Triamterene: Uses, Interactions, Mechanism of Action

Captopril; Hydrochlorothiazide, HCTZ tablets

What is this medicine?

CAPTOPRIL; HYDROCHLOROTHIAZIDE (KAP toe pril; hye droe klor oh THYE a zide) is a combination of a diuretic and an ACE inhibitor. It is used to treat high blood pressure.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Capozide

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• bone marrow disease
• decreased urine
• diabetes
• heart or blood vessel disease
• if you are on a special diet like a low salt diet
• immune system problems, like lupus
• kidney disease
• liver disease
• previous swelling of the tongue, face, or lips with difficulty breathing, difficulty swallowing, hoarseness, or tightening of the throat
• recent heart attack or stroke
• an unusual or allergic reaction to captopril, hydrochlorothiazide, sulfa drugs, other medicines, insect venom, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take this medicine on an empty stomach, at least 1 hour before meals. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking this medicine except on the advice of your doctor or health care professional.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medication with any of the following medications:

This medicine may also interact with the following:

• amphotericin B
• barbiturates like phenobarbital
• blood pressure medicines
• calcium supplements
• corticosteroids like prednisone
• diabetic medications
• digoxin
• diuretics, especially potassium-sparing diuretics like triamterene, spironolactone or amiloride
• lithium
• MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate
• medicines for angina like nitroglycerin
• medicines that treat or prevent blood clots like warfarin
• medicines used to treat gout
• methenamine
• NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
• potassium salts or potassium supplements
• prescription pain medicines
• skeletal muscle relaxants like tubocurarine
• some cholesterol-lowering medications like cholestyramine or colestipol

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care provider for regular checks on your progress. Check your blood pressure as directed. Ask your doctor or health care provider what your blood pressure should be and when you should contact him or her. Call your doctor or health care provider if you notice an irregular or fast heart beat.

You must not get dehydrated. Ask your doctor or health care provider how much fluid you need to drink a day. Check with him or her if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care provider or pharmacist for more information.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.

This medicine may increase blood sugar. Ask your healthcare provider if changes in diet or medicines are needed if you have diabetes.

Avoid salt substitutes unless you are told otherwise by your doctor or health care provider.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Do not treat yourself for coughs, colds, or pain while you are taking this medicine without asking your doctor or health care provider for advice. Some ingredients may increase your blood pressure.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• breathing problems
• changes in vision
• chest pain
• confusion
• decreased amount of urine passed
• eye pain
• fast or irregular heart beat
• feeling faint or lightheaded, falls
• muscle cramps
• nausea, vomiting
• persistent dry cough
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• signs and symptoms of high blood sugar such as being more thirsty or hungry or having to urinate more than normal. You may also feel very tired or have blurry vision.
• stomach pain
• swelling of your hands or feet
• unusual bleeding or bruising
• worsened gout pain
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• change in sex drive or performance
• cough
• headache

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature below 30 degrees C (86 degrees F). Protect from moisture and light. Keep container tightly closed. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Triamterene 50mg Capsules – Summary of Product Characteristics (SmPC)

This information is intended for use by health professionals

Dytac 50mg Capsules Triamterene 50mg Capsules

Each capsule contains 50mg triamterene EP.

Opaque, maroon-coloured capsules containing as a yellow, granular powder.

Triamterene is a potassium-conserving diuretic, thought to act by directly inhibiting the exchange of sodium for potassium and hydrogen in the distal renal tubule. Potassium-conserving diuretic for the control of oedema in cardiac failure, cirrhosis of the liver or the nephrotic syndrome, and in that associated with corticosteroid treatment. When Dytac is used as an adjuvant to potassium-depleting diuretics, such loss may be inhibited and diuresis enhanced.

Method of Administration

Oral

Dosage

Adults only: When given alone, the usual dosage range is from 3 to a maximum of 5 Dytac capsules a day. The optimal daily dosage is 4 capsules, given in divided doses after breakfast and lunch. After the first week, treatment should preferably be given on alternate days to ensure satisfactory maintenance diuresis without an increase in blood urea levels. When given with another diuretic, lower dosages of both should be used initially.Elderly: A lower dosage may be sufficient. The normally occurring reduction in glomerular filtration with age should be borne in mind.

