What Are the Most Common Triamcinolone Side Effects?

Triamcinolone is also known as triamcinolone, and its chemical name is 9-fluoro-11, 16, 17, 21-tetrahydroxyprogestin-1,4-diene-3,20-dione. White or off-white crystalline powder; odorless. Soluble in dimethylformamide, slightly soluble in methanol or ethanol, and almost insoluble in water or chloroform. The molecular formula is C21H27FO6, the molecular weight is 394.43400, the density is 1.42g / cm3, the melting point is 262-263 ° C (lit.), and the boiling point is 587.5ºC at 760mmHg.

Triamcinolone is also known as triamcinolone, and its chemical name is 9-fluoro-11, 16, 17, 21-tetrahydroxyprogestin-1,4-diene-3,20-dione. White or off-white crystalline powder; odorless. Soluble in dimethylformamide, slightly soluble in methanol or ethanol, and almost insoluble in water or chloroform. The molecular formula is C21H27FO6, the molecular weight is 394.43400, the density is 1.42g / cm3, the melting point is 262-263 ° C (lit.), and the boiling point is 587.5ºC at 760mmHg.

Chinese name

Triamcinolone

Foreign name

triamcinolone

CAS number

124-94-7

Molecular formula

C21H27FO6

Molecular weight

394.43400

Triamcinolone compounds

Basic information

Chinese name:

Chinese alias: 9a-fluoro-11b, 16a, 17a, 21-tetrahydroxy-1,4-pregnene-3,20-dione; 9-Fluoro-11, 16, 17,21-tetrahydroxy-1,4- pregnadiene-3,20-dione; floxadone; triamcinolone;

English name: triamcinolone

English alias: (8S, 9R, 10S, 11S, 13S, 14S, 16R, 17S) -9-fluoro-11,16,17-trihydroxy-17- (2-hydroxyacetyl) -10,13-dimethyl-6,7 , 8,11,12,14,15,16-octahydrocyclopenta [a] phenanthren-3-one; Triamcinolone;

CAS number: 124-94-7

MDL number: MFCD00010477

EINECS number: 204-718-7

RTECS number: TU3850000

PubChem number: 24278749

Molecular formula: C21H27FO6

Molecular weight: 394.43400

Structural formula:

Exact quality: 394.17900

PSA: 115.06000

LogP: 0.62050 ^[1]

Physical and chemical properties of Triamcinolone

Appearance and properties: white to off-white crystalline powder

Density: 1.42g / cm ³

Melting point: 262-263 ° C (lit.)

Boiling point: 587.5ºC at 760mmHg

Flash point: 309.1ºC

Refractive index: 1.617

Vapor pressure: 3E-16mmHg at 25 ° C ^[1]

Triamcinolone molecular structure data

1. Molar refractive index: 97.14

2. Molar volume (cm3 / mol): 277.3

3. Isometric Zhang Rong (90.2K): 789.3

4. Surface tension (dyne / cm): 65.5

5. Polarizability (10-24cm3): 38.51 ^[2]

Computational Chemical Data for Triamcinolone

1. Hydrophobic parameter calculation reference value (XlogP): None

2.Number of hydrogen-bonded donors: 4

3.Number of hydrogen bond acceptors: 7

4.Number of rotatable chemical bonds: 2

5.Number of tautomers: 9

6. Topological molecular polar surface area 115

7.Number of heavy atoms: 28

8.Surface charge: 0

9.Complexity: 807

10.Number of isotope atoms: 0

11. Determine the number of atomic stereocenters: 8

12. Uncertain number of atomic stereocenters: 0

13. Determine the number of chemical bond stereocenters: 0

14. Uncertain number of chemical bond stereocenters: 0 ^[2]

15.Number of covalent bond units: 1

Triamcinolone use

For systemic lupus erythematosus, rheumatic disease, nephrotic syndrome and other immune kidney diseases, idiopathic thrombocytopenic purpura and other immune blood diseases, and other diseases to which prednisone acetate is adapted.

Triamcinolone Pharmacopoeia Standard

The main chemical composition of Triamcinolone

9-fluoro-11, 16, 17, 21-tetrahydroxyprogesterone-1,4-diene-3,20-dione. Calculated based on dry products, containing C21H27FO6 should be 97.0% to 102.0%. ^[3]

Triamcinolone traits

White or off-white crystalline powder; odorless.

