Triamcinolone in the treatment of allergic conditions

Abstract

HE purpose of this report is to relate our experience with the use of triamcinolone in the treatment of allergic diseases. An attempt will be made to emphasize methods of administration, clinical effectiveness, occurrence of side effects, balance studies, and any possible advantages over other steroids. CHEMISTRY Many synthetic steroids have recently been made available in the hope that greater glucocorticoid, mineral-corticoid, and anti-inflammatory potency may thus be obtained without the production of accompanying undesirable side effects. These side actions are modified by various changes in the chemical composition of cortisone and hydrocortisone. Thus, cortisone (Compound E) is characterized by the carbonyl oxygen at carbon 11 and the hydroxyl grouping at carbon 17. The numbers at each position indicate a carbon atom (Fig. 1). The introduction of a hydroxyl group at position 11 yields hydrocortisones or Compound F (Fig. 2). It is the principal natural glucocorticoid hormone, whereas aldosterone is the principal natural mineral-corticoid hormone. The glucocorticoid activity is an index of its anti-inflammatory property. Prednisone and prednisolone are obtained by the removal of hydrogen from positions 1 and 2, respectively (Figs. 3 and 4). This changes the properties of the product, making it much more potent. When a hydroxyl group is added at the 16 alpha position to desoxycorticosterone, the salt-retaining activity is reduced. When the 16 alpha-hydroxyl group is added to hydrocortisone or to A1 hydrocortisone (prednisolone), glucocorticoid activity is lowered, with no sodium retenti0n.l The substitution of a methyl group for the hydrogen atom in the sixth alpha position produces another analogue of hydrocortisone, namely, methylprednisolone (Fig. 5). Triamcinolone is obtained by the fluorination of the product (the addition of fluorine at position 9a) and the addition of a hydroxyl group at position 16a (Fig. 6). This change reduces the sodium--retention effect produced by fluorination. Fluorination is known to increase both the mineral-corticoid and the glucocorticoid activity of the drug. Triamcinolone (Aristocort), then, is the generic term for this new synthetic corticosteroid. It is the diacetate ester of 9cr Cl 19, 823.