Hyperkalaemia, progressive renal failure, increasing hepatic dysfunction, addison’s disease, known hypersensitivity to the drug and anuria. Routine concomitant administration of potassium supplements, or other potassium-conserving drugs, including ACE inhibitors.

Use with caution in patients with diabetes mellitus, hepatic or renal insufficiency; in those predisposed to gout since Dytac has been shown in rare instances to elevate uric acid levels; with hypotensive agents since an additive effect may result; and in diabetic nephropathy, due to increased risk of hyperkalaemia.It is advisable to monitor blood urea, serum potassium levels and electrolytes periodically. This is important in the elderly, those with renal impairment and those receiving concomitant treatment with NSAIDs.Combinations of folate antagonists and triamterene are not advisable in pregnancy or in patients with hepatic cirrhosis because of the increased theoretical risk of folate deficiency developing.

Use with caution with hypotensive agents. When given with another diuretic, lower dosage of both should be given initially. Triamterene reduces excretion of Lithium and may thus precipitate intoxification. It is advisable to monitor blood urea and serum potassium levels periodically in patients receiving concomitant treatment with NSAIDs. Renal failure, reversible on stopping treatment, has been reported very rarely which may be due to an interaction between triamterene and some NSAIDs. It has been suggested that the suppression of urinary prostaglandins by NSAIDs could potentiate the nephrotoxic effects of traimterene.Occasional reports of reduced renal function when triamterene given with indometacin avoid concomitant use. Triamterene has the following interaction information:Drugs likely to increase the risk of severe hyperkalaemia when given with triamterene:• ACE inhibitors angiotensin-II receptor antagonists.• tacrolimus • indometacin• potassium salts.• trilostane.• ciclosporin• aliskiren• chlorpropamide • amiloride• aldosterone antagonists such as eplerenone and spironolactoneDrugs likely to enhance the hypotensive effect when give with triamterene:• alprostadil• ACE inhibitors• drospirenone (monitor serum potassium during first cycle)• adrenergic neurone blockers• alcohol• aldesleukin• alpha-blockers , also increased risk of first-dose hypotension with post-synaptic alpha-blockers such as prazosin• general anaesthetics• angiotensin-II receptor antagonists• anxiolytics and hypnotics• with baclofen• beta-blockers• calcium-channel blockers• clonidine• hydralazine• levodopa• MAOIs• methyldopa• minoxidil• diazoxide• moxisylyte• moxonidine• nitrates• phenothiazines• sodium nitroprusside• tizanidineEffects of diuretics is antagonised by following drugs:• ketorolac• indometacin• oestrogens • corticosteroidsHypokalaemia caused by diuretics increases risk of ventricular arrhythmias with following drugs:• sertindole• pimozide (avoid concomitant use)• platinum compounds• atomoxetine• amisulprideIncreased risk of postural hypotension when diuretics given with tricyclics. Increased risk of hyponatraemia when diuretics given with carbamazepine

There is no clinical evidence to suggest any associated hazards to the foetus, However triamterene has been found to cross the placenta in humans. Nevertheless, drugs should be avoided in pregnancy unless essential, especially during the first trimester. Triamterene may appear in the breast milk, and if the drug is essential, the patient should stop breastfeeding.

Triamterene:

Weakness, minor decreases in blood pressure, and rash have been reported. Anaphylaxis is a remote possibility.Metabolic acidosis occasionally occurs. Electrolyte imbalance may also indicate excessive dosage or be secondary to the condition under treatment.Renal failure, reversible on stopping treatment, has been reported very rarely and has been due to acute interstitial nephritis or an interaction between triamterene and some NSAIDs.Triamterene has been found in renal stones both alone and in association with other usual calculus components. There is no evidence that stone formation is increased in patients taking triamterene-containing drugs.Jaundice and abnormalities of serum levels of liver enzymes, have also been reported.Triamterene may cause a blue fluorescence of the urine under certain light conditions. Triamterene interferes with bioassay of folic acid.

