WordNet

a synthetic corticosteroid (trade names Aristocort or Aristopak or Kenalog) used as an anti-inflammatory agent (同)Aristocort, Aristopak, Kenalog

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/20 21:53:01」(JST)

wiki en

Triamcinolone is a long-acting synthetic corticosteroid given orally, by injection, by inhalation, or as a topical ointment or cream.

Uses

Triamcinolone is used to treat a number of different medical conditions, such as eczema, psoriasis, arthritis, allergies, ulcerative colitis, lupus, sympathetic ophthalmia, temporal arteritis, uveitis, ocular inflammation, Urushiol-induced contact dermatitis, aphthous ulcers (usually as triamcinolone acetonide), visualization during vitrectomy and the prevention of asthma attacks. It will not treat an asthma attack once it has already begun.^[1]^[2]^[3] It has also been used off-label for macular degeneration.^[4]

Prior to 2007 it was sold under the name Azmacort as a corticosteroid inhaler for asthma long-term care.

In 2010, TEVA and Perrigo launched the first generic inhalable triamcinolone.^[5]

Triamcinolone is used to alleviate infection-induced eczema in fungal skin infections in the combination drug of econazole/triamcinolone.

The derivative triamcinolone acetonide is one of the ingredients of Ledermix, an endodontic (tooth's root canal) lotion used between sessions, and Sanofi sold it under the brand name Nasacort. Triamcinolone acetonide is also used as intra lesional steroid injection to treat keloids and hypertrophic scars.

Forms

Different triamcinolone derivatives are available, including acetonide, benetonide, furetonide, hexacetonide and diacetate.

Triamcinolone acetonide is a more potent type of triamcinolone, being about eight times as effective as prednisone.

Side effects

Side effects of triamcinolone include sore throat, nosebleeds, increased coughing, headache, and runny nose.^{[citation needed]} White patches in the throat or nose indicate a serious side effect. Symptoms of an allergic reaction include rash, itch, swelling, severe dizziness, trouble breathing.^[6] An additional side effect for women is a prolonged menstrual cycle.

Trade names

Trade names for triamcinolone include Aristocort (Sandoz, now Novartis), Kenacort (Bristol-Myers Squibb), Kenalog (Bristol-Myers Squibb), Tricort (Cadila), Triaderm (Schering-Plough), Azmacort (KOS), Trilone, Volon A, Tristoject, Tricortone and Ratio-Triacomb.

References

Aristocort (triamcinolone) topical cream

Kenalog (triamcinolone) IM injection

^ Triamcinolone - Drugs.com
^ Triamcinolone Inhalation - Drugs.com
^ Alcon Receives FDA Approval of Triesence Injectable Triamcinolone Suspension for Use in Eye Surgery - Drugs.com
^ Age-Related Macular Degeneration (AMD) Treatment
^ Perrigo Announces Launch Of Generic Version Of Nasacort AQ - CBS Detroit
^ "Drugs and Treatments - Nasacort AQ Nasl - Patient Handout". WebMD. Retrieved 2008-03-24.

External links

Triamcinolone Topical | MedlinePlus
Triamcinolone (Topical Application Route) | MayoClinic

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. Fox-Fordyce disease (apocrine miliaria)
2. 関節内および軟部組織注射：注射剤の種類および投与頻度 intraarticular and soft tissue injections what agents to inject and how frequently
3. 成人における関節吸引または注射：手技および適応 joint aspiration or injection in adults technique and indications
4. 網膜静脈閉塞：治療 retinal vein occlusion treatment
5. 糖尿病性網膜症：予防および治療 diabetic retinopathy prevention and treatment

English Journal

The influence of peri-incisional triamcinolone acetonide injection on wound edge apposition.

