetonide (Azmacort), which are not bronchodilators and are not indicated for rapid rehef of acute asthma, are used in bronchospastic states intractable to an adequate trial of conventional therapy. 

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