A Medico-Marketing PPS on Triamcinolone

1. Triamcinolone acetonide
Shilpa Garg

2. Corticosteroids
 Corticosteroids are man-made drugs that closely
resemble cortisol, a hormone that adrenal glands
produce naturally.
 Corticosteroids are often referred to by the shortened
term “steroids.”
 Corticosteroids are different from the male hormone-
related steroid compounds that some athletes abuse.

3. Corticosteroids
 Corticosteroids act on the immune system by blocking
the production of substances that trigger allergic and
inflammatory actions, such as prostaglandins.
 However, they also hamper the function of white blood
cells which destroy foreign bodies and help keep the
immune system functioning properly.
 The interference with white blood cell function yields
a side effect of increased susceptibility to infection.

4. Corticosteroids
 Corticosteroids decrease inflammation by acting
within cells to prevent the release of certain chemicals
that are important in the immune system.
 These chemicals are normally involved in producing
immune and allergic responses, resulting in
inflammation.
 By decreasing the release of these chemicals in a
particular area, inflammation is reduced.

5. Corticosteroids
 This can help control a wide number of disease
states, characterised by excessive inflammation.
 They include severe allergic reactions, inflammation
of the lungs in asthma and inflammation of the joints
in arthritis.
 The injection can be given as a single dose to people
who suffer from hayfever and don't respond to
conventional therapy.

6. How are Corticosteroids Beneficial?
 When inflammation threatens to damage critical body
organs, steroids can be organ-saving and in many
instances, life-saving.
 For example, steroids may prevent the progression of
kidney inflammation which could lead to kidney
failure in people who have lupus (a systemic disease
that results from an autoimmune mechanism) or
vasculitis (inflammation of a vessel). For these
patients, steroid therapy may eliminate the need for
kidney dialysis or transplantation.

7. How are Corticosteroids Beneficial?
Low doses of steroids may provide
significant relief from pain and stiffness
for people with rheumatoid arthritis.
Temporary use of higher doses of
steroids may help a person recover from
a severe flare-up of arthritis.

8. How to decide if Corticosteroids are the
Right Treatment?
 The decision to prescribe steroids is always made on an
individual basis. The patient’s age, physical activity and
other medications he is taking are considered before
prescribing
 The doctor will also make sure that the patient understand
the potential benefits and risks of steroids before starting
the treatment.
 The potential benefits and risks of steroids vary with:
 the nature and severity of the disease being treated;
 the presence or absence of other treatment alternatives;
and
 the presence or absence of other significant medical
problems.

9. Corticosteroids
 Corticosteroids affect the strength of heart muscle and
its response to natural chemicals affecting heart rate.
 They affect the water and salt balance in the body and
also enable the body to cope with stress. Stress
includes changes in temperature, pain, fear, anxiety
and illness and can be hazardous if the body is not
equiped to cope, due to low levels of corticosteroids

10. Corticosteroids
 Corticosteroids allow us to respond to stress by
 increasing the rate and force of the heartbeat,
 increasing blood supply to essential tissues
(muscle, heart, brain),
 increasing the body's supply of energy by raising blood
sugar and by several other effects on body systems.

11. Corticosteroids
 Corticosteroid Drugs Include:
 Betamethasone
 Budesonide
 Cortisone
 Dexamethasone
 Hydrocortisone
 Methylprednisolone
 Prednisolone
 Prednisone
 Triamcinolone
 Prednisone is the most commonly used type of steroid
to treat certain rheumatologic diseases.

12. Corticosteroids
 Corticosteroids are versatile in their mode of application. They
can be given:
orally

injected into the vein or muscle

applied locally to the skin

injected directly into inflamed joints

 Corticosteroid drugs can also be used as ingredients contained
in:
eye products (to treat various eye conditions)

inhalers (to treat asthma or bronchial disease)

nasal drops and sprays (to treat various nasal problems)

topical creams, ointments, etc. (to treat various skin problems)

 Corticosteroids can be used in conjunction with other drugs, and
are prescribed for short-term and long-term use.

13. Triamcinolone acetonide
 Triamcinolone acetonide is a more potent type of
corticosteroid , being about 8 times as effective as
prednisone.
 A synthetic glucocorticoid corticosteroid with marked
anti-inflammatory action, in a sterile aqueous
suspension suitable for intralesional and intra-
articular injection

14. Triamcinolone
 Triamcinolone acetonide is a synthetic corticosteroid
and is given by injection in many situations where a
lasting corticosteroid effect is required.
 This includes replacement therapy in people whose
adrenal glands are not producing enough natural
steroids (adrenal insufficiency) and decreasing
inflammation in certain disease states.

