曲安奈德 (去炎松)
Triamcinolone Acetonide
Triamcinolone acetonide
別名: Vetalog · Kenalog · Aristospan · triamcinoloni acetonidum · TMC
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Glucocorticoid effects | 2 mg PO once daily for 7 days; 0.11-0.22 mg/kg IM or SC | PO/IM/SC | once daily (PO) or single dose (IM/SC) | 7 days for PO | 🌎 NA |
| Antiinflammatory effects | 0.05 mg/kg PO two to three times daily | PO | q8-12h | — | 🌎 NA |
| 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 | 🌎 NA |
| 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 | 🌎 NA |
| 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 | — | 🌎 NA |
| 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 | — | 🌎 NA |
- Inflammatory, allergic, or dermatological disorders (Injectable): If symptoms recur, may repeat or institute oral therapy.
- Intralesional injection: May repeat as necessary.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Glucocorticoid effects | 0.25-0.5 mg PO once daily for 7 days | PO | q24h | 7 days | 🌎 NA |
| 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 | 🌎 NA |
| Pemphigus complex | 0.4-0.8 mg/kg/day PO | PO | q24h | — | 🌎 NA |
| 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 | 🌎 NA |
| 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 | 🌎 NA |
| 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 | — | 🌎 NA |
| 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 | — | 🌎 NA |
| 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 | 🌎 NA |
- Inflammatory, allergic, or dermatological disorders (Injectable): If symptoms recur, may repeat or institute oral therapy.
- Intralesional injection: May repeat as necessary.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Glucocorticoid effects | 0.011-0.022 mg/kg PO twice daily; 0.011-0.022 mg/kg IM or SC; 6-18 mg intra-articularly or intrasynovially, may repeat after 3-4 days | PO/IM/SC/IA | q12h (PO) or as directed | — | 🌎 NA |
| Intra-articular injection | 12 mg IA on days 0, 13, 27 | IA | Specific days | 27 days | 🌎 NA |
- Glucocorticoid effects: ARCI UCGFS Class 4 Drug
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Glucocorticoid effects | 0.02-0.04 mg/kg IM; 6-18 mg intra-articularly. | IM/IA | As directed | — | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
曲安奈德 (Triamcinolone acetonide) 是一種合成的中效糖皮質激素，其效力約為氫化可的松 (hydrocortisone) 的 4 到 10 倍（在某些模型中高達 40 倍）。
臨床要點與主要特徵：
- 無鹽皮質激素活性： 與氫化可的松或潑尼松不同，曲安奈德缺乏明顯的鹽皮質激素作用，這意味著它不會引起顯著的鈉或水分滯留。
- 給藥途徑多樣： 可用於全身性（口服、注射）、局部、關節內（特別是在馬匹運動醫學中）以及病灶內注射（例如用於食道狹窄或舔舐性肉芽腫）。
- 作用時間： 口服時，其代謝活性持續 24-48 小時。然而，肌肉內 (IM) 或皮下 (SC) 儲庫注射的作用可持續 4 到 6 週（有時長達 8 週），這使其適用於難以每天餵藥的慢性發炎或過敏性疾病，但這也會增加長期腎上腺抑制的風險。
- 馬匹應用： 經常被用於高活動度關節的關節內注射，以減少滑膜炎並改善跛行。在賽馬規定中屬於 ARCI 第 4 類藥物。
作用機制
Triamcinolone exerts its effects via classic genomic and non-genomic glucocorticoid pathways:
- Genomic Pathway: Free triamcinolone crosses the cell membrane and binds to the cytosolic glucocorticoid receptor (GR).
- The receptor-ligand complex translocates to the nucleus and binds to Glucocorticoid Response Elements (GREs) on DNA.
- 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.
- Eicosanoid Suppression: This → halts the synthesis of pro-inflammatory prostaglandins and leukotrienes (via COX and LOX pathways).
- 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.