Symptoms of electrolyte imbalance, especially hyperkalaemia, are likely. Symptoms include nausea, vomiting, weakness, lassitude, muscular weakness, hypotension and cardiac arrhythmias. Treatment consists of gastric lavage with careful monitoring of electrolytes and fluid balance. Cardiac rhythm should be monitored and appropriate measures taken to correct hyperkalaemia as necessary. There is no specific antidote. Renal dialysis may be of some benefit in cases of severe overdosage.Triamterene is incompletely but fairly rapidly absorbed from the gastro-intestinal tract. It has been estimated to have a plasma half-life of about 2 hours. Triamterene is extensively metabolised and is mainly excreted in the urine in the form of metabolites with some unchanged triamterene; variable mounts are also excreted in the bile.

Triamterene is a potassium-conserving diuretic thought to act by directly inhibiting the exchange of sodium for potassium and hydrogen in the distal renal tubule.

Onset of action is 2-4 hours after ingestion. Diuresis generally tapers off 7-9 hours after administration. Triamterene is incompletely but fairly rapidly absorbed from the gastrointestinal tract. It has been estimated to have a plasma half life of about 2 hours. Triamterene is extensively metabolised and is mainly excreted in the urine in the form of metabolites with some unchanged triamterene; variable amounts are also excreted in the bile.

No further information of relevance.

Magnesium stearateLactoseBlack Iron oxide E172Erythrosine E127Titanium Dioxide E171Gelatin

36 months for blister packs60 months for securitainers/amber glass bottles/polyethylene vials.

Polypropylene securitainers/amber glass bottles/polyethylene vials contain 30 or 250 capsules Blister packs contain 30 capsules.

Mercury Pharma Group Ltd
Capital House, 85 King William Street,
London EC4N 7BL, UK

Hydrochlorothiazide and Triamterene: Dosage, Mechanism/Onset of Action, Half-Life

Drug Interactions

Ajmaline: Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Monitor therapy

Alcohol (Ethyl): May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Allopurinol: Thiazide and Thiazide-Like Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Allopurinol. Specifically, Thiazide Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Monitor therapy

Ammonium Chloride: Potassium-Sparing Diuretics may enhance the adverse/toxic effect of Ammonium Chloride. Specifically the risk of systemic acidosis. Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Angiotensin II Receptor Blockers: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy

Anticholinergic Agents: May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Benazepril: HydroCHLOROthiazide may enhance the hypotensive effect of Benazepril. HydroCHLOROthiazide may enhance the nephrotoxic effect of Benazepril. Benazepril may decrease the serum concentration of HydroCHLOROthiazide. Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. Consider therapy modification

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Avoid combination

Calcium Salts: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Monitor therapy

CarBAMazepine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia. Monitor therapy

Cardiac Glycosides: Potassium-Sparing Diuretics may diminish the therapeutic effect of Cardiac Glycosides. In particular, the inotropic effects of digoxin appear to be diminished. Potassium-Sparing Diuretics may increase the serum concentration of Cardiac Glycosides. This particular effect may be unique to Spironolactone. Monitor therapy

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Monitor therapy

Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Cyclophosphamide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. Monitor therapy

CycloSPORINE (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of CycloSPORINE (Systemic). Avoid combination

Dexketoprofen: May enhance the adverse/toxic effect of Sulfonamides. Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Monitor therapy

Diazoxide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Dichlorphenamide. Monitor therapy

Dofetilide: HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. Avoid combination

Drospirenone: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification

Fexinidazole [INT]: Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Fexinidazole [INT]. Avoid combination

Heparin: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Monitor serum potassium concentrations closely. The spironolactone Canadian product monograph lists its combination with heparin or low molecular weight heparins as contraindicated. Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Monitor serum potassium concentrations closely. The spironolactone Canadian product monograph lists its combination with heparin or low molecular weight heparins as contraindicated. Monitor therapy

