Protopic Ointment (acrolimus) vs. Triamcinolone: Uses & Side Effects

Protopic ointment vs. triamcinolone: What’s the difference?

• Protopic ointment (acrolimus) and triamcinolone are used to treat atopic dermatitis (eczema).
• Triamcinolone is also used to relieve skin inflammation, itching, dryness, and redness caused by a number of conditions such as allergic reactions and psoriasis.
• Protopic ointment is an immunosuppressive and triamcinolone is a corticosteroid.
• Side effects of Protopic Ointment and triamcinolone that are similar include application site reactions (skin redness, burning, itching).
• Side effects of Protopic Ointment that are different from triamcinolone include flu-like symptoms, allergic reactions, and headache.
• Side effects of triamcinolone that are different from Protopic Ointment include application site reactions (irritation, excessive dryness, peeling, thinning of your skin, blistering skin, stretch marks, and acne).

What is Protopic ointment? What is triamcinolone?

Protopic ointment (acrolimus) is a topical (for the skin) immunosuppressive medication used to treat eczema (atopic dermatitis). Atopic dermatitis is a chronic skin disease in which the skin becomes inflamed, causing redness, itching, swelling, cracking, crusting, weeping, and scaling. The inflammation is caused by an activation of the immune system though it is unknown why the immune system becomes activated. Protopic ointment suppresses the immune system and the inflammation by inhibiting the enzyme calcineurin that is needed for the multiplication of T-cells, cells required to activate the immune system.

Triamcinolone acetonide is a topical (for the skin) corticosteroid prescribed to relieve skin inflammation, itching, dryness, and redness caused by a number of conditions such as allergic reactions, eczema, and psoriasis. The dental paste form of triamcinolone is used to treat mouth ulcers. Corticosteroids are naturally occurring hormones produced by the adrenal glands that prevent or suppress inflammation and immune responses. It reduces the actions of chemicals in the body that cause inflammation.

Eczema
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What are the side effects of Protopic and triamcinolone?

Protopic

The most common side effects of tacrolimus ointment are skin reactions at the site of use, including:

• redness,
• burning,
• itching,
• Flu-like symptoms,
• allergic reactions, and
• headache.

Continuous long-term use of tacrolimus should be avoided because rare cases of skin cancer and lymphoma have occurred during tacrolimus treatment.

Triamcinolone

Common side effects of triamcinolone include:

• Abnormal or excessive hair growth
• Acne
• Adrenal suppression
• Appetite changes
• Bloating
• Blood clots
• Bruising or swelling
• Cardiac enlargement
• Cataract
• Circulatory collapse
• Delayed wound healing
• Diabetes mellitus
• Euphoria
• Fracture
• Headache
• Increased appetite
• Increased intracranial pressure
• Indigestion
• Irregular heart rate (arrhythmia)
• Joint pain
• Joint tissues damage
• Lupus erythematosus-like lesions
• Male-pattern hair growth on women
• Muscle tissue disease
• Nausea
• Nerve pain
• Nosebleed
• Osteoporosis
• Other skin changes
• Pseudotumor cerebri (on withdrawal)
• Psychosis
• Irregular menstrual periods
• Scaling
• Severe allergic reaction (anaphylaxis)
• Sleep problems (insomnia)
• Spinning sensation (vertigo)
• Stomach or side pain
• Stroke
• Sweating more than usual
• Tendon rupture
• Thinning hair
• Vasculitis

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

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What is the dosage for Protopic and triamcinolone?

Protopic

Tacrolimus ointment is applied to the affected areas of skin twice daily. The 0.1% concentration of tacrolimus ointment is approved for the treatment of adults, while the 0.03% concentration is approved for the treatment of both children (ages two and older) and adults.

Triamcinolone

Adult and Pediatric Dosage Forms and Strengths

Injectable suspension

• 5 mg/mL
• 10 mg/mL
• 20 mg/mL
• 40 mg/mL

Dosing Consideraations – Should be Given as Follows:

Triamcinolone Acetonide

Adult:

• Treatment of rheumatic or arthritic disorders
• 60 mg intramuscularly (IM) every 6 weeks; may be supplemented by additional 20-100 mg IM as needed
• Intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day
• Intra-articular/intrasynovial/soft-tissue injection: Large joints, 15-40 mg; small joints/tendon sheath inflammation, 2.5-10 mg

Pediatric:

• Treatment of rheumatic conditions
• 0.11-1.6 mg/kg/day intramuscularly (IM) divided every 3-4 hours
• Children 6-12 years: 0.03-0.2 mg/kg IM every 1-7 days
• Children over 12 years: 60 mg IM every 6 weeks; may be supplemented by additional 20-100 mg IM as needed
• Children over 12 years, intralesional injection (10 mg/mL suspension): 1 mg per injection site 1 or more times weekly; not to exceed 30 mg/day

Triamcinolone Hexacetonide

• Treatment of rheumatic or arthritic disorders
• Intralesional injection: 0.5 mg/²; repeated as needed
• Intra-articular injection (20 mg/mL suspension): 10-20 mg (large joint); 2-6 mg (small joints); repeated every 3-4 weeks as needed

Dosing Considerations

• Dilute with local anesthetic (1% or 2% lidocaine without parabens) before intra-articular or intralesional injection
• Dilute with D5/NS or D10/NS or NS or SWI before intralesional injection
• Avoid diluents containing parabens or phenols

Ringworm is caused by a fungus.
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What drugs interact with Protopic and triamcinolone?

Protopic

No studies have been done to determine if tacrolimus ointment has important interactions with other drugs. Interactions are unlikely because only small amounts of tacrolimus are absorbed from the skin; however, it still is possible that important interactions might occur.

Triamcinolone

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of triamcinolone include:

• mifepristone

Triamcinolone has serious interactions with at least 72 different drugs.
Triamcinolone has moderate interactions with at least 229 different drugs.
Triamcinolone has mild interactions with at least 121 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

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Are Protopic and triamcinolone safe to use while pregnant or breastfeeding?

Protopic

Only small amounts of tacrolimus are absorbed from the ointment, and it is not known if these amounts are toxic to the fetus. Among women who have received oral tacrolimus while pregnant, high potassium levels and kidney injury have been reported in their newborns. Therefore, tacrolimus ointment should be used during pregnancy only if the benefits outweigh the potential risks to the fetus.

Only small amounts of tacrolimus are absorbed from the ointment, and it is not known how much, if any, appears in breast milk. However, it is known that tacrolimus, when taken orally, passes into breast milk. Consideration should be given to discontinuing either breastfeeding or tacrolimus ointment in nursing mothers.

Triamcinolone

• Use triamcinolone with caution during pregnancy if benefits outweigh risks
• Animal studies show risk and human studies are not available or neither animal nor human studies were done
• Fetal harm can occur with use of triamcinolone in the first trimester
• Triamcinolone is excreted in breast milk; use caution if breastfeeding