Soluble in dimethylformamide, slightly soluble in methanol or ethanol, and almost insoluble in water or chloroform.

Triamcinolone

Take this product, weigh it accurately, add dimethylformamide to dissolve and quantitatively dilute it to make a solution containing about 2mg per 1ml. According to the law, the specific rotation is + 65 ° to + 72 °.

Triamcinolone identification

(1) In the chromatogram recorded under the content determination item, the retention time of the main peak of the test solution should be consistent with the retention time of the main peak of the reference solution.

(2) The infrared light absorption spectrum of this product should be the same as that of the control ("Infrared Spectra of Drugs" 747). ^[3]

Triamcinolone inspection

relative substance

Take this product, add methanol to dissolve and dilute it to make a solution containing about 0.5mg per 1ml as the test solution; take 1ml precisely, place it in a 100ml measuring bottle, dilute to the mark with methanol, shake well, and use it as a control solution . According to the chromatographic conditions under the content determination item, take 20 l of the reference solution and inject it into the liquid chromatograph, adjust the detection sensitivity, so that the peak height of the main component chromatographic peak is about 30% of the full range; and then accurately measure the test solution and the reference solution. Each 20 l was injected into the liquid chromatograph, and the chromatogram was recorded to 4.5 times the main component peak retention time. If there is an impurity peak in the chromatogram of the test solution, the impurity peak area with a peak area between 0.5 and 1.0 times the main peak area of the control solution must not exceed two, and the area of other single impurity peaks must not exceed 0.5 times the main peak area of the control solution (0.5% ), The sum of the peak areas of each impurity must not be greater than 2 times (2.0%) the area of the main peak of the control solution. Any peak that is less than 0.02 times the area of the main peak of the control solution in the chromatogram of the test solution can be ignored. ^[3]

Loss on drying

Take this product and dry it under reduced pressure at 60 ° C for 4 hours. The weight loss shall not exceed 1.5%. (

Residue on ignition

Take 1.0g of this product and inspect it according to law. The residual residue should not exceed 0.2%.

Heavy metal

Take the residue left under the item of burning residue and inspect it according to law. The content of heavy metals must not exceed 10 parts per million.

Determination of Triamcinolone

As determined by high performance liquid chromatography.

Chromatographic conditions and system suitability tests

Octadecylsilane-bonded silica gel was used as the filler; acetonitrile-water (18:82) was used as the mobile phase; the detection wavelength was 238 nm. The theoretical plate number is calculated to be not less than 6000 according to the Qu'anxi Long peak, and the resolution of the Qu'anxi Long peak from the adjacent impurity peaks should meet the requirements.

Assay

Take this product, weigh it accurately, add methanol to dissolve and quantitatively dilute it to make a solution containing about 0.16mg per 1ml. Take 5ml precisely, place it in a 50ml measuring bottle, dilute to the mark with methanol, shake well, and take 20l accurately Inject into the liquid chromatograph, record the chromatogram; take another triamcinolone reference substance, and measure in the same way. Calculate the peak area according to the external standard method. ^[3]

Qu An Xilong laboratory determination method

Method name: Triamcinolone API-Triamcinolone-High Performance Liquid Chromatography

Scope of application: This method uses high performance liquid chromatography to determine the content of triamcinolone in triamcinolone API.

This method is applicable to Quanxilong API.

Principle of the method: The test product is dissolved in the mobile phase and quantitatively diluted, and then diluted with an internal standard solution, and then subjected to chromatographic separation by high-performance liquid chromatography. The peak area of triamcinolone is detected at a wavelength of 240 nm using an ultraviolet absorption detector. Show its content.

Reagent: 1. Methanol

Hydrocortisone

Equipment: 1. Instrument

1.1 HPLC

1.2 Column

Octadecylsilane-bonded silica gel is used as a filler, and the theoretical plate number should not be less than 2500 according to the calculation of Qu'anxi Longfeng.

