Triamcinolone 0.025% Ointment 454gm

Manufacturer PERRIGO PHARMACEUTICALS Active Ingredient Triamcinolone Cream and Ointment(trye am SIN oh lone) Pronunciation trye am SIN oh lone
It is used to treat skin rashes and other skin irritation.
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Drug Class
Corticosteroid, Topical
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Pharmacologic Class
Glucocorticoid receptor agonist, Anti-inflammatory
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Pregnancy Category
Category C
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FDA Approved
Jan 1970
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

Triamcinolone ointment is a medicine applied to the skin to reduce redness, swelling, itching, and discomfort caused by various skin conditions like eczema or psoriasis. It's a type of steroid that works by calming down the skin's immune response.
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How to Use This Medicine

Proper Use of This Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. Use this medication only as directed, and continue to use it even if your symptoms improve.

Application Instructions

Apply this medication only to your skin, avoiding the mouth, nose, and eyes, as it may cause burning.
Wash your hands before and after applying the medication, unless your hand is the treated area.
Clean the affected area before applying the medication, and make sure it is dry.
Apply a thin layer of the medication to the affected skin and gently rub it in.
Avoid applying the medication to the face, underarms, or groin area unless your doctor instructs you to do so.
Do not use bandages, dressings, or other coverings unless your doctor advises you to do so.
If the treated area is in the diaper region, avoid using tight-fitting diapers or plastic pants, as this may increase the amount of medication absorbed into the body.
Do not use this medication to treat diaper rash.
Avoid applying the medication to cuts, scrapes, or damaged skin.

Storage and Disposal

Store this medication at room temperature, away from freezing temperatures.
Keep all medications in a safe place, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. Check with your pharmacist for guidance on the best way to dispose of medications, and consider participating in local drug take-back programs.

Missed Dose

If you miss a dose, apply it as soon as you remember.
If it is close to the time for your next dose, skip the missed dose and resume your regular schedule.
* Do not apply two doses at the same time or use extra doses to make up for a missed dose.
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Lifestyle & Tips

  • Wash hands before and after applying the ointment.
  • Apply a thin layer to the affected skin area, gently rubbing it in until it disappears. Do not use more than directed.
  • Avoid applying to the eyes, mouth, or inside the nose.
  • Do not cover the treated area with bandages or plastic wrap unless specifically instructed by your doctor, as this can increase absorption and side effects.
  • Do not use on the face, groin, or armpits unless directed by your doctor, as these areas are more prone to side effects.
  • Use for the shortest duration necessary to control symptoms.
  • If you miss a dose, apply it as soon as you remember, then continue with your regular schedule. Do not apply extra to make up for a missed dose.

Dosing & Administration

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Adult Dosing

Standard Dose: Apply a thin film to the affected area 2 to 4 times daily.
Dose Range: 2 - 4 mg

Condition-Specific Dosing:

psoriasis: Apply 2-4 times daily, may use occlusive dressing for severe cases under medical supervision.
eczema: Apply 2-4 times daily.
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Pediatric Dosing

Neonatal: Not established
Infant: Apply a thin film to the affected area 2 to 4 times daily. Use with caution; increased risk of systemic absorption due to higher surface area to body weight ratio. Avoid prolonged use or occlusive dressings.
Child: Apply a thin film to the affected area 2 to 4 times daily. Use with caution; increased risk of systemic absorption. Avoid prolonged use or occlusive dressings.
Adolescent: Apply a thin film to the affected area 2 to 4 times daily.
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Dose Adjustments

Renal Impairment:

Mild: No adjustment needed for topical use.
Moderate: No adjustment needed for topical use.
Severe: No adjustment needed for topical use.
Dialysis: No specific considerations for topical use due to minimal systemic absorption.

Hepatic Impairment:

Mild: No adjustment needed for topical use.
Moderate: No adjustment needed for topical use.
Severe: No adjustment needed for topical use.

Pharmacology

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Mechanism of Action

Triamcinolone acetonide is a synthetic corticosteroid that possesses anti-inflammatory, antipruritic, and vasoconstrictive properties. It acts by inducing phospholipase A2 inhibitory proteins, collectively called lipocortins. These proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.
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Pharmacokinetics

Absorption:

Bioavailability: Minimal systemic absorption (typically <1%) through intact skin; increased with inflammation, skin barrier disruption, prolonged use, or occlusive dressings.
Tmax: Not precisely quantifiable for topical application due to minimal systemic absorption.
FoodEffect: Not applicable for topical formulation.

