Pharmacological properties

Pharmacodynamics. active agent of ointment is Triamcinolonum acetonide — gks, the containing fluorine and at topical administration showing anti-inflammatory, antiallergic and antipruritic action.

Pharmacological action of GKS is based by

on regulation of synthesis of specific proteins of an organism and ensuring fitness of an organism to stressful situations due to decrease in utilization of glucose and strengthening of a gluconeogenesis (hyperglycemia). GKS promote adjournment of a glycogen, first of all in a liver, due to strengthening of secretion of insulin in the conditions of a hyperglycemia. Reduce synthesis and strengthen catabolism of proteins of a muscle, skin and bone tissue; promote a lipolysis. Narrow vessels, reduce their permeability and puffiness of fabrics.

Numerous receptors of GKS are also in tissues of a brain and heart. GKS strengthen β-adrenergic reactions in lungs, expand bronchial tubes and reduce vascular resistance in lungs.

In high doses slow down corticotropin secretion, at adrenokortikosteroidny insufficiency strengthen glomerular filtration and a diuresis; cause cankers of mucous membranes. In high doses show antiallergic and anti-inflammatory properties.

Etherification of molecule GKS fatty acids in the 17th and 21st positions significantly strengthens its influence on skin. The arrangement of cyclic acetonide in the 16th and 17th positions strengthens local anti-inflammatory action, without affecting system effect of GKS. Fluorine promotes further increase in local activity of medicine.

Pharmacokinetics. Triamcinolonum well gets into deep skin layers, partially comes to blood. At application of an occlusive bandage on the struck skin sites it is soaked up in the quantity sufficient for manifestation of system effect. GKS are quickly distributed in body tissues. The main metabolite of Triamcinolonum — 6-β-гидрокситриамцинолон, is removed by a liver, kidneys, with a stake and urine in equal ratios. T _½ — about 5 h, a half-life period — 18–36 h

Indication

Disease of skin sensitive to corticosteroids (eczema, vulgar psoriasis, allergic dermatitis).

Use

For external use.

Adult a thin film of ointment is applied by 2–3 times a day on an affected area of skin (the maximum dose — no more than 15 g of ointment a day) or use medicament under an occlusive bandage (the maximum dose — no more than 10 g of ointment a day).

to Children 1 years are aged more senior than

a thin film of ointment is applied by at most 2 times a day on an affected area of skin. Duration of use of medicine for children should not exceed 5 days. Use of an occlusive bandage for children is contraindicated.

to Elderly people medicine needs to be used carefully and within a short period of time as it must be kept in mind that at this category of patients the skin is thinner.

Contraindication

Hypersensitivity to Triamcinolonum to acetonide or any excipient of medicine.

Drug cannot be used in eyes or on sites of skin around eyes.

Use as monotherapy without performing specific treatment at fungal and bacterial skin infections; tuberculosis; virus damages of skin, especially at a herpes simplex and chicken pox; at parasitic infections (mange); skin manifestations of syphilis; skin reactions after vaccination; perianal and genital itch; shin ulcer; varicosity; widespread blyashechny psoriasis; damages of face skin (pink eels, vulgar eels, perioral dermatitis); the skin intertrigo caused by wet diapers; treatment of dry peeling of skin and putting ointment on a breast just before feeding by a breast; children aged till 1 year.

Side effects

at topical administration are characteristic

glucocorticosteroid medicines side effects of local character, however, depending on amount of the substance which came to a system blood-groove system effects are possible.

At prolonged use on big surfaces the oppression of function of bark of adrenal glands, especially at children is possible

and also at application of occlusive bandages; the negative nitrogenous balance owing to the strengthened disintegration of proteins is possible.

from the immune system: hypersensitivity reactions.

from water and electrolytic exchange: oppression of function of bark of adrenal glands (secondary insufficiency of bark of adrenal glands), a gipokaliyemichesky Alkalosis, a delay in an organism of water and sodium, a hypopotassemia, AG.

from central nervous system: mental violations, spasms, dizziness, headache, increase in intracranial pressure, insomnia.

from an organ of sight: cataract, back subkapsulyarny cataract, exophthalmos, glaucoma, papilledema, helcoma, exophthalmos. The likelihood of developing a cataract is higher at children.

