트리암시놀론 아세토니드

글루코코르티코이드

트리암시놀론 아세토니드는 히드로코르티손보다 약 4~10배(일부 모델에서는 최대 40배) 더 강력한 합성 중시간 작용형 **글루코코르티코이드**입니다. **임상적 진주 및 주요 특징:** * **무기질코르티코이드 활성 없음:** 히드로코르티손이나 프레드니손과 달리 트리암시놀론은 눈에 띄는 무기질코르티코이드 효과가 없어 유의미한 나트륨이나 수분 저류를 유발하지 않습니다. * **다양한 투여 경로:** 전신(경구, 주사), 국소, 관절 내(특히 말 스포츠 의학에서), 병변 내(예: 식도 협착 또는 핥음 육아종) 투여 등 다양하게 활용됩니다. * **작용 시간:** 경구 투여 시 대사 활성은 24~48시간 지속됩니다. 그러나 근육 내(IM) 또는 피하(SC) 데포 주사는 4~6주(때로는 최대 8주) 동안 지속될 수 있어 매일 투약하기 어려운 만성 염증이나 알레르기 질환에 유용하지만, 장기간의 부신 억제 위험을 증가시킵니다. * **말에서의 사용:** 활막염을 줄이고 파행을 개선하기 위해 움직임이 많은 관절의 관절 내 주사로 자주 사용됩니다. 경마 규정상 ARCI 클래스 4 약물에 해당합니다.

작용 기전: Triamcinolone exerts its effects via classic genomic and non-genomic glucocorticoid pathways: 1. **Genomic Pathway:** Free triamcinolone crosses the cell membrane and binds to the cytosolic **glucocorticoid receptor (GR)**. 2. The receptor-ligand complex translocates to the nucleus and binds to **Glucocorticoid Response Elements (GREs)** on DNA. 3. **Anti-inflammatory Protein Induction:** It upregulates the expression of **lipocortin-1 (annexin A1)**. Lipocortin-1 inhibits **phospholipase A2**, thereby blocking the release of arachidonic acid from membrane phospholipids. 4. **Eicosanoid Suppression:** This → halts the synthesis of pro-inflammatory prostaglandins and leukotrienes (via COX and LOX pathways). 5. **Cytokine Inhibition:** It suppresses the transcription of major inflammatory cytokines (e.g., IL-1, IL-6, TNF-α) and reduces inflammatory cell migration and capillary permeability.

동물 종별 용량

Cats

Glucocorticoid effects · 0.25-0.5 mg PO once daily for 7 days · PO · q24h · 7 days
Pododermatitis, feline plasmacytic pharyngitis · 2-4 mg (total dose) PO once a day or every other day 0.4-0.6 mg/kg PO once daily, then taper. · PO · q24h or q48h · Tapered
Pemphigus complex · 0.4-0.8 mg/kg/day PO · PO · q24h
General therapy (Tablets) · 0.11 mg/kg PO initially once a day, may increase to 0.22 mg/kg PO once daily if initial response is unsatisfactory. As soon as possible, but not later than 2 weeks, reduce dose gradually to 0.028-0.055 mg/kg/day · PO · q24h · Taper within 2 weeks
Inflammatory, allergic, or dermatological disorders (Injectable) · 0.11-0.22 mg/kg for inflammatory or allergic disorders, and 0.22 mg/kg for dermatological disorders. · IM/SC · As needed · Effects generally persist for 7-15 days · If symptoms recur, may repeat or institute oral therapy.
Intralesional injection · Usual dose is 1.2-1.8 mg; inject around lesion at 0.5-2.5 cm intervals. Do not exceed 0.6 mg at any one site or 6 mg total dose. · Intralesional · As needed · May repeat as necessary.
To prevent re-stricture after esophageal dilation · Using an endoscopically directed needle, inject 0.5-1 mL of Vetalog (2 mg/mL) submucosally at time of dilation procedure. Infiltration is done circumferentially at four points around the site. · Submucosal · Once at time of procedure
Adjunctive treatment of miliary dermatitis · 0.2-0.6 mg/kg PO once daily for 10-14 days, then tapered. · PO · q24h · 10-14 days, then taper

Cattle

투여 경로

POIMSCIntra-articular (IA)IntrasynovialIntralesionalSubmucosalTopicalInhaled

금기

Systemic fungal infections
Viral infections
Active tuberculosis
Peptic ulcers
Corneal ulcers
Acute psychoses
Cushingoid syndrome
Idiopathic thrombocytopenia (IM administration)
Hypersensitivity to the drug

이상반응

Polyuria (PU)
Polydipsia (PD)
Polyphagia (PP)
Weight gain
Panting (dogs)
Dull, dry haircoat
Vomiting and diarrhea
Elevated liver enzymes (e.g., ALP)
Pancreatitis
Gastrointestinal ulceration
Lipidemias
Insulin resistance / Activation of diabetes mellitus
Muscle wasting
Behavioral changes (depression, lethargy, viciousness)
Iatrogenic hyperadrenocorticism (Cushing's syndrome) with chronic use
Laminitis (horses)

약물 상호작용

Amphotericin B · May cause hypokalemia when administered concomitantly
Opiate Analgesics / Local Anesthetics (Epidural) · Combination in epidurals has caused serious CNS injuries and death; restrict volume to very small intrathecal test doses
Anticholinesterase Agents (e.g., pyridostigmine) · May lead to profound muscle weakness in myasthenia gravis patients; discontinue 24h prior if possible
Aspirin · Glucocorticoids may reduce salicylate blood levels
Barbiturates · May increase the metabolism of glucocorticoids and decrease blood levels
Cyclophosphamide · Glucocorticoids may inhibit hepatic metabolism of cyclophosphamide; dosage adjustments may be required
Cyclosporine · May mutually inhibit hepatic metabolism, increasing blood levels of both drugs
Potassium-depleting Diuretics (e.g., spironolactone) · May cause hypokalemia
Erythromycin, Clarithromycin · May increase triamcinolone levels
Estrogens · May potentiate the effects of triamcinolone
Insulin · Insulin requirements may increase due to glucocorticoid-induced insulin resistance
Isoniazid · Triamcinolone may decrease isoniazid levels

모니터링

Weight, appetite, signs of edema
Serum and/or urine electrolytes
Total plasma proteins, albumin
Blood glucose
Growth and development in young animals
ACTH stimulation test if necessary

과용량

Short-term administration of massive doses is unlikely to cause harmful effects, though one case of acute CNS effects in a dog after accidental ingestion has been reported. If acute clinical signs occur, provide supportive treatment. **Chronic Toxicity:** Chronic overdosage or prolonged use leads to serious adverse effects, primarily manifesting as iatrogenic hyperadrenocorticism (Cushing's syndrome), immunosuppression, and adrenal axis suppression.

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