1.3 UV absorption detector

2.Chromatographic conditions

2.1 Mobile phase: methanol water = 60 40

2.2 Detection wavelength: 240nm

2.3 Column temperature: room temperature

Sample preparation: 1. Preparation of internal standard solution

Accurately weigh the appropriate amount of hydrocortisone, add the mobile phase to make a solution of about 20 & microg per 1mL, which is the internal standard solution.

2. Preparation of reference solution

Accurately weigh the appropriate amount of Triamcinolone reference substance, add the mobile phase to dissolve and quantitatively dilute it to a solution containing approximately 0.16mg per 1mL, accurately measure 5mL, place it in a 50mL volumetric flask, and dilute to the mark with the internal standard solution, shake well That is the reference solution.

3. Preparation of test solution

Accurately weigh the appropriate amount of the test sample, add the mobile phase to dissolve and quantitatively dilute it to a solution containing about 0.16mg per 1mL, accurately measure 5mL, place it in a 50mL volumetric flask, dilute to the mark with the internal standard solution, and shake to obtain Test solution.

Note: "Precision weighing" means that the weighed weight should be accurate to one thousandth of the weighed weight. "Precision measurement" means that the accuracy of measuring the volume should meet the accuracy requirements of the volume pipette in national standards.

Operation steps: Precisely draw 20 mL of each of the reference solution and the test solution, inject them into a high-performance liquid chromatograph, and measure the peak area of triamcinolone (C21H27FO6) with a UV absorption detector at a wavelength of 240 nm, and calculate its content. ^[4]

Triamcinolone pharmacology and toxicology:

This product is a glucocorticoid drug.

1. Effects on immune organs: Glucocorticoids can reduce the weight of the thymus, lymph nodes and spleen, reduce the volume, and rapidly reduce lymphocytes in peripheral blood and bone marrow.

2. Affecting the distribution of lymphocytes: T cells were transferred to the bone marrow after the application of hydrocortisone in mice. Lymphocyte redistribution was also seen in the clinic after treatment, and mononuclear-macrophages in inflammatory exudates were significantly reduced, mainly because glucocorticoids inhibited their metastasis, not due to cell lysis.

3 Effect on cellular immunity: glucocorticoids inhibit the proliferation of T lymphocytes against mitogens ConA, PHA and antigens, and can also inhibit the same mixed lymphocyte response. Glucocorticoids inhibit Tc cell activation and its cytotoxic effect.

4 Effect on humoral immunity: Corticosteroids have a significant inhibitory effect on antibody production in sensitive animals but have inconsistent effects on human antibody levels. The inhibition of IgG and IgA is stronger than that of IgM. There have been reports of increased serum IgE levels in patients with asthma after the end of corticosteroid therapy.

5. Effect on macrophages: Macrophages are the most sensitive to glucocorticoids. The concentration that inhibits the chemotactic effect of macrophages is only 1/30 of the inhibition of neutrophils, and weakens the bactericidal effect of macrophages. The production of cytokines such as interleukin-1 (IL-1) and plasminogen activator by monocytes can be inhibited by corticosteroids.

6. Anti-inflammatory effects: The strong anti-inflammatory effects of glucocorticoids may be the combined result of multiple factors:

(1) Inhibit arachidonic acid metabolism to produce prostaglandins and inhibit leukotriene synthesis;

(2) increase blood vessel tension and reduce capillary permeability;

(3) inhibit the accumulation of phagocytic cells at the site of inflammation, and inhibit its function of processing antigens and producing IL-1;

(4) Interfering with complement activation and reducing the production of inflammatory mediators;

(5) stabilize the lysosomal membrane and prevent the release of lysosomal enzymes;

(6) Inhibit fibroblast proliferation and secretion, delay granulation tissue formation and wound healing time. ^[5]

Triamcinolone pharmacokinetics:

The oral absorption rate of glucocorticoids is directly proportional to its lipid solubility, while the absorption rate of injections is directly proportional to its degree of water solubility. About 90% of glucocorticoids are combined with plasma proteins without biological activity, and less than 10% have biological activity. Its distribution in the body is not selective, but due to increased blood flow and vascular permeability at the site of inflammation, the drug concentration there can be higher than other organs. Glucocorticoids are mainly inactivated in the liver, and lymphocytes also have the ability to oxidize or reduce glucocorticoids. In recent years, it has been proven that B cells metabolize glucocorticoids faster than T cells, explaining the mechanism that B cells are more tolerant to glucocorticoids than T cells. Cortisone is converted into cortisol in the body to produce activity, and dexamethasone itself is active. Several glucocorticoids commonly used in the clinic have different half-lives in vivo, which can be used as medicine basis. Glucocorticoids are excreted by the kidneys, and the free cortisone in the urine is less than 2%, while more than 90% are inactivated, indicating that the level of active hormones in plasma will not be increased during renal insufficiency. ^[5]

