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28/01/13 Triamcinolone (topical): Drug information Official re p rint from U p ToDate ® www.uptodate.com ©2013

Triamcinolone (topical): Drug information

Official reprint from UpToDate ® www.uptodate.com ©2013 UpToDate ®

Triamcinolone (topical): Drug information

Copyright 1978-2013 Lexicomp, Inc. All rights reserved.

Copyright 1978-2013 Lexicomp, Inc. All rights reserved. (For additional information see "Triamcinolone

For abbreviations and symbols that may be used in Lexicomp (show table)

Brand Names: U.S.

Brand Names: Canada Pharmacologic Category

Dosing: Adult

Kenalog®; Oralone®; Pediaderm™ TA; Trianex™; Triderm®; Zytopic™

Kenalog®; Oracort; Triaderm

Corticosteroid, Topical

Dermatoses (steroid-responsive, including contact/atopic dermatitis): Topical:

Cream, Ointment:

0.025% or 0.05%: Apply thin film to affected areas 2-4 times/day

0.1% or 0.5%: Apply thin film to affected areas 2-3 times/day

Spray: Apply to affected area 3-4 times/day

Oral inflammatory lesions/ulcers: Oral topical: Press a small dab (about 1 / 4 inch) to the lesion until a thin

film develops; a larger quantity may be required for coverage of some lesions. For optimal results, use only enough to coat the lesion with a thin film; do not rub in.

Dosing: Geriatric

Dosage Forms: U.S.

Refer to adult dosing.

Excipient information presented when available (limited, particularly for generics);

consult specific product labeling.

Aerosol, spray, topical, as acetonide:

Kenalog®: 0.2 mg/2-second spray (63 g, 100 g) [contains dehydrated ethanol 10.3%]

Cream, topical, as acetonide: 0.025% (15 g, 80 g, 454 g); 0.1% (15 g, 30 g, 80 g, 454 g); 0.5% (15 g)

Triderm®: 0.1% (30 g, 85 g)

Cream, topical, as acetonide [kit]:

Pediaderm™ TA: 0.1% (30 g) [packaged with protective emollient]

Zytopic™: 0.1% (85 g) [packaged with cleanser and moisturizer]

Lotion, topical, as acetonide: 0.025% (60 mL); 0.1% (60 mL); 0.1%

Ointment, topical, as acetonide: 0.025% (15 g, 80 g, 454 g); 0.05% (430 g); 0.1% (15 g, 80 g, 454 g); 0.5% (15

g)

Trianex™: 0.05% (17 g, 85 g)

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Triamcinolone (topical): Drug information

Paste, oral topical, as acetonide: 0.1% (5 g)

Oralone®: 0.1% (5 g)

Generic Equivalent Available: U.S. Administration

Oral topical: Apply small dab to lesion until a thin film develops; do not rub in. Apply at bedtime or after meals if applications are needed throughout the day.

Yes: Excludes spray

Topical:

Ointment: Apply a thin film sparingly. Do not use on open skin or wounds. Do not occlude area unless directed; if using occluding dressing, monitor for infection.

Spray: Avoid eyes and do not inhale if spraying near face. Occlusive dressing may be used if instructed; monitor for infection.

Use

Oral topical: Adjunctive treatment and temporary relief of symptoms associated with oral inflammatory lesions and ulcerative lesions resulting from trauma

Topical: Inflammatory dermatoses responsive to steroids

Medication Safety Issues

Sound-alike/look-alike issues:

Kenalog® may be confused with Ketalar®

Other safety concerns:

TAC (occasional abbreviation for triamcinolone) is an error-prone abbreviation (mistaken as tetracaine- adrenaline-cocaine)

Adverse Reactions Significant

Frequency not defined.

Dermatologic: Acneiform eruptions, allergic contact dermatitis, dryness, folliculitis, hypertrichosis, hypopigmentation, miliaria, perioral dermatitis, pruritus, skin atrophy, skin infection (secondary), skin maceration, striae

Endocrine: HPA axis suppression; metabolic effects (hyperglycemia, hypokalemia)

Local: Burning, irritation

Contraindications

Hypersensitivity to triamcinolone or any component of the formulation; fungal, viral, or

bacterial infections of the mouth or throat (oral topical formulation)

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if

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Triamcinolone (topical): Drug information

dermatological infection persists despite appropriate antimicrobial therapy.

• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Special populations:

• Elderly: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.

• Pediatrics: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.

Other warnings/precautions:

• Appropriate use: Do not use occlusive dressings on weeping or exudative lesions and general caution with occlusive dressings should be observed; discontinue if skin irritation or contact dermatitis should occur; do not use in patients with decreased skin circulation.