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Indomethacin: May enhance the nephrotoxic effect of Triamterene. Management: Consider alternatives to concomitant treatment with triamterene and indomethacin. If the combination cannot be avoided, monitor for development of renal failure. Consider therapy modification

Ipragliflozin: May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Monitor therapy

Ivabradine: Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. Monitor therapy

Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Monitor therapy

Levosulpiride: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. Avoid combination

Licorice: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Lithium: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. Consider therapy modification

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Mecamylamine: Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. Avoid combination

Methenamine: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Methenamine. Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). Monitor therapy

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification

Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Monitor therapy

OXcarbazepine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia. Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Consider therapy modification

Promazine: Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

QuiNIDine: Potassium-Sparing Diuretics may diminish the therapeutic effect of QuiNIDine. Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Consider therapy modification

Spironolactone: Triamterene may enhance the hyperkalemic effect of Spironolactone. Avoid combination

Tacrolimus (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Tacrolimus (Systemic). Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Monitor therapy

Topiramate: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Management: Monitor for increased topiramate levels/adverse effects (e.g., hypokalemia) with initiation/dose increase of a thiazide diuretic. Closely monitor serum potassium concentrations with concomitant therapy. Topiramate dose reductions may be necessary. Consider therapy modification

Toremifene: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. Monitor therapy

Valsartan: HydroCHLOROthiazide may enhance the hypotensive effect of Valsartan. Valsartan may increase the serum concentration of HydroCHLOROthiazide. Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Monitor therapy

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy

Adverse Reactions

Also see individual agents. Frequency not defined.

Cardiovascular: Angina pectoris, cardiac arrhythmia, necrotizing angiitis, orthostatic hypotension, tachycardia

Central nervous system: Anxiety, depression, dizziness, fatigue, glossopyrosis, headache, insomnia, paresthesia, restlessness, vertigo

Dermatologic: Skin photosensitivity, skin rash, urticaria

Endocrine & metabolic: Acidosis, diabetes mellitus, glycosuria, hypercalcemia, hyperglycemia, hyperkalemia, hyperuricemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia

Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, dysgeusia, gastric distress, nausea, pancreatitis, sialadenitis, stomach cramps, tongue discoloration (bright orange), vomiting, xerostomia

Genitourinary: Impotence, urine discoloration, urine sedimentation abnormality

Hematologic & oncologic: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, megaloblastic anemia, purpura, thrombocytopenia

Hepatic: Abnormal liver function tests, jaundice

Hypersensitivity: Anaphylaxis

Neuromuscular & skeletal: Exacerbation of systemic lupus erythematosus, lupus-like syndrome (subacute, cutaneous), muscle cramps, weakness

Ophthalmic: Transient blurred vision, xanthopsia

Renal: Acute renal failure, increased blood urea nitrogen, increased serum creatinine, interstitial nephritis, nephrolithiasis

Respiratory: Dyspnea, hypersensitivity pneumonitis, pulmonary edema, respiratory distress

Miscellaneous: Fever

<1%, postmarketing, and/or case reports: Malignant neoplasm of lip (Friedman 2012)

Source: Wolters Kluwer Health. Last updated January 16, 2020.