15. Triamcinolone
 Triamcinolone may also be given by injection directly
into a joint to relieve inflammation and pain and
increase mobility of the affected joint, in conditions
such as arthritis.
 Triamcinolone also decreases the numbers of white
blood cells circulating in the blood. This is useful for
the treatment of certain types of leukaemia, where
there is an abnormally large production of certain
white blood cells.
 It is also used to treat some diseases which are caused
by the immune system attacking the body's own
tissues (auto immune diseases).

16. General Indications
 An attack of the body by its immune system resulting in
the destruction of red blood cells (autoimmune haemolytic
anaemia)
 Cancer of the lymph nodes
 Hayfever
 Inflammation of the bony projection at the end of a long
bone e.g. humerus in the arm (epicondylitis)
 Inflammation of the envelope (bursa) found around parts
of the body which are subject to friction e.g. joints, muscles
and tendons (bursitis)
 Inflammation of the tissue surrounding a tendon
(tenosynovitis)

17. General Indications
 Inflammatory disorders e.g. asthma, arthritis, severe
allergic reactions, Crohn's disease, systemic lupus
erythematosus
 Insufficient production of natural steroid hormones by
the adrenal glands (adrenal insufficiency)
 Joint injection in inflammatory disease of the joints
(e.g. rheumatoid arthritis)
 Joint injection in osteoarthritis with associated
inflammation
 Leukaemia

18. Indications and Usage
 The intra-articular (within the cavity of a joint) or
soft tissue administration of triamcinolone
acetonide injectable, is indicated as adjunctive therapy
for short-term administration (to tide the patient over
an acute episode or exacerbation) in
acute gouty arthritis

acute and sub-acute bursitis

acute nonspecific tenosynovitis

epicondylitis

rheumatoid arthritis

synovitis of osteoarthritis


19. Indications and Usage
 The intralesional (injected directly into a lesion)
administration of triamcinolone acetonide injectable, is
indicated for:
 Alopecia (Baldness)
 Discoid lupus erythematosus (Skin disease in which
there are red scaly patches, especially over the nose
and cheeks along with skin lesions)
 Keloids (hard prominent irregular scar tissue in the
skin)
 Lichen planus (wide flat purple pimples on
forearms, neck and thighs)

20. Indications and Usage
 The intralesional (injected directly into a lesion)
administration of triamcinolone acetonide injectable, is
indicated for:
 Lichen simplex chronicus (A thickened area of
itching skin resulting from rubbing and scratching)
 Psoriatic plaques
 Necrobiosis lipoidica (patchy degeneration of skin
causing areas of white scarring and thinning)
 Also can be useful in cystic tumors of an
aponeurosis (thin but strong fibrous sheet of tissue
that replaces a tendon)

21. Dosage
For the purpose of comparison, the
following is the equivalent milligram Cortisone, 25 Triamcinolone, 4
dosage of the various
glucocorticoids.
Hydrocortisone, 20 Paramethasone, 2
Prednisolone, 5 Betamethasone, 0.75
These dose relationships apply
only to oral or intravenous
administration of these compounds.
Prednisone, 5 Dexamethasone, 0.75
When these substances or their
derivatives are injected intramuscularly
or into joint spaces, their relative
Methylprednisolone, 4
properties may be greatly altered.

22. Dosage : Intra-Articular
Administration
 The initial dose of triamcinolone acetonide
injectable for intra-articular administration may vary
from 2.5 mg to 5 mg for smaller joints and from 5 to 15
mg for larger joints, depending on the specific disease
entity being treated.
 Single injections into several joints, up to a total of 20
mg or more, have been given

23. Dosage : Intralesional
 For intralesional administration, the initial dose per
injection site will vary depending on the specific disease
entity and lesion being treated. The site of injection and
volume of injection should be carefully considered due to
the potential for cutaneous atrophy.
 Multiple sites separated by one centimeter or more may be
injected, keeping in mind that the greater the total volume
employed the more corticosteroid becomes available for
systemic absorption and systemic effects. Such injections
may be repeated, if necessary, at weekly or less frequent
intervals.

24. Warnings and Precautions
 Pregnancy
 Teratogenic Effects: Pregnancy
Category C
 There are no adequate and well-controlled studies in
pregnant women. Corticosteroids should be used during
pregnancy only if the potential benefit justifies the
potential risk to the fetus. Infants born to mothers who
have received corticosteroids during pregnancy should
be carefully observed for signs of hypoadrenalism.

