From the Guidelines
Patients on metformin and Ozelpic (semaglutide) 0.25mg should consult their healthcare provider before using Kenalog (triamcinolone) or dexamethasone for seasonal allergies, as these corticosteroids can affect blood sugar levels. Between the two options, Kenalog injections typically last longer, providing relief for 2-6 weeks from a single dose, while oral dexamethasone usually requires daily dosing for shorter periods.
Key Considerations
- Kenalog may be preferred for its convenience of less frequent administration, but it carries a higher risk of prolonged blood sugar elevation.
- Both medications can temporarily increase blood glucose by promoting gluconeogenesis and insulin resistance, potentially requiring adjustments to diabetes medications.
- Patients should monitor their blood sugar more frequently when starting either steroid and report significant changes to their doctor.
- The decision between these medications should be individualized based on allergy severity, diabetes control, and other health factors, as recommended by the 2017 Joint Task Force on Practice Parameters 1.
Treatment Recommendations
- For initial treatment of seasonal allergic rhinitis, an intranasal corticosteroid is recommended over an oral antihistamine or a leukotriene receptor antagonist 1.
- For moderate to severe seasonal allergic rhinitis, a combination of an intranasal corticosteroid and an intranasal antihistamine may be recommended for initial treatment 1.
From the Research
Patient Medication Interaction
- The patient is currently taking metformin and Ozempic (semaglutide) 0.25mg, and is considering using Kenalog (triamcinolone) for seasonal allergies or dexamethasone.
- According to the study 2, intranasal corticosteroids such as triamcinolone are accepted as safe and effective first-line therapy for allergic rhinitis.
- However, the study 3 suggests that coadministration of metformin or sitagliptin with dexamethasone does not prevent dexamethasone-induced metabolic disturbances.
Duration of Action
- The duration of action of triamcinolone and dexamethasone is not directly compared in the provided studies.
- However, it is known that dexamethasone has a longer duration of action compared to other corticosteroids, but the specific duration of action of triamcinolone and dexamethasone is not mentioned in the studies 2, 3.
Safety and Efficacy
- The study 4 compared the efficacy and safety of semaglutide (a GLP-1 receptor agonist) with canagliflozin (an SGLT2 inhibitor) in patients with type 2 diabetes, and found that semaglutide was superior to canagliflozin in reducing HbA1c and bodyweight.
- The study 5 found that the addition of metformin to corticosteroids might be a promising front-line treatment for newly diagnosed ITP patients with pre-existing T2DM, with a higher incidence of stomach upset.
- The study 6 highlights the risk of metabolic acidosis associated with the combination of metformin and SGLT2 inhibitors, which may be relevant to the patient's current medication regimen.