triamterene hydrochlorothiazide

Triamterene and Hydrochlorothiazide tablets, 75 mg/50 mg, 500 count bottle (NDC 0781-5067-05) 02/23/2018: Sandoz Inc. has made a business decision to permanently discontinue Triamterene and Hydrochlorothiazide tablets. A-S Medication Solutions. Each capsule of triamterene and hydrochlorothiazide for oral use, with opaque yellow cap and opaque white body, contains triamterene 37.5 mg and hydrochlorothiazide 25 mg, and is imprinted with 855. It also treats high blood pressure. However, elderly patients are more likely to have kidney problems and high blood potassium (hyperkalemia), which may require caution in patients receiving this medicine. My doc gave me this medicine as sometimes my BP gets to 140-150/85-95. I thought Diamox was the one. Triamterene / hydrochlorothiazide is an oral diuretic (water pill) that is used for treating high blood pressure (hypertension) and edema (water accumulation). Hydrochlorothiazide and triamterene is a combination medicine that is used to treat fluid retention (edema) and high blood pressure (hypertension). ). It is often used in high blood pressure. Triamterene is used alone or with other medications to treat edema (fluid retention; excess fluid held in body tissues) caused by various conditions, including liver and heart disease. Hydrochlorothiazide and Triamterene – Last updated on July 28, 2021 All rights owned and reserved by Memorial Sloan Kettering Cancer Center. Triamterene Kidney Stones. Labeler Name: American Health Packaging. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Hydrochlorothiazide and Triamterene This information from Lexicomp explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Estimated number of patients in the United States (2018) 1,416,877. This medication is a combination of two “water pills” (diuretics): triamterene and hydrochlorothiazide. This eMedTV segment offers a detailed look at the drug, including how it works, dosing information, and possible side effects. If you miss a dose of this medicine, take it as soon as possible. They are used in combination to treat edema (fluid retention) that occurs with congestive heart failure and disorders of the liver and kidney. It treats swelling from heart, kidney, or liver disease. Brand Names: US Dyazide [DSC]; Maxzide; Maxzide-25 Triamterene and Hydrochlorothiazide. TRIAMTERENE; HYDROCHLOROTHIAZIDE (trye AM ter een; hye droe klor oh THYE a zide) is a combination of 2 diuretics. . Triamterene is a pteridine derivative with potassium-sparing diuretic property.Triamterene blocks the sodium-potassium exchange pump (Na-K-ATPase) in the luminal membrane of principal cells in the late distal tubule, cortical collecting tubule and collecting duct in the kidney. Maxzide-25. Triamterene is a potassium-sparing diuretic. Tablets (Maxzide): Each tablet contains 37.5 mg triamterene and 50 mg hydrochlorothiazide. If you have any of these problems, you may not have the ability to make use of triamterene, or you could need a dosage modification or … Whether triamterene has an independent effect on … Our Dyazide (hydrochlorothiazide and triamterene) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. These drugs are commonly referred to as “water pills.” Fast shipping & discrete packaging! Triamterene-HCTZ is typically used for the treatment of fluid retention and high blood pressure. Patients who become hypokalemic on 25 mg of hydrochlorothiazide may be transferred directly to hydrochlorothiazide 25 mg-triamterene 37.5 mg orally once a day. HCTZ is taken regularly by over 20 million people. No information is available on the relationship of age to the effects of triamterene and hydrochlorothiazide combination in geriatric patients. It can also be used for the treatment of other conditions as prescribed by the doctor. Log in to print or send this list to your patient and save lists of resources you use frequently. Offered information from medical trials of lisinopril are insufficient to reveal that lisinopril does not trigger agranulocytosis at comparable prices. Davis PT Collection. A Question from a Reader: Q. I took hydrochlorothiazide (HCTZ) for about 15 years to lower my high blood pressure. (when combined with 50 mg triamterene) and hydrochlorothiazide (50 mg) led to a weight loss of 3.2 lbs. Triamterene is a diuretic that prevents re-absorption of sodium in exchange for potassium, which reduces sodium and water in the body. Read this chapter of Davis’s Drug Guide for Rehabilitation Professionals online now, exclusively on F.A. Triamterene-HCTZ is a diuretic. indigestion. Hydrochlorothiazide is a thiazide diuretic (water pill). Hydrochlorothiazide and triamterene is a combination medicine that is used to treat fluid retention (edema) and high blood pressure (hypertension). They are useful in short operations because of its major drawback. Zestoretic Coupon. Educational Resources. 