Distribution:

Vd: Not precisely quantifiable for topical application; systemically absorbed drug distributes throughout the body.
ProteinBinding: Variable, generally high for corticosteroids (e.g., >90% for cortisol).
CnssPenetration: Limited (systemic absorption is minimal).

Elimination:

HalfLife: Not precisely quantifiable for topical application; systemic half-life of absorbed drug is variable.
Clearance: Not precisely quantifiable for topical application.
ExcretionRoute: Primarily renal (metabolites), some biliary.
Unchanged: <1% (systemically absorbed)
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Pharmacodynamics

OnsetOfAction: Within hours of application (for symptomatic relief).
PeakEffect: Within days of consistent application.
DurationOfAction: Depends on frequency of application; effects persist for several hours after application.

Safety & Warnings

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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar, including:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Passing urine more often
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Signs of a weak adrenal gland, such as:
+ Severe upset stomach or vomiting
+ Severe dizziness or fainting
+ Muscle weakness
+ Feeling very tired
+ Mood changes
+ Decreased appetite
+ Weight loss
Signs of Cushing's syndrome, including:
+ Weight gain in the upper back or belly
+ Moon face
+ Severe headache
+ Slow healing
Irritation at the site where the medication was applied
Skin changes, such as:
+ Pimples
+ Stretch marks
+ Slow healing
+ Hair growth
Change in skin color
Thinning of the skin

Other Possible Side Effects

Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical help if they bother you or do not go away:

Burning
Itching
* Dry skin

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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Seek Immediate Medical Attention If You Experience:

  • Worsening of the skin condition or no improvement after 1-2 weeks of use.
  • Signs of skin infection (e.g., pus, spreading redness, fever).
  • Severe burning, stinging, or irritation at the application site.
  • Skin thinning, easy bruising, stretch marks, or changes in skin color.
  • Unusual hair growth or acne-like breakouts in the treated area.
  • If used extensively or for prolonged periods, watch for signs of systemic absorption like unusual weight gain, swelling in the face, or fatigue (rare).
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is not an exhaustive list, and it is crucial to disclose all your medications and health issues to your doctor and pharmacist.
Any health problems you have, as they may interact with this medication. Your doctor and pharmacist need to be aware of your complete medical history to ensure safe treatment.
Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor. It is vital to verify that it is safe to take this medication in conjunction with your other medications and health conditions.
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Precautions & Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Adhere to the prescribed duration of treatment and do not use this drug for an extended period beyond what your doctor has recommended.

Before using any other medications or products on your skin, including soaps, consult with your doctor to ensure safe and effective treatment. Exercise caution when applying this medication to a large area of skin, and discuss any concerns with your doctor.

Using this medication too frequently can exacerbate your skin condition. If the patient is a child, use this drug with caution, as the risk of certain side effects may be increased in children. In some cases, this medication may affect growth in children and teenagers, and regular growth checks may be necessary. Consult with your doctor to discuss this potential risk.

If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. It is crucial to weigh the benefits and risks of using this medication during these situations to ensure the best possible outcome for both you and your baby.
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Overdose Information

Overdose Symptoms:

  • With excessive or prolonged topical use, especially over large areas or under occlusion, systemic effects of corticosteroid excess may occur, including:
  • Cushing's syndrome (e.g., moon face, central obesity, striae)
  • Hyperglycemia (high blood sugar)
  • Glucosuria (sugar in urine)
  • Adrenal suppression (fatigue, weakness, nausea, vomiting)

What to Do:

Discontinue the medication gradually under medical supervision. Symptomatic and supportive treatment. Call a poison control center (1-800-222-1222) or seek emergency medical attention.

Drug Interactions

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Contraindicated Interactions

  • None known for topical triamcinolone 0.025% ointment.
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Major Interactions

  • None known for topical triamcinolone 0.025% ointment.
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Moderate Interactions

  • None known for topical triamcinolone 0.025% ointment.
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Minor Interactions

  • None known for topical triamcinolone 0.025% ointment.

