Triamcinolone dosing

The appropriate intravitreal triamcinolone dose has not yet been established. The ISIS study compares 2 mg versus 4 mg of triamcinolone in patients with macular edema. Preliminary data indicates that the 4 mg dose is more effective at treating macular edema (30). Two studies by Jonas et al. (32,33) in Europe, demonstrated measurable vitreous triamcinolone for seven to eight months and 1.5 years, respectively, after an injection of 20 25 mg of the drug. Prospective trials that compare the 20 25 mg dose to lower doses will be necessary to clarify the optimal dosing regimen. 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

Systemic corticosteroids are a useful option in patients with contraindications to NSAIDs or colchicine (primarily renal impairment) or polyarticular attacks, especially in elderly patients. A single intramuscular injection of a long-acting corticosteroid such as triamcinolone hexacetonide may be used. Oral agents may be needed, especially for severe attacks. Prednisone 40 to 60 mg (or an equivalent dose of another agent) is given daily, with a gradual taper over 2 weeks. 

Intraarticular corticosteroid injections can provide relief, particularly when a joint effusion is present. Average doses for injection of large joints in adults are methylprednisolone acetate 20 to 40 mg or triamcinolone hexacetonide 10 to 20 mg. After aseptic aspiration of the effusion and corticosteroid injection, initial pain relief may occur within 24 to 72 hours, with peak relief occurring in about 1 week and lasting for 4 to 8 weeks. The patient should minimize joint activity and stress on the joint for several days after the injection. Therapy is generally limited to three or four injections per year because of the potential systemic effects of the drugs and because the need for more frequent injections indicates poor response to therapy. 

Two further communications [31,32] reported that prednisolone stearoylglycollate, in substantial doses, was the least potent anti-inflammatory steroid (among the representative series studied) with respect to pituitary-adrenal inhibition. The order of increasing suppressive potency in this test was prednisolone stearoylglycollate, prednisolone, triamcinolone, dexamethasone, betamethasone. Techniques used in the comparative evaluations included the metyrapone test and gas-liquid chromatography. 

Triamcinolone Nystatin (Mycolog ) [Anti-inflammatory Antifungal/Corticosteroid] Uses Cutaneous candidiasis Action Antifungal anti-inflammatory Dose Apply lightly to area bid max 25 mg/d Caution [C, ] Contra Varicella systemic fungal Infxns Disp Cream oint SE Local irritation, hypertrichosis, pigmentation changes Interactions T Effects W/barbiturates, phenytoin, rifampin T effects OF salicylates, vaccines EMS See Triamcinolone OD See Triamcinolone... 

Inhalant 110, 220 mcg/actuation in 14, 30, 60, 120 dose units Triamcinolone (Azmacort)... 

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. 

Beclomethasone dipropionate, triamcinolone acetonide, budesonide, flunisolide, and mometasone furoate are available as nasal sprays for the topical treatment of allergic rhinitis. They are effective at doses (one or two sprays one, two, or three times daily) that in most patients result in plasma levels that are too low to influence adrenal function or have any other systemic effects. 

Tri-Nasal spray is a metered-dose manual-spray pump in an amber polyethylene terephthalate bottle with 0.05% w/v triamcinolone acetonide in a solution containing citric acid, edetate disodium, polyethylene glycol 3350, propy-... 

Williams RO III, Brown J, Liu J. Influence of micronization method on the performance of a suspension triamcinolone acetonide pressurized metered-dose inhaler formulation. Pharm Dev Technol 1999 4(2) 167-179. 

A 45-year-old woman was given a single-dose of intramuscular triamcinolone acetonide 40 mg for acute... 

A 75-year-old man developed triamcinolone-induced anaphylaxis and dose-related positive prick skin tests to triamcinolone, suggesting that an IgE-mediated hypersensitivity mechanism may have played a part... 

A 48-year-old man taking losartan, low-dose amitriptyline, and triamcinolone acetonide nasal spray developed pain in the abdomen and hips. Radiography and magnetic resonance imaging showed rapidly... 

Iglesias P, Gonzalez J, Dfez JJ. Acute and persistent iatrogenic Cushing s syndrome after a single dose of triamcinolone acetonide. J Endocrinol Invest 2005 28(ll) 1019-23. 

The available studies suggest that fluticasone is more effective than beclomethasone, triamcinolone, or budesonide. However, budesonide delivered by Turbuhaler has equivalent efficacy to fluticasone delivered by metered-dose inhaler or Diskhaler, and is more effective than beclomethasone. When comparative safety is considered, budesonide and triamcinolone delivered by metered-dose inhaler have less systemic activity than fluticasone. Beclomethasone and fluticasone delivered by metered-dose inhaler are equivalent. Budesonide delivered by... 

The effect of inhaled triamcinolone on adrenal response has been assessed in 221 patients with chronic obstructive airway disease in a randomized placebo-controlled trial (57). The patients received either inhaled triamcinolone 1200 micrograms/day or placebo for 3 years. Basal cortisol concentrations were significantly lower with triamcinolone than placebo after 1 and 3 years. Cortisol concentrations were not suppressed at 30 minutes and 60 minutes after co-syntropin injection. The authors concluded that triamcinolone is safe in chronic obstructive airway disease patients at the tested dose with respect to adrenal gland response. 

S. Suarez, R. Gonzalez-Rothi, H. Schreier, and G. Hochhaus, The effect of dose and release rate on pulmonary targeting of of liposomal triamcinolone acetonide phosphate, Pharm. Res. 15 461 (1998). 

A 4-mg dose of triamcinolone is equivalent in anti-inflammatory activity to about 5 mg prednisolone. It is used, either in the form of the free alcohol or in... 

IVTA has been used in several small series of patients with pseudophakic CME reftactory to all therapies. The studies all noted initial benefit in both retinal thickness (monitored by optical coherence tomography) and in visual acuity, but differing amounts of triamcinolone were used (4, 8, and 25 mg) and outcomes varied, with most patients demonstrating recurrence of edema after 3 to 4 months. The most stable duration of benefit was seen with the highest dose (25 mg). 

Increases in intraocular pressure and development of posterior subcapsular cataracts are femiliar sequelae to corticosteroid therapy. Increased intraocular pressure after IVTA is considerably more common than endophthalmitis and has been established in different studies. Results are not readily comparable, because different amounts of triamcinolone were administered. However, it should be noted that approximately 30% or more of patients had an increase in intraocular pressure, regardless of the dose given, which is consistent with the finding that a significant number of patients are steroid... 

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