14124-50-6. Your healthcare professional might have the ability to aid you avoid or minimize these adverse effects, however do contact them if any of the following side impacts continue, or if … Triamterene Hydrochlorothiazide 37 5 25 Mg: No Prescription Needed. Her medications included hydrochlorothiazide, 25 mg/triamterene, 37.5 mg. The amount of triamterene added to the 25 mg of hydrochlorothiazide in MAXZIDE-25 MG tablets was also determined from steadystate dose-response evaluations in which various doses of liquid preparations of triamterene were administered to hypertensive persons who developed hypokalemia with hydrochlorothiazide (25 mg given once daily). Triamterene (Dyrenium®) is a prescription medicine that is used for treating fluid retention. It is known as a “potassium-sparing” diuretic and is used to treat water retention (edema) due to various causes. Usually, the drug is used in combination with hydrochlorothiazide, another diuretic (see Triamterene-HCTZ). Other uses include treating diabetes insipidus and renal tubular acidosis and to decrease the risk of kidney stones in those with a high calcium level in the urine. Is this dose safe? Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Children—Use and dose must be determined by your doctor. Buy Plavix Online. The results from this double-blind, multi-investigator study showed that a combination of 50 mg triamterene plus 25 mg hydrochlorothiazide and a combination of 25 mg spironolactone plus 25 mg hydrochlorothiazide were equally efficacious in lowering blood pressure in hypertensive outpatients, and that they produced the same type and incidence of adverse effects. BACKGROUND Triamterene, because of its potassium-sparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Triamterene and Hydrochlorothiazide. Acute oral LD50 of triamterene in rats is 400 mg/kg and 285-380 mg/kg in mice. Abusing paxil and hydrochlorothiazide with triamterene. This medicine is usually given to people in whom other diuretics have caused hypokalemia (low potassium levels in your blood). Side effects such as mineral (sodium, potassium, or magnesium) deficiency, high blood calcium, high blood uric acid, increases in blood fats and sugars, skin sensitivity to light, and even vision problems are not uncommon. Each component complements the action of the other. hydrochlorothiazide – UpToDate. Triamterene and hydrochlorothiazide capsules are also indicated for those patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked. Missed Dose . Triamterene is a potassium-sparing diuretic. Amiloride hydrochloride has now been recognized as a safe and effective potassium-sparing diuretic alternative to triamterene with a similar mechanism of pharmacologic activity. While this was a relatively small-scale study, it showed that treatment with: hydrochlorothiazide (25 mg) led to weight loss of: 1.9 lbs. Additional Information. Juicy Triamterene Over Of And Jam-packed Which Details Is Rest Read Effects Of Foo Archive Really The Hydrochlorothiazide Quite The Release Great Press Side At Website The. Each capsule of DYAZIDE (hydrochlorothiazide and triamterene) for oral use, with opaque red cap and opaque white body, contains hydrochlorothiazide 25 mg and triamterene 37.5 mg, and is imprinted with the product name DYAZIDE (hydrochlorothiazide and triamterene) and SB. Hydrochlorothiazide is a diuretic/antihypertensive agent and triamterene is an antikaliuretic agent. Hydrochlorothiazide prevents kidneys’ capability to soak up too much salt, therefore decreases water retention in the physical body. This medicine is used to treat high blood pressure and edema or swelling from excess water. It is used to treat high blood pressure and edema (swelling). Triamterene or hydrochlorothiazide-induced fluctuations in serum electrolyte concentration (including potassium loss in patients with hepatic cirrhosis) can occur and precipitate hepatic encephalopathy in susceptible patients. Triamterene and hydrochlorothiazide is also indicated for those patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked (e.g., patients on concomitant digitalis preparations, or with a history of cardiac arrhythmias, etc. Adult: Each tab/cap contains triamterene 37.5 mg and hydrochlorothiazide 25 mg: 1-2 tab/cap once daily.Each tab contains triamterene 50 mg and hydrochlorothiazide 25 mg: Initially, 1 tab daily after the morning meal, adjust thereafter according to response. Hydrochlorothiazide and Triamterene This information from Lexicomp explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Many doctors believe that hydrochlorothiazide (HCTZ) side effects are mild and rare. Triamterene is a “water pill” that works in your kidneys to increase the amount of urine you make. Is triamterene hctz (hydrochlorothiazide) 37.5/25 a low dose med for high bp? Triamterene and hydrochlorothiazide is a diuretic, antihypertensive drug product, principally due to its hydrochlorothiazide component; the … stomach fullness or discomfort. Both these medications belong to the class of medications called diuretics (“water pills”). Consult your doctor before breastfeeding. It is found in lisinopril HCTZ, losartan HCTZ, triamterene HCTZ and valsartan HCT among many others. A-S Medication Solutions. Use of thiazide diuretics in patients with primary (essential) hypertension. