Polcortolon tablets 4mg №50
Description for Polcortolon tablets 4mg №50
Table. 4 mg blister, № 25, № 50
Triamcinolone 4 mg
Other ingredients: lactose, potato starch, magnesium stearate.
Pharmacological properties: The Pharmacodynamics. Polkortolon - a synthetic fluorinated corticosteroids, a derivative of prednisolone with a pronounced anti-inflammatory effect. Triamcinolone 4 mg for anti-inflammatory activity equivalent to 4 mg of methylprednisolone, prednisolone 5 mg, 0.75 mg of dexamethasone, betamethasone 0.6 mg and 20 mg hydrocortisone. Has little mineralocorticoid activity. Triamcinolone inhibits the development of symptoms of inflammation without affecting the cause of its occurrence, inhibits the accumulation of macrophages, white blood cells and other cells in the inflammation. Inhibits phagocytosis, release of lysosomal enzymes, as well as the synthesis and release of inflammatory mediators. Reduces the expansion and capillary permeability, which leads to a reduction of edema. The drug has immunosuppressive effects, ie, inhibits cellular immune responses, reduces the number of T-lymphocytes, monocytes and eosinophils. May also inhibit the penetration of immune complexes across the membrane and reduce the concentration of complement components and immunoglobulins. Triamcinolone inhibits the release of ACTH pituitary gland, which reduces the synthesis of corticosteroids in the adrenal cortex: after a single dose of triamcinolone at a dose of 60-100 mg of adrenal suppression persists for 24-48 h and returned to baseline levels after 30-40 days. Almost every patient taking the drug at a dose of 12-16 mg / day for 10 days, may develop adrenal insufficiency. After prolonged use of high doses of triamcinolone in adrenal function may not recover for a year, and in some cases of infringement, are irreversible. Triamcinolone enhances protein catabolism, inhibits the synthesis and increases protein breakdown in the lymphatic, connective, muscle and skin that can cause them to atrophy. The drug causes an increase in the concentration of glucose in the blood serum, effect on fat metabolism, increases the concentration of fatty acids in blood plasma. With prolonged use may be incorrect distribution of adipose tissue.
The drug slows the synthesis of bone tissue, reduces the concentration of calcium in the blood plasma, can inhibit bone growth in children and adolescents and may lead to the development of osteoporosis at any age. Enhances the action of endogenous and exogenous catecholamines.
Pharmacokinetics. Bioavailability of triamcinolone after oral administration is 20-30%. Effect appears after 1-2 h and persists for 6-8 hours, T ½ triamcinolone from the serum of ≥ 2-5 h of fabrics - 18-36 hours, about 40% of triamcinolone is associated with serum proteins (mainly globulins ). The drug is metabolized in the liver, to a lesser extent - in the kidneys.
Excreted primarily in the urine as inactive metabolites.
Triamcinolone passes through the placenta and into breast milk.
INDICATIONS: Endocrine diseases: primary (Addison's disease) and secondary adrenocortical insufficiency, adrenogenital syndrome (congenital hyperplasia of adrenal gland), thyroiditis (negnoyny).
Severe allergic disease, the ineffectiveness of other methods of treatment: serum sickness, hypersensitivity reaction to medication, asthma, anaphylactic reactions (GCS - as auxiliary treatment after failure of other treatments).
Collagen (in acute or in some cases as maintenance therapy): rheumatic or non-rheumatic myocarditis, acute rheumatic myocarditis, and rheumatic fever, systemic lupus erythematosus.
Dermatological diseases: inflammation of the skin - polymorphous erythema to severe (Stevens - Johnson), a severe form of psoriasis, dermatitis herpetiformis bulezny, seborrheic dermatitis.
Diseases of the digestive tract (in acute, prolonged treatment is contraindicated): ulcerative colitis, Crohn's disease.