Triamcinolone indications:

Apply its strong immunosuppressive effect to treat allergic inflammation and various autoimmune diseases. Because its main pharmacological effects are the same as prednisone acetate (prednisone), its indications are basically the same as prednisone, mainly including:

1. Connective tissue diseases such as systemic lupus erythematosus;

2. Immune kidney diseases such as nephrotic syndrome;

3 Immune diseases such as idiopathic thrombocytopenic purpura;

4 Other diseases for which prednisone acetate is suitable. ^[5]

Triamcinolone dosage

oral. The initial dose is 1-12 tablets (4 to 48 mg) per day, and the specific dosage can be determined according to the disease type and the condition of the doctor. It is best to take the whole day once a day at 8-9 am to minimize the interference with the hypothalamus-pituitary-adrenal axis of the patient's body. After the condition is controlled, it should be gradually reduced gradually according to the doctor's order. Some patients require a long-term maintenance dose of 1-2 tablets (4-8 mg) daily. ^[5]

Triamcinolone adverse reactions

Similar to other glucocorticoids, such as:

1. Gastrointestinal reactions: middle and upper abdominal discomfort, bloating, anorexia, nausea, and a small number of patients may induce stomach, duodenal ulcers and even blood and perforation;

2. Endocrine and metabolic abnormalities: long-term application can induce endocrine abnormalities (such as steroidal diabetes, irregular menstruation, and child growth inhibition); electrolyte disorders; Cushing-like syndrome: abnormal hair distribution, full moon face, buffalo back, purple skin, Muscle atrophy, hypertension, hypokalemia, osteoporosis, muscle weakness,

3 Neuropsychiatric disorders: excitement, insomnia, mild depression, drowsiness, a few can induce headaches, increased intracranial pressure, convulsions or mental disorders;

4 Ophthalmic complications: subcorneal cataract, elevated intraocular pressure, and glaucoma. ^[5]

Triamcinolone taboo:

(1) Disabled for all kinds of bacterial infections and systemic fungal infections;

(2) Disabled for allergies. ^[5]

Notes for Qu An Xilong :

1. Because taking this medicine can suppress the immune system, patients are more susceptible to infection than healthy people and special attention should be paid.

2. It should be used with caution in the following cases: heart disease or acute heart failure; diabetes; diverticulitis; emotional instability or psychotic tendencies; glaucoma; liver damage; herpes simplex of the eye; hyperlipoproteinemia; hypertension; hypothyroidism; Myasthenia gravis; osteoporosis; gastric ulcer, gastritis or esophagitis; impaired renal function or stones; tuberculosis; reduced prothrombin.

3 Use with caution in pregnant and lactating women.

4 Children's long-term use can inhibit growth and development and should be used with caution.

5. Blood pressure, weight, blood sugar and urine glucose, serum electrolytes, fecal occult blood are regularly checked, and eye examinations are performed.

6. For long-term and high-dose applications, the bilateral hip joint phases need to be tracked regularly;

7. For those who cannot exclude infection (including those infected with tuberculosis), effective antibacterial drugs should be used in combination;

8. The hypothalamus-pituitary-adrenal axis should be checked for suppression after long-term high-dose administration before withdrawal.

9. Use with caution by athletes. ^[5]

Triamcinolone for pregnant and lactating women:

Use with caution.

Triamcinolone medication for children:

This product is not suitable for children, and only used in short-term treatment when necessary.

Triamcinolone for elderly:

Use with caution.