安全性與警告
禁忌症
- Systemic fungal infections
- Viral infections
- Active tuberculosis
- Peptic ulcers
- Corneal ulcers
- Acute psychoses
- Cushingoid syndrome
- Idiopathic thrombocytopenia (IM administration)
- Hypersensitivity to the drug
不良反應
- 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)
注意事項
Tapering Required: Animals receiving systemic glucocorticoids (other than short 'burst' therapy) must be tapered off slowly to allow endogenous ACTH and adrenal function to recover.
- Stress Dosing: If a patient undergoes a stressor (surgery, trauma, illness) during tapering, additional glucocorticoids should be administered.
- Pregnancy Warning: Corticosteroid therapy may induce parturition in large animal species during the latter stages of pregnancy. Teratogenic effects are possible with excessive doses early in pregnancy (FDA Category C).
- Growth Retardation: Can retard growth when administered to young, growing animals.
- Disease Exacerbation: Use with extreme caution in patients with diabetes mellitus, osteoporosis, predisposition to thrombophlebitis, hypertension, congestive heart failure (CHF), and renal insufficiency.
藥物相互作用
May cause hypokalemia when administered concomitantly
Combination in epidurals has caused serious CNS injuries and death; restrict volume to very small intrathecal test doses
May lead to profound muscle weakness in myasthenia gravis patients; discontinue 24h prior if possible
Glucocorticoids may reduce salicylate blood levels
May increase the metabolism of glucocorticoids and decrease blood levels
Glucocorticoids may inhibit hepatic metabolism of cyclophosphamide; dosage adjustments may be required
May mutually inhibit hepatic metabolism, increasing blood levels of both drugs
May cause hypokalemia
May increase triamcinolone levels
May potentiate the effects of triamcinolone
Insulin requirements may increase due to glucocorticoid-induced insulin resistance
Triamcinolone may decrease isoniazid levels
May decrease metabolism of glucocorticoids; ketoconazole may induce adrenal insufficiency upon steroid withdrawal
Higher than usual doses of steroids may be necessary to treat mitotane-induced adrenal insufficiency
Increased risk of gastrointestinal ulceration
May increase the metabolism of glucocorticoids and decrease triamcinolone blood levels
May increase the metabolism of glucocorticoids and decrease triamcinolone blood levels
May augment viral replication of live vaccines; diminished immune response to killed vaccines/toxoids
May affect INR; requires monitoring
監測
- 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
藥物動力學
代謝
Hepatic metabolism
過量
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.
可用產品
劑型
- Tablets
- Injection (suspension)
- Topical preparations
- Oral mucosal paste
- Inhaled products
獸醫用
- Triamcinolone Acetonide Tablets: 0.5 mg, 1.5 mg (Vetalog)
- Triamcinolone acetonide Suspension for Injection: 2 mg/mL; 6 mg/mL (Vetalog Parenteral)
人用標示
- Triamcinolone Acetonide Injection: 10 mg/mL & 40 mg/mL suspension (Kenalog-10 & -40)
- Triamcinolone Hexacetonide Injection: 5 mg/mL & 20 mg/mL suspension (Aristospan Intralesional & Intra-articular)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store at room temperature (15-30°C); the injection should be protected from light.
飼主須知
寵物主人重要指引：
- 預期的副作用： 您的寵物在服藥期間非常容易出現喝水量增加、排尿頻繁以及食慾大增的情況。請確保牠們隨時有乾淨的飲水，並增加帶牠們上廁所的次數。
- 切勿突然停藥： 如果您的寵物已經服用此藥超過幾天，絕對不要突然停藥。服用此藥期間，身體自然的類固醇分泌會處於休眠狀態，突然停藥可能會引發危及生命的危機。請務必遵循獸醫師的逐漸減量計畫。
- 行為改變： 有些寵物可能會比平時更常喘氣、顯得焦躁不安，或出現行為改變（如嗜睡或易怒）。如果情況嚴重，請聯繫您的獸醫師。
- 腸胃不適： 請留意是否有嘔吐、腹瀉或排出黑色/柏油狀糞便，這可能是胃潰瘍的徵兆。
- 感染風險： 因為此藥物會抑制免疫系統，請密切觀察寵物是否有任何感染跡象（例如無法癒合的皮膚傷口、發燒），並避免讓牠們接觸生病的動物。
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