Hematological diseases: acquired hemolytic anemia (due to autoimmunization), congenital aplastic anemia, erythroblastopenia (erythrocytic anemia), thrombocytopenia secondary adult idiopathic thrombocytopenic purpura (Verlgofa disease) in adults.
Hypercalcemia associated with cancer.
Non-rheumatic diseases of joints (short-term, as an auxiliary treatment for exacerbations): acute and subacute bursitis, epicondylitis, acute nonspecific tenosynovitis, post-traumatic inflammation of the bones and joints, acute gouty arthritis.
Cancer (as palliative therapy in combination with anticancer treatments): leukemia and lymphoma in adults with acute leukemia in children.
Edema: to normalize the diuresis and remission of proteinuria in the nephrotic syndrome, systemic lupus erythematosus.
Neurological disease: tuberculous inflammation of the meninges with subarachnoid block (along with anti-TB treatment), multiple sclerosis during relapse.
Ophthalmic disease: inflammation of the iris and ciliary body, inflammation of the choroid and retina, generalized inflammation of the choroid posterior chamber of the eye, inflammation of the optic nerve, sympathetic inflammation of the vascular wall, anterior chamber inflammation, allergic inflammation of the conjunctiva, inflammation of the cornea (not associated with infection herpes or fungal infection), the edge of the cornea ultseratsiya associated with allergies.
Diseases of the respiratory system: berylliosis, Leffler syndrome, aspiration pneumonia, symptomatic sarcoidosis, lightning, or miliary tuberculosis of the lungs (while TB treatment).
Rheumatic diseases (such as an auxiliary treatment during the exacerbation): ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, juvenile rheumatoid arthritis (in ineffectiveness of other treatments), bursitis in osteoarthritis.
Prevention and treatment of graft rejection (in conjunction with other immunosuppressive drugs).
APPLICATION: The course and the dose is adjusted individually depending on the course of disease and clinical effect. It is recommended to use the drug in accordance with the circadian rhythm 1 time per day in the morning. In some cases you may need more frequent taking triamcinolone.
Adults and children over the age of 14 years: 4-48 mg / day in one or more receptions.
In case of insufficiency of the adrenal cortex - 4-12 mg / day with simultaneous treatment mineralokortikosteroidami. Large variability in doses used in endocrine disorders, making it impossible to provide detailed dosing.
In rheumatoid arthritis, acute gouty arthritis, ankylosing spondylitis, psoriatic arthritis, spine, acute and subacute bursitis, nonspecific tenosynovitis initial dose is 8-16 mg / day, although some patients may be necessary to use higher doses of the drug.
In systemic lupus erythematosus initial dose is usually 20-32 mg / day. Patients with severe symptoms apply higher initial dose - 48 mg / day or higher.
Acute rheumatic myocarditis
In patients with severe acute rheumatic myocarditis with pericardial exudate and / or congestive heart failure treated with corticosteroids is effective against acute and severe inflammatory changes. The initial dose of triamcinolone - 20-60 mg / day. After improving the daily dose can be reduced. Supportive treatment lasts at least 6-8 weeks, sometimes - up to 3 months. Corticosteroid treatment does not replace etiotrop treatment.
When buleznom Dermatitis herpetiformis, severe polymorphous erythema, psoriasis deskvamatsionnom initial dose is 8-16 mg / day.
In severe psoriasis, the initial dose is 8-16 mg / day. The duration of maintenance therapy depends on clinical effectiveness.
With seasonal or perennial allergic rhinitis triamcinolone is used in a dose 8.12 mg / day. With resistance to therapy may be necessary to use higher initial and maintenance dose. In bronchial asthma, the recommended dose - 8-16 mg / day.
With allergic rhinitis and asthma, use of corticosteroids to reduce the severity of exacerbations and long-term treatment is rarely recommended.
In contact and atopic dermatitis topical treatment may be supplemented by brief oral administration 8-16 mg of triamcinolone per day.