Monitoring

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Baseline Monitoring

Skin condition assessment

Rationale: To establish baseline severity of dermatosis, identify areas for application, and rule out contraindications (e.g., active infection).

Timing: Prior to initiation of therapy.

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Routine Monitoring

Efficacy (reduction in inflammation, pruritus, erythema)

Frequency: Weekly to bi-weekly, then as needed.

Target: Significant improvement in symptoms.

Action Threshold: Lack of improvement or worsening symptoms may indicate need for re-evaluation or alternative therapy.

Local adverse effects (skin atrophy, striae, telangiectasias, folliculitis, perioral dermatitis, acneiform eruptions)

Frequency: At each follow-up visit, especially with prolonged use or on sensitive areas.

Target: Absence of or minimal adverse effects.

Action Threshold: Presence of significant adverse effects warrants dose reduction, discontinuation, or change in therapy.

Signs of infection (bacterial, fungal, viral)

Frequency: At each follow-up visit.

Target: Absence of infection.

Action Threshold: Presence of infection requires appropriate antimicrobial therapy and potential discontinuation of triamcinolone.

Systemic effects (e.g., Cushing's syndrome, hyperglycemia, adrenal suppression)

Frequency: Rarely needed for typical topical use; consider if large areas, prolonged use, or occlusive dressings are employed, especially in children.

Target: Normal physiological parameters.

Action Threshold: Symptoms or signs of systemic absorption require immediate medical attention and discontinuation.

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Symptom Monitoring

  • Worsening of skin condition
  • Increased redness, swelling, or pain (signs of infection)
  • Severe burning or stinging at application site
  • Skin thinning, easy bruising, or stretch marks (striae)
  • New hair growth or acne-like breakouts
  • Unusual fatigue, weight gain, or changes in mood (rare, systemic effects)

Special Patient Groups

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Pregnancy

Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Avoid large amounts, prolonged use, or application to large surface areas.

Trimester-Specific Risks:

First Trimester: Potential for teratogenicity with high systemic exposure, but minimal with topical use.
Second Trimester: Minimal risk with appropriate topical use.
Third Trimester: Minimal risk with appropriate topical use; theoretical risk of adrenal suppression in the neonate with extensive maternal use.
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Lactation

Considered compatible with caution. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Avoid applying to the breast area to prevent infant ingestion.

Infant Risk: Low risk with proper use. Monitor infant for any signs of adverse effects (e.g., growth suppression).
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Pediatric Use

Children are more susceptible to systemic adverse effects from topical corticosteroids due to a larger skin surface area to body weight ratio. Use the least potent effective corticosteroid for the shortest duration. Avoid occlusive dressings. Monitor for signs of adrenal suppression (e.g., growth retardation, delayed weight gain) and Cushing's syndrome.

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Geriatric Use

No specific dose adjustments are typically needed. However, elderly patients may have thinner skin, which could increase the risk of local adverse effects like skin atrophy and purpura. Monitor skin integrity closely.

Clinical Information

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Clinical Pearls

  • Triamcinolone 0.025% ointment is a low-potency topical corticosteroid, suitable for mild to moderate dermatoses, especially on sensitive areas or for maintenance therapy.
  • Ointments are generally more potent than creams for the same concentration and are preferred for dry, scaly lesions.
  • Instruct patients to apply a very thin layer; a little goes a long way.
  • Avoid abrupt discontinuation after prolonged use on chronic conditions, as this can lead to rebound flares. Tapering may be necessary.
  • Not for use on skin infections (bacterial, fungal, viral) without concomitant antimicrobial therapy, as corticosteroids can mask or worsen infections.
  • Educate patients on proper application technique and the importance of not exceeding prescribed duration or frequency to minimize side effects.
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Alternative Therapies

  • Other topical corticosteroids (e.g., hydrocortisone, fluocinolone, betamethasone)
  • Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) for steroid-sparing therapy, especially on the face or intertriginous areas.
  • Emollients and moisturizers for barrier repair.
  • Antihistamines for pruritus (oral or topical, if appropriate).
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Cost & Coverage

Average Cost: $20 - $60 per 454gm tube
Generic Available: Yes
Insurance Coverage: Tier 1 or Tier 2 (preferred generic)
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General Drug Facts

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.