from a cardiovascular system: heart failure, AG.

from digestive system: gastric bleeding, gastrointestinal bleeding, gastrointestinal perforation, esophagitis, pancreatitis, ulcer.

from skin: dermatitis, burning, a folliculitis, akneformny rash, contact dermatitis, dryness and thinning of skin, an erythema, a hirsutism, the increased sweating, an intertrigo, an itch, a skin atrophy, hypopigmentation, irritation, striya, teleangiectasias, delay of healing of wounds.

from the musculoskeletal system: a growth inhibition at children, a steroid myopathy, osteoporosis, an osteonecrosis, aseptic necrosis.

Laboratory deviations: increase in intraocular pressure, negative nitrogenous balance, delay of reactions at skin tests.

Infection and parasitic diseases: activization of latent infections, masking of a course of infections, opportunistic infections.

Special instructions

At emergence of the phenomena of irritation of skin should stop use of ointment Ftorokortum and to continue treatment by other medicine.

perhaps systemic action of medicine — in such cases is required to

At application of occlusive bandages and treatment of big body surfaces extra care.

At use of ointment the microorganisms which are on skin (first of all piogenic microorganisms, sometimes a blastomyces), can get through the loosened corneal layer and cause various pyodermas which are treated by disinfectants which are washed away. Fungus diseases are possible, under an occlusive bandage bruises can sometimes develop. At prolonged use of ointment on the same part of a body, especially at patients of young age, the atrophy of this site of skin can develop.

Some areas of a body, such as axillary hollows, inguinal folds (where there are natural occlusion and skin more gentle and thin) are more inclined

to development of extensions and easily noticeable atrophy of this site of skin which has irreversible character. Therefore use of ointment on these sites of skin has to be short.

to

in case of development of a fungal or bacterial infection of skin needs additional application of local or system therapy.

to

does not recommend use of ointment on a hairy part of the head.

Prolonged use of medicine on face skin is not recommended to

because of danger of an atrophy of skin. Not to allow hit of medicine in eyes. In case of hit in eyes to wash out them a large amount of flowing water and to see a doctor.

At treatment of psoriasis the withdrawal, steroid dependence, development of generalized pustulous psoriasis and local or system toxicity because of violation of barrier function of skin is possible

. Treatment of patients with psoriasis local corticosteroids perhaps only under strict observation of the doctor.

Prescribing of ointment to children is aged more senior than 1 year perhaps only in exceptional cases. Duration of use of medicine for children should not exceed 5 days. Use of an occlusive bandage for children is contraindicated.

in case of application for children needs to consider possibility of signs of oppression gipotalamo - a hypophysial and adrenal system and Cushing's syndrome which arise at children more often than at adult patients, through a bigger ratio of the area of integuments to body weight, and, respectively, children are more inclined to system toxicity. At the children receiving corticosteroids for topical administration noted sharp insufficiency of bark of adrenal glands, Cushing's syndrome, increase in intracranial pressure.

Use during pregnancy and feeding by a breast. Use of ointment in the I trimester of pregnancy is contraindicated. The data confirming safety of use of medicine during pregnancy in II and III trimester are not enough. The question of use of medicine in II and III trimester of pregnancy and during feeding by a breast is solved by the doctor in each case individually, carefully weighing a ratio of the expected effect of treatment and potential risk at impact of medicine on a fruit.

Absorption of GKS in the blood circulatory system is followed by their penetration into breast milk and influence on bark of adrenal glands and growth of the baby.

Children. At children aged till 1 year it is contraindicated to apply ointment.

Ability to influence speed of response at control of vehicles or work with other mechanisms. At the moment there are no messages. However at control of vehicles or other mechanisms it is recommended to observe extra care, considering a possibility of development of undesirable reactions from nervous system.

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Interaction

to

At local application gks does not know interaction with other medicines.

Overdose

Depending on amount of the steroid which came to an organism the development of both local, and system side reactions is possible

. at overdose of medicine it is impossible to stop sharply treatment, it is done gradually, reducing a medicine dose. at development of symptoms of insufficiency of bark of adrenal glands can be required in/in introduction of a hydrocortisone.

Storage conditions

At a temperature of 8-15 °C.