25. Warnings and Precautions
 Nursing Mothers
 Systemically administered corticosteroids appear in
human milk and could suppress growth, interfere with
endogenous corticosteroid production, or cause other
untoward effects. Caution should be exercised when
corticosteroids are administered to a nursing woman.

26. Warnings and Precautions
 Pediatric Use
 This product contains benzyl alcohol as a preservative.
 Benzyl alcohol, a component of this product, has been
associated with serious adverse events and death,
particularly in pediatric patients.
 The “gasping syndrome” (characterized by central
nervous system depression, metabolic acidosis, gasping
respirations, and high levels of benzyl alcohol and its
metabolites found in the blood and urine) has been
associated with benzyl alcohol dosages >99 mg/kg/day
in neonates and low-birth-weight neonates.

27. Warnings and Precautions
 Pediatric Use
 Published studies provide evidence of efficacy and safety
in pediatric patients for the treatment of nephrotic
syndrome (>2 years of age), and aggressive lymphomas
and leukemias (>1 month of age).
 Other indications for pediatric use of
corticosteroids, e.g., severe asthma and wheezing, are
based on adequate and well-controlled trials conducted
in adults, on the premises that the course of the diseases
and their pathophysiology are considered to be
substantially similar in both populations.

28. Warnings and Precautions
 Geriatric Use
 No overall differences in safety or effectiveness were
observed between elderly subjects and younger subjects,
and other reported clinical experience has not identified
differences in responses between the elderly and
younger patients, but greater sensitivity of some older
individuals cannot be ruled out.

29. Adverse Reactions
 The occurrence of side effects depends on the dose, type of
corticosteroid and length of treatment.
 Some side effects are more serious than others. Common
side effects of systemic corticosteroid include:
 Difficulty in sleeping (insomnia)
 Depression
 Thinning of the skin
 Increased pressure inside the eye (glaucoma)
 Irregular menstrual cycle
 Decreased functioning of the adrenal gland (adrenal
suppression)

30. Adverse Reactions
 Common side effects of systemic corticosteroid include:
Thinning of the bones (osteoporosis)

Ulceration of the stomach or intestine

Increased susceptibility to infections

Acne

An extreme allergic reaction (anaphylaxis)

Increased risk of fractures of the bones

Increased hair growth (hirsutism)

Yeast infection of the moist areas of the body, especially

the vagina (candidiasis)
 Muscle wasting and weakness

31. Side Effects of Corticosteroids can be
Minimized
 To minimize the side effects of corticosteroids, doctors follow several guidelines:
 Use steroids only when necessary.
 Monitor the patient closely to detect the development of
serious side effects.
If possible, use local steroids for local problems.

Use the minimal dose required to gain control of the

disease.
Reduce the dose gradually as long as the disease remains

under control.
Monitor blood pressure often and treat if necessary.

Prescribe calcium supplements to help maintain bone

density.

32. Contraindications
 Triamcinolone acetonide injectable is contraindicated
in patients who are hypersensitive to any components
of this product.
 Intramuscular corticosteroid preparations are
contraindicated for idiopathic thrombocytopenic
purpura (A rare autoimmune disorder characterized by an acute
shortage of platelets with resultant bruising and spontaneous
bleeding).

33. Overdosage
 Treatment of acute overdosage is by supportive and
symptomatic therapy.
 For chronic overdosage in the face of severe disease
requiring continuous steroid therapy, the dosage of the
corticosteroid may be reduced only temporarily, or
alternate day treatment may be introduced.

34. Glossary of Medical Terms
 Gout: A condition that results from crystals of uric acid
depositing in tissues of the body. Gout is characterized
by an overload of uric acid in the body and recurring
attacks of joint inflammation (arthritis).
 Bursitis: Bursitis is inflammation of a bursa. A bursa is
a tiny fluid-filled sac that functions as a gliding surface
to reduce friction between tissues of the body. There are
160 bursae in the body. The major bursae are located
adjacent to the tendons near the large joints, such as the
shoulders, elbows, hips, and knees

35. Glossary of Medical Terms
 Epicondylitis: Epicondylitis is an inflammation or
damage to the area of an epicondyle of bone. An
epicondyle is a projection of bone above a condyle (a
rounded prominence at the end of a bone, usually where
the bone connects to another bone) where ligaments
and tendons are attached.
 Epidural : Outside the dura, the outermost, toughest,
and most fibrous of the three membranes (meninges)
covering the brain and the spinal cord.