Wesley CK1, Teo LH, Xu T, Unger RH, Unger WP.Author information 1Private Practice , 710 Park Avenue, New York , USA.AbstractLocal administration of corticosteroids has been demonstrated to have both beneficial and detrimental effects on wound healing. The advantages of limiting localized edema must be weighed against corticosteroids' disadvantageous inhibition of the normal growth factor profile production that is essential for would healing. A single-center prospective, randomized, controlled, single-blind study of 57 patients undergoing hair restoration surgery (HRS) by one of three different surgeons revealed: 1) no dehiscence along the donor wound; 2) no statistically significant difference (p < 0.05) in wound edge apposition noted between patients receiving or not receiving intralesional corticosteroids at any of the four measured scalp regions and 3) a non-statistically significant trend emerged suggesting the benefit of corticosteroid at the temples (points of decreased donor closing tension) versus its potential hindrance along the mastoids (points of increased tension). These results suggest that peri-incisional triamcinolone acetonide (PITMC) does not have a statistically significant effect on donor wound edge apposition within 8-10 days of HRS. A subtle, though not statistically significant, trend emerged demonstrating the benefit of PITMC with respect to early phase donor wound edge apposition in areas of least donor closing tension and the hindrance of PITMC in regions of increased tension.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Aug;25(4):345-9. doi: 10.3109/09546634.2012.755253. Epub 2013 Feb 3.
Local administration of corticosteroids has been demonstrated to have both beneficial and detrimental effects on wound healing. The advantages of limiting localized edema must be weighed against corticosteroids' disadvantageous inhibition of the normal growth factor profile production that is essent
PMID 23210735

Antidepressant effects of citalopram on treatment of alopecia areata in patients with major depressive disorder.

Abedini H1, Farshi S, Mirabzadeh A, Keshavarz S.Author information 1Psychiatry Department, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.AbstractOBJECTIVE: The authors sought to determine whether antidepressant therapy could enhance the efficacy of dermatological treatment in alopecia areata patients who suffer from major depressive disorder.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Apr;25(2):153-5. doi: 10.3109/09546634.2013.768761. Epub 2013 May 6.
OBJECTIVE: The authors sought to determine whether antidepressant therapy could enhance the efficacy of dermatological treatment in alopecia areata patients who suffer from major depressive disorder.METHODS: Sixty patients were enrolled in the study. Thirty patients with alopecia who were diagnosed
PMID 23339335

Impact of intravitreal triamcinolone acetonide versus intravitreal bevacizumab on retrobulbar hemodynamic in patients with diabetic macular edema.

Shahin M1, Gad MA, Hamza W.Author information 1Department of Ophthalmology, Faculty of Medicine, Mansoura University , Mansoura , Egypt and.AbstractAbstract Purpose: To evaluate and compare retrobulbar hemodynamic changes measured with color Doppler imaging (CDI) in diabetic patients receiving intravitreal triamcinolone acetonide (IVTA) versus bevacizumab. Methods: Patients with diffuse diabetic macular edema were assessed prospectively by CDI following intravitreal injection of triamcinolone acetonide (group I, 12 eyes) versus bevacizumab (group II, 14 eyes). CDI was used to measure the peak systolic velocity (PSV), end diastolic velocity (EDV) and the resistive index (RI) of the central retinal artery (CRA), ophthalmic artery (OA) and posterior ciliary arteries (PCA) one day preoperatively and one week postoperatively. Results: In group I, EDV of OA and CRA decreased significantly (p = 0.007 and 0.018, respectively). The PSV and RI of PCA decreased significantly (p = 0.035 and 0.002, respectively). In group II, both the PSV and EDV of the CRA decreased significantly (p = 0.000). Comparing the percentage of change in both groups, PSV of the CRA decreased significantly in group II (p = 0.034), while IVTA has more significant effect on the ophthalmic artery hemodynamic parameters as EDV decreased and RI increased significantly (p = 0.045 and 0.043, respectively) Conclusion: Intravitreal injections of triamcinolone acetonide and bevacizumab have a significant effect on the ocular hemodynamic. The effect of bevacizumab is statistically significant on the PSV of CRA compared to IVTA.
Cutaneous and ocular toxicology.Cutan Ocul Toxicol.2014 Mar;33(1):49-53. doi: 10.3109/15569527.2013.796478. Epub 2013 Jun 6.
Abstract Purpose: To evaluate and compare retrobulbar hemodynamic changes measured with color Doppler imaging (CDI) in diabetic patients receiving intravitreal triamcinolone acetonide (IVTA) versus bevacizumab. Methods: Patients with diffuse diabetic macular edema were assessed prospectively by CDI
PMID 23742103

Japanese Journal

CLINICAL INVESTIGATION : Photodynamic therapy combined with intravitreal bevacizumab and sub-tenon triamcinolone acetonide injections for age-related macular degeneration

Yoshizawa Chikako,Saito Wataru,Hirose Shigeki [他]
Japanese journal of ophthalmology : the official English-language journal of the Japanese Ophthalmological Society 57(1), 68-73, 2013-01-00
NAID 40019546384