Qu An Xilong expert review

Domestic reports reported that imported 0.1% triamcinolone acetate was used to treat 7 cases of atopic dermatitis for 21 consecutive days. As a result, 6 cases of dermatitis improved more than 50%; 16 cases of neurodermatitis improved, and 16 cases improved 50% or more. . No adverse reactions such as skin atrophy and telangiectasia were seen. The Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences divided 57 patients with systemic lupus erythematosus (SIE) randomly and double-blindly into two groups, taking triamcinolone 0.8 mg / kg or 1 mg / kg prednisone acetate each day. Results The total effective rate of both groups was 73.7%, but the weight gain and the incidence of full-face face adverse reactions in the patients receiving this product were significantly lower than the latter. It is mainly used for the treatment of allergic diseases and the treatment of arthritis patients with hypertension or edema, with obvious curative effects. Triamcinolone A's acetate derivative is a medium-acting glucocorticoid. The effect is similar to that of Triamcinolone. Its anti-inflammatory and anti-allergic effects are strong and long-lasting. It is suitable for various skin diseases such as neurodermatitis and eczema. Domestic reports reported that 321 cases of various soft tissue strains were treated with this product. 5 to 20 mg each time, add 0.25% lidocaine solution as a local tenderness point closure. Once a week, 5 consecutive times is a course of treatment. Some patients recovered 8 times. If the symptoms are not improved after 3 injections, it will be invalid, and the closure will not be continued. After recent follow-up, 164 cases (51.1%) were cured after treatment with this product, 88 cases (27.4%) were markedly effective, 31 cases (9.7%) were effective, 38 cases (11.8%) were ineffective, and the total effective rate was 88.2%. In another report, 78 patients (40 males and 38 females) were treated with this product for bronchial asthma with a course of 1 to 25 years. The suspension injection of this product was bilaterally injected into Feishu acupoints, 0.2ml (8mg) per acupoint, every 2 weeks, for 1 to 3 months (7 cases in one month, 12 cases in 2 months, 59 cases in 3 months). Results Initial results were obtained in 1 to 3 days, 54 cases were clinically cured and markedly effective, 22 cases were effective, and the total effective rate was 98.7%. 38 cases were followed up for more than 2 years and remained stable. It is a long-acting adrenal corticosteroid, with strong and long-lasting anti-inflammatory and anti-allergic effects, and an anhydrous sodium retention effect. There are many dosage forms, which are used for the treatment of allergic diseases such as respiratory, otolaryngology, dermatology, ophthalmology and other diseases in various professions. ^[6]

Triamcinolone treatment for eczema

The World Health Organization WHO clearly states in its guidance document on immunodesensitization treatment that "immunodesensitization treatment is the only fundamental treatment that can completely treat allergic eczema." The international authoritative organization for allergy research has also proposed that "the use of high-quality standardized desensitization preparations and the use of the best allergy treatment plan, including the elimination of eczema allergens, immune repair of patients, symptomatic drug treatment of allergic eczema with skin inflammation, standardization Desensitization immunotherapy, referred to as "four in one quadruple therapy" scheme.

First, try to find allergens. Sometimes allergens are hard to find, and they are always unclear, because people are in contact with too many things. The illness comes from the mouth, you can record it yourself, what you have eaten in the past three days, if the rash is a few times because of eating something, remember to stop eating later. Also pay attention to environmental factors, do not go where there are many flowers and pollen, wear a mask when going out during the pollen season. There are also more common, such as allergies to the eye frame, allergies to the accessories of the belt, these should be avoided. Because it starts to feel itchy after using a certain kind of cosmetics, it generally means that you are allergic to the ingredients in the cosmetics, so you should not use this kind of cosmetics. This is prevention-oriented and try to find the cause. Can't find the reason to avoid some allergic factors in your life.

Second, eczema can be very itchy, and scratches often make skin lesions worse. In fact, the more the dermatitis gets, the more itchy it gets, the more itchy the more it gets, causing a vicious circle. Therefore, do not scratch when itching, it tends to get more and more itchy.

Third, see a doctor. For rash, you can take some anti-allergic drugs. If you have a severe itch, you can take some chlorpheniramine and antihistamines. Your doctor will prescribe some topical medications, most commonly corticosteroids. There are more than 20 kinds of hormone drugs, and hormones have different strengths. We advocate not to use the strongest medicine at the beginning, and the strongest medicine is not suitable for long-term use, and long-term use has side effects. You can also use some topical ointments and potions.