ORREPASTE- IS IT SAFE? USES, SIDE EFFECTS, DOSAGE

Sunday, December 16, 2018

What is Orrepaste?

Orrepaste is a corticosteroid available in various forms and is used commonly for treating pain at knee due to osteoarthritis and for skin problems too. It is available in injectable form, as a paste to apply on skin, in inhalation form and as a dental paste. Its chemical name is triamcinolone acetonide. It has an extended release action. It gives a slight odour. It is not soluble in water but highly so in alcohol because of its lipid soluble nature.

ORREPASTE- IS IT SAFE? USES, SIDE EFFECTS, DOSAGE

What is the generic name(s)?
How does it work?
What are its uses?
How effective is this medicine?
Is it addictive?
What is the dosage?
What if I miss a dose?
What to do in case of Overdose?
What to do if there is an allergic reaction?
What are the side effects?
What are the adverse effects of Orrepaste?
Does this medicine has any drug interactions?
What are the precautions I need to take?
Is it safe to use if I am pregnant?
Is it safe to use if I am breastfeeding?
Can this medicine be given to children and infants?
Is this medicine available as over the counter (OTC ) product?
Frequently Asked Questions
Reference

What is the generic name(s)?

The generic name of Orrepaste is Triamcinolone. Some of the popular brand names are Nasacort, Kenalog, Azmacort, Trilone, Aristocort, Orabase or Volon A.

How does it work?

It is an anti-inflammatory, an immuno-modulating corticosteroid. There are certain anti-inflammatory components such as Helenalin which are activated due to the activation of the receptor on which glucocorticoids act upon. There is inhibition of release of arachidonic acid which is a poly essential fatty acid. This leads to blockade in inflammation pathways and causes no secretion of prostaglandins which has the capacity to cause pain by stimulating free nerve endings. It reduces bone degrading chemicals in the human body.

What are its uses?

It has the following uses:

The suspension can be used intra-articular for managing knee pain.
In the form of a paste, it treats conditions like Eczema, Allergies, Sun rashes and Dermatitis.
It reduces itching or swelling in regions with skin conditions.
Treatment of mouth ulcers.
Ulcerative colitis and psoriasis (psoriatic arthritis also).
Arthritis
Systemic Lupus Erythematous
Mouth sores
Allergic rhinitis
Uveitis
Rheumatoid arthritis, etc

How effective is this medicine?

Orrepaste has been declared as over the counter (OTC) drug by FDA in the United States as nasal irritation remedy(Sold as Nasacort).

Statistically speaking osteogenesis knee pain was reduced significantly in weeks (has its side effects too). It has not been proved very effective in skin conditions. The treatment is symptomatic.

This all is true provided all the necessary guidelines instructed by the physician are followed strictly otherwise careless use will lead to unnecessary and harmful side-effects.

Is it addictive?

In a study by FDA, out of 5405 people taking this medication, 3 developed addiction. The prevalence is more in females than males. For patients on a regular habit of taking it, if it is stopped due to completion of course, they are bound to be at a risk of showing withdrawal symptoms but it is rare. To avoid addiction, first and foremost self-medication should be ceased. With proper prescription by proper consultation from a doctor, accurate doses should be consumed, and then, there will be decreased chances of addiction.

What is the dosage?

This medicine has to be used as per the form and dosage as suggested the doctor. HEre is a handy reference for general dosages of its various forms:

For intra-articular use,

32 mg is to be injected in the knee for a single dosage at a time. It should be given every 3 to 4 weeks. Frequency should not be high to avoid damage to joint.

As a cream,

Appy 2-4 times per day (around 0.1-0.5%)

As a paste for mouth ulcers,

Once a day after meals. Use a cotton swab to apply it on the gums.

For nasal use

In adults -:

Nasal spray should be sprayed twice a day in both nostrils . 1 spray a day should be done as maintenance dose in a further duration of course as and when told by the doctor when the symptoms are controlled.

For children (up to 12 years)-:

There should be 1 spray given per day to both nostrils. The maintenance dose is 1 spray.

For children (above 12 years)

The dosage is 2 sprays in a day. The maintenance dose is 1 spray.