CLINICAL INVESTIGATION : One-year results of bevacizumab intravitreal and posterior sub-Tenon injection of triamcinolone acetonide with reduced laser fluence photodynamic therapy for retinal angiomatous proliferation

Shirakata Yukari,Shiragami Chieko,Yamashita Ayana [他]
Japanese journal of ophthalmology : the official English-language journal of the Japanese Ophthalmological Society 56(6), 599-607, 2012-11-00
NAID 40019483776

ばね指に対するトリアムシノロン腱鞘内注射後深指屈筋腱皮下断裂をきたした1例

住浦誠治,山本学,長弘行雄,池田慶裕,武藤正記
整形外科と災害外科 61(4), 828-831, 2012-09-25
NAID 10031013952

Related Pictures

★リンクテーブル★

リンク元	「糖質コルチコイド」「KAP STEP2CK2008 002」「トリアムシノロン」「TR」
拡張検索	「triamcinolone diacetate」「triamcinolone hexacetonide」「triamcinolone acetonide」「diacetyltriamcinolone」

「糖質コルチコイド」

Triamcinolone
Systematic (IUPAC) name
	(11β,16α)-9-Fluoro-11,16,17,21-tetrahydroxypregna-1,4-diene-3,20-dione
Clinical data
Trade names	Kenalog Nasacort
AHFS/Drugs.com	monograph
Pregnancy; category	AU: A; US: C (Risk not ruled out);
Legal status	UK: Prescription-only (POM); US: ℞-only;
Routes of; administration	Oral, topical, IM, intra-articular, intrasynovial
Pharmacokinetic data
Protein binding	68%
Metabolism	Hepatic
Biological half-life	88 minutes
Excretion	Fecal and renal
Identifiers
CAS Registry Number	124-94-7
ATC code	A01AC01 C05AA12, D07AB09, H02AB08, R01AD11, R03BA06, S01BA05
PubChem	CID: 31307
IUPHAR/BPS	2870
DrugBank	DB00620
ChemSpider	29046
UNII	1ZK20VI6TY
KEGG	D00385
ChEBI	CHEBI:9667
ChEMBL	CHEMBL1451
Synonyms	Click show to see (8S,9R,10S,11S,13S,14S,16R,17S)-9-fluoro-11,16,17-trihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-6,7,8,9,10,11,12,13,14,15,16,17-dodecahydro-3H-cyclopenta[a]phenanthren-3-one; (1R,2S,10S,11S,13R,14S,15S,17S)-1-fluoro-13,14,17-trihydroxy-14-(2-hydroxyacetyl)-2,15-dimethyltetracyclo[8.7.0.02,7.011,15]heptadeca-3,6-dien-5-one
Chemical data
Formula	C21H27FO6
Molecular mass	394.434 g/mol
	SMILES O=C(CO)[C@]3(O)[C@]2(C[C@H](O)[C@]4(F)[C@@]/1(\C(=C/C(=O)\C=C\1)CC[C@H]4[C@@H]2C[C@H]3O)C)C ;
	InChI InChI=1S/C21H27FO6/c1-18-6-5-12(24)7-11(18)3-4-13-14-8-15(25)21(28,17(27)10-23)19(14,2)9-16(26)20(13,18)22/h5-7,13-16,23,25-26,28H,3-4,8-10H2,1-2H3/t13-,14-,15+,16-,18-,19-,20-,21-/m0/s1 ; Key:GFNANZIMVAIWHM-OBYCQNJPSA-N ;
(what is this?) (verify)

　　[★]

英: glucocorticoid (Z), glucocorticoids
関: グルココルチコイド
関: 副腎皮質、副腎皮質ホルモン

以下、内的に合成される糖質コルチコイドについて述べる

種類

ステロイドホルモン

分類

副腎皮質ホルモン

性状

ステロイド

産生組織

副腎皮質索状層

標的組織

生理作用

1. エネルギー代謝

糖新生においてグルコースの前駆体となるアミノ酸を肝臓に供給すべく動員する作用 (SP.894)

a. 糖代謝作用

糖新生の亢進

血糖上昇

肝細胞以外のグルコースの取り込みを抑制 (SP.894) ←　末梢でインスリンの作用に拮抗

グルコース-6-ホスファターゼの活性亢進 (SP.894)