With allergic conjunctivitis, keratitis, iridocyclitis, chorioretinitis, inflammation of the anterior chamber, diffuse choroidal the back of the eye, optic neuritis and choroidal initial dose is 12-40 mg / day, depending on the severity of the condition, nature and extent of inflammation, but it usually comes improvement quickly.
Diseases of the respiratory system
In sarcoidosis, Loeffler syndrome, berylliosis, or dessiminirovannom fulminant pulmonary tuberculosis (also with antibacterial treatment) the initial dose is 16-48 mg / day.
The initial dose is 16-60 mg / day. Therapeutic dose should be used depending on patient response to treatment. If, after a relatively long treatment does not come better, should be abolished triamcinolone. After achieving clinical response should gradually reduce the dose to the minimum effective.
In stressful situations (eg surgery, infection, trauma) may be necessary to increase the dose.
Cancer (in palliative care)
In acute leukemia in children is usually triamcinolone dose of 1-2 mg / kg body weight per day. As a rule, the improvement occurs between 6 th and 21 th day of receiving triamcinolone, and the treatment lasts for 4-6 weeks.
In leukemia and lymphoma in adults is usually the daily dose is 16-40 mg, although the leukemia may be necessary to increase the daily dose to 100 mg.
Triamcinolone is used to normalize the diuresis and reduction of proteinuria in the nephrotic syndrome without uremia (idiopathic or systemic lupus erythematosus). The average dose is 16-20 mg (sometimes up to 48 mg) per day to normalize the diuresis. Typically, urine output is normalized at the 14 th day, sometimes - later.
After normalization of urine output should continue to improve the treatment, then the dose should be reduced. In mild cases, the drug is used at a dose of 4 mg / day.
At the beginning of a subarachnoid block triamcinolone is used in conjunction with appropriate antimicrobial therapy.
Usually used 32-48 mg / day once or divided into several stages.
Children with adrenal insufficiency dose of 0.117 mg / kg or 3.3 mg / m 2 body surface 1 times in the morning or in 2 divided doses. In other cases, the dose is 0,416-1,7 mg / kg or 12,5-15 mg/m2 body surface.
CONTRAINDICATIONS: Hypersensitivity to the drug. Children aged ≤ 6 years. Systemic fungal lesions, acute infectious disease. Vaccinations, especially those containing live viruses. Malignant neoplasms with metastases.
Other contraindications are relative and depend on the expected benefits of the planned duration and route of administration, for example, the benefits of a systemic or local application. Other situations in the application to include more warnings and precautions, rather than a contraindication.
Inflammation in the active phase
Corticosteroids may reduce the body's response to infection and activate or sharpen local or systemic infections that are resistant to antimicrobial therapy, as well as latent or healed tuberculosis.
During treatment with corticosteroids can be complicated control of this disease.
For prolonged use of corticosteroids may worsen the state of osteoporosis, especially in elderly patients, there is a risk of pain associated with a decrease in the height of the vertebral body due to an increase of lumbar lordosis.
Proximal myopathy in history, caused by the use of corticosteroids, is contraindicated for use of the drug, because it is a special risk of this side effect, is directly associated with the use of triamcinolone. After steroid withdrawal severity of myopathy, usually decreases within a few months. The maximum risk of this side effect noted in children.
Peptic ulcer disease can sometimes occur when using corticosteroids. Also there is a risk of bleeding and perforation. The group at particular risk include patients taking NSAIDs.
Particularly in patients with paranoia or depression in the history of the use of the drug may increase the risk of suicide.
Slow healing of tissues can be pronounced in patients with recent surgery for intestinal anastomosis overlay.
Patients taking corticosteroids should not be vaccinated against chickenpox. Virtually all types of vaccination should not be performed in patients treated with corticosteroids at high doses, given the possibility of neurological complications or reducing antibody.
Triamcinolone is not recommended for patients with diverticulitis, glaucoma, pregnancy and lactation.