• High-potency products: Avoid the use of high-potency steroids on the face.

• Oral cavity application: When used as a topical agent in the oral cavity, if significant regeneration or repair of oral tissues has not occurred in seven days, re-evaluation of the etiology of the oral lesion is advised.

Metabolism/Transport Effects None known. Drug Interactions

Launch Lexi-Interact™ Drug Interactions Program ) Aldesleukin: Corticosteroids may diminish the antineoplastic

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Risk X: Avoid combination

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

Telaprevir: Corticosteroids may decrease the serum concentration of Telaprevir. Telaprevir may increase the serum concentration of Corticosteroids. Management: Concurrent use of telaprevir and systemic corticosteroids is not recommended. When possible, consider alternatives. If used together, employ extra caution and monitor closely for excessive corticosteroid effects and diminished telaprevir effects. Risk D:

Consider therapy modification

Pregnancy Risk Factor Pregnancy Implications

Corticosteroids were found to be teratogenic following topical application in

animal reproduction studies. In general, the use of topical corticosteroids during pregnancy is not considered to

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Triamcinolone (topical): Drug information

have significant risk, however, intrauterine growth retardation in the infant has been reported (rare). The use of large amounts or for prolonged periods of time should be avoided.

Lactation

Breast-Feeding Considerations

Excretion in breast milk unknown/use caution

Corticosteroids are excreted in human milk; information specific to

triamcinolone has not been located. The amount of triamcinolone absorbed systemically following topical administration is variable. Hypertension in the nursing infant has been reported following corticosteroid ointment applied to the nipples. Use with caution.

Pricing: U.S. (www.drugstore.com)

Aerosol solution (Kenalog)

(63): $175.99

Cream (Triamcinolone Acetonide)

0.025% (15): $15.99

0.03% (80): $17.99

0.1% (15): $14.99

0.1% (30): $18.99

0.1% (80): $19.99

0.1% (453.6): $40.99

0.5% (15): $19.99

Lotion (Triamcinolone Acetonide)

0.025% (60): $40.99

0.1% (60): $43.99

Ointment (Triamcinolone Acetonide)

0.03% (80): $17.99

0.1% (15): $14.99

0.1% (80): $29.99

0.1% (454): $31.99

0.5% (15): $20.99

Paste (Triamcinolone Acetonide)

0.1% (5): $65.99

International Brand Names

Aftab (DE); Ahbina (KP); Aristo (HK); Aristocort A (MY, TH); Centocort

(TH); Cortiflex (PE); Delphi Creme (BE, NL); Delphicort (AT, DE); Dermacort (HK, MY); Facort (TH); Ftoracort (EE); Gemicort (KP); Generlog (TH); Glytop (AR); Invert Plaster (KP); Kanolone (MY); Kena-Lite (TH); Kenacort (PH, VE); Kenacort A (NL); Kenacort A in Orabase (CH); Kenacort E (PE); Kenacort T (FI, SE); Kenacort-A (BH, EG, ID, KE, TW, TZ, UG); Kenacort-A in Orabase (NL); Kenalog (CL, DK, PK); Kenalog Gel (CL); Kenalog in Orabase (ID, ZA); Keno (SG); Ketricin (ID); Laver (TH); Ledercort (AR, IN, PK); Ledermix (NO); Manolone (TH); Metoral (MY, TH); Nincort (CL, TW); Oracort (NZ); Oramedy (HK, KP, SG); Orrepaste (MY, SG); Sinocort (ID); Tess (IN); Tramsone (SG); Tricin (PH); Tricort (FI, PH); Tricortone (AU); Volon A Antibiotikafrei (AT, DE)

Mechanism of Action

Decreases inflammation by suppression of migration of polymorphonuclear

leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity

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and volume of the lymphatic system

Triamcinolone (topical): Drug information

Pharmacodynamics/Kinetics

Absorption: Topical corticosteroids are absorbed percutaneously. The extent is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, and the use of occlusive dressings.

Half-life elimination: Biologic: 18-36 hours

Excretion: Urine (~40%); feces (~60%)

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REFERENCES

1. American Academy of Pediatrics Committee on Drugs: “Transfer of Drugs and Other Chemicals Into Human Milk,” Pediatrics, 2001, 108(3):776-89. [PubMed 11533352]

2. Pradat P, Robert-Gnansia E, Di Tanna GL, et al, “First Trimester Exposure to Corticosteroids and Oral Clefts,” Birth Defects Res A Clin Mol Teratol, 2003, 67(12):968-70. [PubMed 14745915]

3. Reed, BR, “Dermatologic Drugs, Pregnancy, and Lactation. A Conservative Guide,” Arch Dermatol, 1997, 133(7):894-8. [PubMed 9236528]

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