グリコーゲンの合成亢進

血糖値の上昇に伴い、肝臓などでグルコースからグリコーゲンが作られる (SP.894)

b. タンパク質代謝作用

肝臓での糖新生の基質を末梢から供給する作用

肝細胞以外でのアミノ酸取り込み阻害 (SP.894)

特定のアミノ酸合成を阻害 (SP.894)

生理的範囲：(肝臓)同化作用が起こる、(肝臓以外)異化作用が起こる

ステロイド大量投与時：ほとんど異化作用が起こる→副作用につながる

c. 脂質代謝作用

脂肪細胞に対して、インスリンの拮抗作用を持つが、一方で糖質コルチコイドにより血糖値が上昇する

脂肪分解↑→血糖値↑　…(1)

脂肪細胞に対してグルコースの取り込みを抑制し、中性脂肪の生合成を抑制し、さらに大量の遊離脂肪酸とグリセロールを放出させる。肝臓でグリセロールからグルコースが合成される。 (SP.894)

血糖値↑→脂肪合成↑　…(2)

血糖値の上昇によりインスリンが分泌され、脂肪細胞で脂肪の合成が促進される (SP.894)

(1)、(2)のいずれの反応が起こるかは体の部位によって異なり、脂肪分布の変化が生じる。

中心性肥満、満月様顔貌、バッファローハンプ

2. 電解質代謝作用

糖質コルチコイドの電解質コルチコイド様作用。

Na+再吸収↑、K+排泄↑

コルチゾールの電解質作用はアルドステロンの約１／４００

コルチゾールの量　　　　はアルドステロンの約　２００倍

ゆえに、電解質コルチコイドの１／２の作用力を持つ

3. 水代謝作用

GFR↑、ADHに拮抗、細胞内への水移動の抑制→水利尿作用を有する。　　尿崩症 + 副腎不全　→　多尿がいくらか改善されると考えて良いと思われる。仮面尿崩症

4. 骨・軟骨に対する作用

a. ビタミンDと拮抗して腸管からのCa吸収阻害 (SP.894)
b. 腎尿細管におけるCa再吸収阻害 (SP.894)
c. 骨芽細胞の分化・増殖を抑制 (SP.894)

糖質コルチコイドの大量投与→軟骨↓骨成長↓(活性型ビタミンD₃に拮抗・尿細管Ca再吸収↓→PTH↑、骨芽細胞の分化抑制、タンパク質の異化作用↑)→骨粗鬆症、骨壊死 or 骨端線閉鎖を促進(←？要調査)

b.の機序で尿に排泄されるカルシウムが増加　　→　　高カルシウム尿症　→　尿路結石

5. 抗炎症作用

胸腺やリンパ組織を萎縮させる　→　炎症反応や免疫反応を抑制

リンパ球数の減少、白血球の遊走抑制、抗体産生低下、ヒスタミン放出抑制(局所の毛細血管拡張抑制) (SP.894)

末梢好中球数は増加する(YN.F-78)　→　白血球増多症

SPC.330

a) 核内受容体を介してlipocortinを発現させ、これがphospholipase A2を阻害する。これにより、アラキドン酸の産生が抑制され、炎症を促進するロイコトリエンの産生も抑制される。
b) 末梢血Tリンパ球、単球、好酸球、好塩基球：骨髄からの放出減少と再分配(?)のため末梢血中では減少する。
c) 末梢血好中球：炎症部位への集合が抑制され(血管外への遊走が抑制される(GOO.1600))、末梢血中では増加する。
d) Bリンパ球はヘルパーT細胞が抑制されるために抗体産生能が減少する。
e) リンパ球などの細胞表面の立体構造を換えて抗体や補体の結合を抑制する。
f) 毛細血管(毛細管)の収縮により、血管の透過性は低下する。

6. 循環器

カテコールアミン・アンジオテンシンIIによる血管収縮作用の許容作用　→　糖質コルチコイドなしではその作用を十分に及ぼし得ない

欠乏症では血管のカテコールアミン・アンジオテンシンIIに対する感受性低下

7. 中枢神経系

認知機能や情動を修飾 (SP.895)

8. 成長発達

胎児期の消化酵素・リン脂質(肺胞表面の張力に関与)の合成に関与 (SP.895)
小児期で骨や熱強訴域に直接作用して身長の伸びを抑制する (SP.895)

作用機序

免疫抑制(GOO. 657,674,1600)

