Hydrochlorothiazide / Triamterene
Pronouncation: (high-droe-klor-oh-THIGH-uh-zide/try-AM-tur-een)Class: Diuretic combination
Trade Names:
Maxzide-25MG
- Tablets 37.5 mg triamterene/25 mg hydrochlorothiazide
Trade Names:
Dyazide
- Capsules 37.5 mg triamterene/25 mg hydrochlorothiazide
Trade Names:
Maxzide
- Tablets 75 mg triamterene/50 mg hydrochlorothiazide
Novo-Triamzide (Canada)
Nu-Triazide (Canada)
Pharmacology
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Hydrochlorothiazide inhibits reabsorption of sodium and chloride in ascending loop of Henle and early distal tubules. Triamterene interferes with sodium reabsorption at distal tubule. Combination provides additive diuretic activity and antihypertensive effects and minimizes potassium depletion.
Indications and Usage
Treatment of edema or hypertension in patients who have or are at risk of developing hypokalemia.
Contraindications
Anuria; renal decompensation; severe hepatic disease; hypersensitivity to thiazides, triamterene, or sulfonamide-derived drugs; patients receiving spironolactone, amiloride, or potassium supplements; hyperkalemia; metabolic or respiratory acidosis.
Dosage and Administration
AdultsPO 1 to 2 tablets or capsules daily.
Storage/Stability
Store in tightly closed container at room temperature.
Drug Interactions
Angiotensin-converting enzyme inhibitorsMay result in severely elevated serum potassium levels.
AllopurinolMay increase incidence of hypersensitivity reactions to allopurinol.
AmantadineMay increase amantadine plasma levels and risk for adverse reactions.
AnticoagulantsMay diminish anticoagulant effects.
Bile acid sequestrantsMay reduce thiazide absorption; give thiazide at least 2 h before sequestrant.
DiazoxideMay cause hyperglycemia.
Digitalis glycosidesDiuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.
IndomethacinMay cause rapid progression into acute renal failure.
LithiumMay decrease renal excretion of lithium; monitor lithium levels.
Loop diureticsMay cause synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.
Methenamines, NSAIDsMay decrease effectiveness of thiazide.
Potassium preparationsMay severely increase serum potassium levels, possibly resulting in cardiac arrhythmias or cardiac arrest. Monitor serum potassium closely if potassium is coadministered.
Sulfonylureas, insulinMay decrease hypoglycemic effect of sulfonylureas. May need to adjust dosage of sulfonylureas or insulin.
Laboratory Test Interactions
May interfere with the fluorescent measurement of quinidine serum levels. May decrease serum protein-bound iodine levels without signs of thyroid disturbance.
Adverse Reactions
Cardiovascular
Orthostatic hypotension.
CNS
Dizziness; lightheadedness; vertigo; headache; paresthesias; weakness; restlessness; insomnia; fatigue.
Dermatologic
Purpura; photosensitivity; rash; urticaria; necrotizing angiitis, vasculitis, cutaneous vasculitis; alopecia; exfoliative dermatitis; toxic epidermal necrolysis; erythema multiforme; Stevens-Johnson syndrome.
EENT
Blurred vision; xanthopsia (yellow vision).
GI
Anorexia; gastric irritation; nausea; vomiting; abdominal pain or cramping; bloating; diarrhea; constipation; pancreatitis; sialadenitis; dry mouth.
Genitourinary
Impotence; reduced libido; interstitial nephritis; azotemia; elevated BUN and creatinine.
Hematologic
Leukopenia; thrombocytopenia; agranulocytosis; aplastic or hypoplastic anemia; hemolytic anemia; megaloblastic anemia.
Hepatic
Jaundice; liver enzyme abnormalities.
Metabolic
Hyperglycemia; glycosuria; hyperuricemia; hyperkalemia; electrolyte imbalance; hypochloremia; hyponatremia.
Miscellaneous
Muscle cramp or spasm; fever; anaphylactic reactions.
Precautions
Pregnancy
Category C .
Lactation
Excreted in breast milk.
Children
Safety and efficacy have not been established.
Hypersensitivity
May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may also occur.
Renal Function
May precipitate azotemia or hypermagnesemia; use drug with caution.
Hepatic Function
Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use drug with caution.
Electrolyte imbalances and BUN increase
Hyperkalemia (serum potassium greater than 5.5ߙmEq/L), hyponatremia, hypochloremia, and increases in BUN may occur.
Hematologic effects
Triamterene is a weak folic acid antagonist and may contribute to megaloblastosis.
Lipids
May affect total serum cholesterol, total triglycerides, and LDL in some patients.
Postsympathectomy
Antihypertensive effects may be enhanced.
Renal stones
Triamterene has been found in renal stones; use drug with caution in patients with histories of stone formation.
Overdosage
Symptoms
Orthostatic or general hypotension, tachycardia, syncope, electrolyte abnormalities, potassium deficiency, vomiting, nausea, shock, weakness, confusion, dizziness, cramps of calf muscles, thirst, polyuria, anuria, lethargy.
Patient Information
- Instruct patient to take medication early in day to avoid diuretic effect at night.
- Tell patient to take drug with food or milk and to report GI symptoms.
- Advise patient to limit sodium intake for optimal drug effect.
- Advise patient to limit exposure to sun and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Instruct diabetic patients to report increased levels of blood glucose.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
- Tell patient to report these symptoms to health care provider: decrease in urinary output, jaundice, muscle cramps, weakness, nausea, blurred vision, dizziness.
- Instruct patient to drink 2 to 3 L/day of water unless contraindicated.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
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Hydrochlorothiazide/Triamterene Images
High Blood Pressure, Fluid Retention