What if I miss a dose?

Missing a dose should be made up by taking it as soon as the patient remembers. But it should be avoided if it is already time for the next dose. Also, no other medication should be taken to balance the missed dose.

What to do in case of Overdose?

In case of overdose call for medical help as soon as possible or go nearest the emergency facility of a hospital. Make sure to carry the necessary medicine container or prescription for the doctors at the hospital. This should be followed even if someone has ingested the medicine meant to be used on the skin.

What to do if there is an allergic reaction?

In case of allergic reaction, the care should be the same as that of an anaphylactic reaction. An epinephrine shot should be administered as soon as possible. Two shots can also be given if symptoms do not vanish. An emergency call should be made. If breathing is obstructed due to any reason, a tube can be inserted. If still patent airway is not maintained, tracheostomy can be performed. Later antihistamines might also be given by medical professionals.

What are the side effects?

Nasal inhalation can lead to

Irritation followed by itching
Headache
Vomiting or nausea
Sore throat
Congestion in nose
Cough

Application on the skin might lead to

Burning sensation on the skin
Skin atrophy
Stinging

Application inside the mouth can cause

Dryness or redness
Rashes
Swelling
Peeling and blistering in a serious case

Intra-articular use

Can cause joint pain due to septic issues
Dizziness
Nausea

Severe side effects of intraarticular use are

Blurring vision with dizziness and pain inside the eye
Fever and chills with symptoms of common flu
Early bleeding, uncanny weakness
weight loss, loss of appetite
Tiredness

A doctor should be consulted in case of any serious effect immediately as it could be fatal for the patient’s life.

What are the adverse effects of Orrepaste?

A side effect when life-threatening is an adverse effect. These are :

Hypersensitivity to corticosteroids can lead to an anaphylactic reaction which if not cured, immediately can lead to death.
There can be alterations in whole endocrine functioning of the body and will result in irreversible changes in the body unless the patient opts for corticosteroid replacement therapy.
There can be disturbed blood pressure(usually hypotension), retention of salts, and potassium deficiency which can be decreased with the use of derivatives which are synthetic in nature. Patients with hypertension and serious heart problems i.e. congestive heart failure should be monitored for every spike and fall in their electrolytes level plus the formation of oedema or gain in weight. Deficiency of potassium can be corrected by its oral supplementation.
Renal effects are fluid and salts retention with increased excretion of potassium.
There might be a decrease in bone density due to blockade of the function of osteoblasts(bone forming cells). Also, calcium regulation in the body is affected.
There is a risk of gastrointestinal perforation in certain disorders like peptic ulcers.
There is a risk of protrusion of eyeballs and glaucoma.
There is decreased resistance to infections and if the patient is exposed to them in course of daily living, the condition will be critical.
Convulsions, depression and aggressive behaviour can also result as an adverse reaction due to chemical reactions in the brain.

Does this medicine has any drug interactions?

When given with antibiotics, there is considerable fall in clearance of Orrepaste.
With anticholinesterases, weakness plus myestina gravis can manifest.
If warfarin-like anticoagulants are given with corticosteroid, it’s effectiveness can reduce.
Antidiabetics may require dose re-adjustment.
Serum concentration of Antitubercular drugs can decrease.
Oral contraceptives can increase the effect of corticosteroid.
On longer use of the medication, vaccines may be inactivated due to suppression of the immune system.
There can be interactions assessed in patients taking Acetazolamide.
Barbiturates and calcium channel blockers can also lead to some complications.
Adrenergic neuron blockers can disturb hormone levels.
Allergy tests might give false results.
NSAID’s like aspirin have interaction with Orropaste, leading to gastrointestinal side effects.
There might be a loss of adrenal suppression due to Aminoglutimide.
CYP3A4 inducers may increase metabolism of corticosteroids and demand increase of dosage.
Clearance of steroid will increase with the intake of Cholestyramine.
Patients on glycosides pose a threat of arrhythmia due to excessive potassium.

What are the precautions I need to take?