COX-2の抑制
phospholipase A₂の抑制

糖質コルチコイドはリポコルチンを産生→リポコルチンはホスホリパーゼA₂の活性を修飾→アラキドン酸産生↓

分泌調節

1. 概日リズム
2. フィードバック制御
- 糖質コルチコイドがACTHやCRHを抑制
3. ストレス反応

臨床関連

クッシング症候群(糖質コルチコイド過剰) (SP.894)

合成ステロイドホルモン

用量

低用量から中等量：40mg未満

Low-to-moderate doses — Doses of 1 mg/kg per day of prednisone in children or 40 mg per day in adults may be considered an approximate threshold at which significant toxicities begin to appear with extended use in most individuals.

副作用

副腎皮質ホルモン剤

副腎機能の低下、骨粗鬆症(無菌性大腿骨頭壊死)、高脂血症、高血圧、筋力低下、筋肉痛、白内障、緑内障
ニューモシスチス肺 PCP

Patients receiving a glucocorticoid dose equivalent to ≥20 mg of prednisone daily for one month or longer who also have another cause of immunocompromise (eg, certain hematologic malignancies or a second immunosuppressive drug)

https://www.uptodate.com/contents/treatment-and-prevention-of-pneumocystis-pneumonia-in-hiv-uninfected-patients?

0.5mg/kg以上のプレドニゾロン(PSL)を3週間以上投与され、かつST予防投与されていない間質性肺炎74例中7例(9.5％)でPCPを発症(榎本達治，他．ステロイド療法中の間質性肺炎患者に発症したニューモシスチス肺炎の臨床的検討．日呼吸会誌 2005: 43: 725-30)

Table 59–2 Relative Potencies and Equivalent Doses of Representative Corticosteroids
COMPOUND	ANTIINFLAMMATORY POTENCY	Na+-RETAINING POTENCY	DURATION OF ACTION*	EQUIVALENT DOSE, MG
cortisol	1	1	S	20
cortisone	0.8	0.8	S	25
fludrocortisone	10	125	I	‡
prednisone	4	0.8	I	5
prednisolone	4	0.8	I	5
6α-methylprednisolone	5	0.5	I	4
triamcinolone	5	0	I	4
betamethasone	25	0	L	0.75
dexamethasone	25	0	L	0.75

「KAP STEP2CK2008 002」

　　[★]

glossary

lancinating
throbbing
hilar lymphadenopathy
vitiligo
alopecia areata 円形脱毛症
trichotillomania
psyllium おおばこかオオバコ。緩下薬らしい
Coxsackie virus 手足口病
indolent 無痛性
commensals 共生
actinomycetes 放線菌

サルコイドーシス

疫学

peak age group for sarcoidosis is 20-40
more common in blacks
African Americanがヒント

病態

lungs, heart, kidneys, skin, liver, or other organ

uveitisも来す？
冒されやすい部位は皮膚、眼、肺

亜急性甲状腺炎

病原体：ウイルス

橋本病

Many patients also have other autoimmune diseases.
ホルモンの変化：hypothyroidism are also present in longer-standing cases. Early in the disease, as in this case, T4 and TSH levels may be normal.
MPO抗体は橋本病に特異的ではない；Graves disease and silent lymphocytic thyroiditisでも上がる

円形脱毛症

円形脱毛症と他の疾患の関連：autoimmune disorders, such as Hashimoto thyroiditis, pernicious anemia, and Addison disease
皮膚科的特徴：exclamation hair

http://www.aafp.org/afp/2003/0701/p93.html

治療：triamcinolone or application of anthralin ointment has been beneficial in hastening recovery

プロペシア

フィナステリドは、5α-還元酵素II型を選択的に抑制することによりテストステロンからジヒドロテストステロンへの変換を阻害し、発毛作用を示すものと考えられる。

http://www.info.pmda.go.jp/go/pack/249900XF1021_2_01/249900XF1021_2_01?view=body

同名半盲

bilateral temporal hemianopia and is due to chiasmatic lesions that compromise the crossing fibers originating from the temporal retina

単純ヘルペスウイルスの初感染患者について

Gingivostomatitis and pharyngitis are the most frequent clinical manifestations of primary herpes simplex virus 1 infection, and are most commonly seen in children and young adults. Clinical signs and symptoms include fever, malaise, myalgias, and cervical adenopathy. Common lesions may involve the hard and soft palate, gingiva, tongue, lips, and facial area.