Triamcinolone

CLINICAL USE

Corticosteroid

DOSE IN NORMAL RENAL FUNCTION

IM: 40 mg of acetonide; maximum single dose 100 mg Intra-articular: 2.5–40 mg of acetonide

PHARMACOKINETICS

Molecular weight : 394.4 (434.5 as acetonide)

%Protein binding : Low

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) : 1.4–2.1

half-life – normal/ESRD (hrs) : 2–5/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unknown dialysability. Dose as in normal renal function

HD : Unknown dialysability. Dose as in normal renal function

HDF/high flux : Unknown dialysability. Dose as in normal renal function

CAV/VVHD : Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antibacterials: metabolism accelerated by rifampicin; metabolism possibly inhibited by erythromycin

Anticoagulants: efficacy of coumarins may be altered

Anti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidone

Antifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazole

Antivirals: concentration possibly increased by ritonavir

Ciclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroids Cytotoxics: increased risk of haematological toxicity with methotrexate

Diuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diuretics Vaccines: high dose corticosteroids can impair immune response to vaccines; avoid concomitant use with live vaccines

ADMINISTRATION

Reconstition

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Route

IM, intra-articular, topical, nasal spray, intradermal

Rate of Administration

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Comments

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OTHER INFORMATION

Use with caution in severe renal impairment as sodium and water retention may occur 4 mg is equivalent to 5 mg of prednisolone .

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