Dyrenium Side Effects

Generic Name: triamterene

Note: This page contains information about the side effects of triamterene. Some of the dosage forms included on this document may not apply to the brand name Dyrenium.

Not all side effects for Dyrenium may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to triamterene: oral capsule, oral tablet

In addition to its needed effects, some unwanted effects may be caused by triamterene (the active ingredient contained in Dyrenium). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking triamterene:

Incidence not known
  • Abdominal or stomach pain
  • agitation
  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • chills
  • clay-colored stools
  • cloudy urine
  • confusion
  • convulsions
  • cough
  • dark urine
  • decreased urine output
  • depression
  • difficulty breathing
  • difficulty swallowing
  • dizziness
  • dry mouth
  • fainting spells
  • fast or irregular heartbeats
  • fever
  • headache
  • hives
  • hostility
  • increased thirst
  • irritability
  • itching
  • joint pain
  • lethargy
  • loss of appetite
  • loss of consciousness
  • mood changes
  • muscle pain or cramps
  • muscle twitching
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • pain in the groin or genitals
  • pain in the lower back or side
  • pinpoint red spots on the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips or tongue
  • rapid or unusual weight gain
  • seizures
  • sharp back pain just below the ribs
  • shortness of breath
  • skin rash
  • stupor
  • swelling of the face, ankles, feet, or hands
  • tightness in the chest
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting of blood
  • weakness or heaviness of the legs
  • wheezing
  • yellow eyes or skin

If any of the following symptoms of overdose occur while taking triamterene, get emergency help immediately:

Symptoms of overdose
  • Blurred vision
  • diarrhea
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • indigestion
  • pain or weakness in the hands or feet
  • passing of gas
  • stomach fullness or discomfort
  • sweating
  • trembling

Some of the side effects that can occur with triamterene may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Incidence not known
  • Increased sensitivity of skin to sunlight
  • redness or other discoloration of the skin
  • severe sunburn

For Healthcare Professionals

Applies to triamterene: compounding powder, oral capsule

General

Triamterene (the active ingredient contained in Dyrenium) is generally well-tolerated, especially in patients with adequate urine output. Side effects are reported in less than 1% of patients.[Ref]

Metabolic

Metabolic abnormalities include hyperkalemia, which is more likely in the elderly, diabetic, and in patients with renal insufficiency. It is recommended that serum potassium concentrations be monitored, and that an electrocardiogram be obtained if hyperkalemia is suspected to check for peaked T waves and QRS segment changes.[Ref]

The presence of an arrhythmia or widened QRS complex associated with hyperkalemia requires prompt administration of 10% calcium gluconate 10 to 20 mL intravenously over a 20 to 30 minute interval. Noncardiotoxic hyperkalemia usually responds to 10 units of regular insulin plus glucose 25 grams (as a 20% solution infused over 30 minutes) and consideration of sodium bicarbonate 40 to 150 mEq infused over a 30 to 60 minute interval. Insulin-dependent diabetic patients with preexisting hyperglycemia may not require the concomitant glucose infusion.[Ref]

Gastrointestinal

Gastrointestinal side effects, such as nausea and vomiting, may be lessened by administering the drug after meals.[Ref]

Renal

Renal insufficiency, manifested as increased serum creatinine and BUN, has been reported in less than 1% of patients, but is far more likely, even in patients without preexisting renal insufficiency, if nonsteroidal anti-inflammatory drugs are being coadministered. Triamterene renal calculi is estimated to occur in 1/1,500 to 1/2,000 patients. Rare cases of interstitial nephritis and triamterene (the active ingredient contained in Dyrenium) bladder calculi are reported.[Ref]

Triamterene is less soluble in solutions with a pH below 6, becoming crystallized and precipitating calculi formation under certain circumstances. In addition, triamterene alone, and when combined with hydrochlorothiazide, is associated with interstitial nephritis and acute renal failure in rare cases.[Ref]

Hypersensitivity

Hypersensitivity reactions include rare cases of drug fever, hepatitis, photosensitive dermatitis, and erythema multiforme. In some cases, other drugs were coadministered, making implication of triamterene (the active ingredient contained in Dyrenium) difficult.[Ref]

Hematologic

Triamterene (the active ingredient contained in Dyrenium) inhibits dihydrofolate reductase, resulting in decreased folate production. This may be important in patients who have borderline folate stores, such as pregnant women and alcohol abusers.[Ref]

Hematologic side effects include thrombocytopenia and macrocytic anemia. Rare cases of drug-induced dose-dependent hemagglutination resulting in acute intravascular hemolysis is reported.[Ref]

Hepatic

Hepatic side effects are rare. A case of cholestatic jaundice and centrolobular necrosis of the liver is reported, thought to be due to hypersensitivity. Triamterene (the active ingredient contained in Dyrenium) may cause a spurious elevation in serum lactate dehydrogenase concentrations.[Ref]

Other

A laboratory abnormality is spurious elevation of lactate dehydrogenase concentrations.[Ref]

References

1. Nolan PJ, D'Arcy G "Triamterene drug fever and hepatitis ." Med J Aust 147 (1987): 262

2. Safdi MA "Fever secondary to triamterene therapy ." N Engl J Med 303 (1980): 701

3. Hollenberg NK, Mickiewicz CW "Postmarketing surveillance in 70,898 patients treated with a triamterene/hydrochlorothiazide combination (Maxzide) [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b37-41

4. Jick H, Dinan BJ, Hunter JR "Triamterene and renal stones." J Urol 127 (1982): 224-5

5. Macleod MD, Bell GM, Irvine WJ "Nephrogenic diabetes insipidus associated with Dyazide (triamterene- hydrochlorothiazide)." Br Med J (Clin Res Ed) 283 (1981): 1155-6