For joint pain, it should be taken intra-articularly only.
Orrepaste should not be taken: Through I.V., intramuscularly, through eyes, subcutaneously (like insulin), injection into the skin, intrarectally.
Make sure the person is not allergic to corticosteroids.
Should not be used for small joints like that of hands.
The doctor consulting this medication should be informed beforehand about the existing medications being consumed and history of past surgeries etc and should also have all knowledge of those planned in future.
Wash hands before and after applying the paste.
The diluent used should be of the kit only when used intra-articularly.
Should be kept away from sensitive areas like the eye, genitals, etc.
Do not receive a live vaccine during the course of medication.
Avoid excessive use.
Do not share your medicines with other people even if they have a similar problem as you have. Ask them to visit the doctor who will prescribe them the necessary treatment approach.
Consult a physician before applying on scars, open wounds, incisions and burns.
Complete the course of the medication. It is commonly forgotten when symptoms disappear. But this can lead to rebound symptoms which are more severe in terms of intensity.
Avoid infected people as the sensitivity of the immune system is more after administration.
Never revert to self-medication.

Is it safe to use if I am pregnant?

There have not been many studies done on the topic but it is always a better precaution to not use this medication during the entire duration of pregnancy. Orrepaste poses a threat to the foetus when administered to the mother. It has the capability of passing through the placenta, hence, can lead to teratogenicity. This danger is in oral, inhaled or topical use. There can be deformities in the child when he/she is born due to the direct or indirect intervention of the drug. In general, infants born of mothers who have taken corticosteroids during the course of their pregnancy (for a longer course) should be kept on a check to make sure the infant does not develop adrenaline deficiency.

Is it safe to use if I am breastfeeding?

The benefits of the medication used while breastfeeding do present itself with some risks but with careful and responsible use, it can be consumed by the mother. When used intraarticularly, the medication should not interfere with the milk formed in the breasts nor does it hamper the formation process in any way. When taken directly into systemic circulation, longer duration courses can lead to adrenal suppression. When it is injected into the local site, it might cause reduced milk production. The infant will not be affected. Still, one should always consult with a doctor before using this while she is still breastfeeding a child.

Can this medicine be given to children and infants?

The effect of drugs on paediatric condition is not very well seated. The adverse effects in children are not very different than adults. The child’s vital status is to be assessed and monitored very closely while administering this medicine. Evaluation should be done thoroughly to check for any osteoporosis, ulcer formation, gastric irritation of any form, thromboembolism, or even any psychological or social changes the child might be going through.

Observations should be made for the height, weight, appetite, blood pressure, overall growth (linear or otherwise), intraocular pressure, etc.

Is this medicine available as over the counter (OTC ) product?

Orrepaste is FDA approved over the counter drug in the United States as a treatment for Nasal irritant. Usually, a prescription by a physician is required for any other use.

Frequently asked questions

Question: Can I drive after applying Orrepaste?

If the application of medicine leads to the manifestation of any side effect, then it is not safe to drive as it could lead to accidents. The manifestations include hypotension, drowsiness, dizziness which indicates a weakness of the body. For proper recommendation, consult your doctor.

Question: Can I drink alcohol while applying Orrepaste?

Alcohol compromises judgement, balance as well as proper functioning of the body. The drug causes lots of drowsiness. Alcohol would just increase that load. Therefore it is strongly advised to avoid operating any heavy machinery while taking this medicine.

Question: Can Orrepaste be used in males above 70 years of age?

So far no distinguishing factor has been determined which proves that the medicine works differently on young and elderly. It all works alike with no additional adverse effects or side effects.

Question: Can this corticosteroid cause any psychological illness?

Orrepaste has been known to cause mood swings, aggressive behaviour, mania or depression though it is pretty far fetched. Therefore it should be avoided in patients with a previous history of psychological illness. Also, relatives should be asked to keep an eye on the patient so as to make sure that they can timely report any worsening of the situation.

Question: Can using Orropaste be used for elbow pain?

The major indication is for knee pain and should be used there preferably. A physician should be consulted to advise upon this and it has to be made sure that the pain in the elbow is not soft tissue as the paste is not indicated for that. Also look for alternatives for the pain in elbow which have fewer risks.

Reference

Wikipedia page on Steroid hormone

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