6. Schnaper HW, Maxwell MH "Efficacy and safety of triamterene/hydrochlorothiazide combinations in mild systemic hypertension [published erratum appears in Am J Cardiol 1990 Aug 1;66(3):388]." Am J Cardiol 63 (1989): b32-6

7. Dooley DP, Callsen ME, Geiling JA "Triamterene nephrolithiasis." Mil Med 154 (1989): 126-7

8. Carey RA, Beg MM, McNally CF, Tannenbaum P "Triamterene and renal lithiasis: a review." Clin Ther 6 (1984): 302-9

9. Cohen AB "Hyperkalemic effects of triamterene." Ann Intern Med 65 (1966): 521-7

10. Hansen KB, Bender AD "Changes in serum potassium levels occurring in patients treated with triamterene and a triamterene-hydrochlorothiazide combination." Clin Pharmacol Ther 8 (1967): 392-9

11. Hollenberg NK, Mickiewicz C "Hyperkalemia in diabetes mellitus. Effect of a triamterene- hydrochlorothiazide combination." Arch Intern Med 149 (1989): 1327-30

12. Ettinger B, Oldroyd NO, Sorgel F "Triamterene nephrolithiasis." JAMA 244 (1980): 2443-5

13. Carr MC, Prien EL, Jr Babayan RK "Triamterene nephrolithiasis: renewed attention is warranted." J Urol 144 (1990): 1339-40

14. Walker BR, Capuzzi DM, Alexander F, Familiar RG, Hoppe RC "Hyperkalemia after triamterene in diabetic patients." Clin Pharmacol Ther 13 (1972): 643-51

15. Amery A, Berthaux P, Bulpitt C, Deruyttere M, de Schaepdryver A, Dollery C, Fagard R, Forette F, Hellemans J, Lund-Johansen PMutsers A, Tuomilehto J "Glucose intolerance during diuretic therapy. Results of trial by the European Working Party on Hypertension in the Elderly." Lancet 1 (1978): 681-3

16. Roberts CJ, Channer KS, Bungay D "Hyponatraemia induced by a combination of hydrochlorothiazide and triamterene." Br Med J (Clin Res Ed) 288 (1984): 1962

17. Chainuvati T, Harinasuta U, Zimmerman HJ "Spurious elevation of apparent lactate dehydrogenase activity caused by triamterene." Clin Chem 19 (1973): 1202-4

18. Eitzen AC "Report of a death following administration of triamterene." J Kans Med Soc 67 (1966): 454-5

19. Grunberg RW, Silberg SJ "Triamterene-induced nephrolithiasis." JAMA 245 (1981): 2494-5

20. "Triamterene and the kidney." Lancet 1 (1986): 424

21. Ettinger B, Weil E, Mandel NS, Darling S "Triamterene-induced nephrolithiasis." Ann Intern Med 91 (1979): 745-6

22. Hollander JB "Triamterene bladder calculus." Urology 30 (1987): 154-5

23. Patel KM "Triamterene nephrolithiasis complicating dyazide therapy." J Urol 126 (1981): 230

24. Fairley KF, Woo KT, Birch DF, Leaker BR, Ratnaike S "Triamterene-induced crystalluria and cylinduria: clinical and experimental studies." Clin Nephrol 26 (1986): 169-73

25. Roy LF, Villeneuve JP, Dumont A, Dufresne LR, Duran MA, Morin C, Jobin J "Irreversible renal failure associated with triamterene." Am J Nephrol 11 (1991): 486-8

26. Spence JD, Wong DG, Lindsay RM "Effects of triamterene and amiloride on urinary sediment in hypertensive patients taking hydrochlorothiazide." Lancet 2 (1985): 73-5

27. Gault MH, Snedden W, Taor RE, Churchill DN, Ahmed M "Triamterene urolithiasis." Can Med Assoc J 124 (1981): 1556-7

28. Bailey RR, Lynn KL, Drennan CJ, Turner GA "Triamterene-induced acute interstitial nephritis." Lancet 1 (1982): 226

29. White DJ, Nancollas GH "Triamterene and renal stone formation." J Urol 127 (1982): 593-7

30. Werness PG, Bergert JH, Smith LH "Triamterene urolithiasis: solubility, pk, effect on crystal formation, and matrix binding of triamterene and its metabolites." J Lab Clin Med 99 (1982): 254-62

31. Dickstein ES, Loeser WD "Triamterene calculus." J Urol 133 (1985): 1019

32. Socolow EL "Triamterene-induced nephrolithiasis ." Ann Intern Med 92 (1980): 437

33. Fernandez de Corres L, Bernaola G, Fernandez E, Leanizbarrutia I, Munoz D "Photodermatitis from triamterene." Contact Dermatitis 17 (1987): 114-5

34. Breathnach SM, Dutt MK, Black MM "A severe bullous eruption occurring in a patient with chronic active hepatitis and glomerulonephritis." Arch Dermatol 116 (1980): 1061-3

35. Takahashi H, Tsukada T "Triamterene-induced immune haemolytic anaemia with acute intravascular haemolysis and acute renal failure." Scand J Haematol 23 (1979): 169-76

36. Corcino J, Waxman S, Herbert V "Mechanism of triamterene-induced megaloblastosis." Ann Intern Med 73 (1970): 419-24

37. Lieberman FL, Bateman JR "Megaloblastic anemia possibly induced by triamterene in patients with alcoholic cirrhosis. Two case reports." Ann Intern Med 68 (1968): 168-73

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