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. #117 ( 16) Estimated number of prescriptions in the United States (2018) 6,007,404. This medication is helpful for people who need to take hydrochlorothiazide and have low potassium levels. Find 160 user ratings and reviews for Triamterene-hydrochlorothiazide Oral on WebMD including side effects and drug interactions, medication effectiveness, ease of use and satisfaction Why did my doc prescribe triamterene hctz (hydrochlorothiazide) 37.5/25 for altitude illness? hydrochlorothiazide and triamterene is usually given to people in whom other diuretics have caused hypokalemia (low potassium levels in your blood). Triamterene and hydrochlorothiazide is a diuretic, antihypertensive drug product, principally due to its hydrochlorothiazide component; the triamterene component reduces the excessive potassium loss which may occur with hydrochlorothiazide use. Triamterene and Hydrochlorothiazide. sweating. Simply look and you will understand: there is no more threat for you or room for questions, only most trustworthy pharmacies with budget friendly drugs. The diuretic raises uric acid levels. Hydrochlorothiazide and triamterene is a combination medicine used to treat fluid retention (edema) and high blood pressure (hypertension). Hydrochlorothiazide passes into breast milk, but is unlikely to harm a nursing infant. Initially one Maxzide-25mg tab/day. hydrochlorothiazide; triamterene related erectile dysfunction * Warning : The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used … This is called a non-discrimination point or focus] astonishing hypothesis n. The deep circumflex iliac vessels during tedious p.231 dissections. 50090-1270. Triamterene and hydrochlorothiazide is a diuretic, antihypertensive drug product, principally due to its hydrochlorothiazide component; the triamterene component reduces the excessive potassium loss which may occur with hydrochlorothiazide use. Welcome to Faux Mocha. Triamterene-HCTZ may raise your body’s potassium levels, which can become life-threatening if not treated. Triampur compositum. Hydrochlorothiazide hinders renal systems’ potential to absorb excessive salt, thus reduces water recognition in the body. Dytide H. Triamterene/HCTZ. Brand Names: US Dyazide [DSC]; Maxzide; Maxzide-25 It is often used in high blood pressure. The combination of triamterene and hydrochlorothiazide is used to treat high blood pressure and edema (fluid retention; excess fluid held in body tissues) in patients who have lower amounts of potassium in their bodies or for whom low potassium levels in the body could be dangerous. Studies were undertaken to assess the difference between therapy with the triamterene-hydrochlorothiazide combination (Dya … Slimin. Hydrochlorothiazide, while effective, often causes low potassium levels in the blood. Some of the brands for triamterene + hydrochlorothiazide might be better known than triamterene + hydrochlorothiazide itself. Triamterene is a potassium-sparing diuretic. These side effects may go away during treatment as your body adjusts to the medicine. -Patients in whom hypokalemia cannot be risked may be initiated on hydrochlorothiazide … Usual dosage: 1–2 Maxzide-25mg tabs or one Maxzide tab once daily. https://pubchem.ncbi.nlm.nih.gov/compound/Triamterene-and-hydrochlorothiazide F.A. Hydrochlorothiazide is a thiazide diuretic (water pill). It helps you make more urine and to lose salt and excess water from your body. This particular medication contains two diuretics that work together to keep electrolyte levels in balance. Here are all the possible meanings and translations of the word triamterene. Triamterene is a potassium-sparing diuretic used in combination with thiazide diuretics for the treatment of hypertension and edema. In combination with hydrochlorothiazide, it is marketed under the names Maxzide and Dyazide. A pteridine that is used as a mild diuretic. pain or weakness in the hands or feet. Buy Now! Medication class. Hydrochlorothiazide and triamterene is a combination medicine that is used to treat fluid retention (edema) and high blood pressure (hypertension). Specifically it is used in those who develop low blood potassium (hypokalemia) when on only hydrochlorothiazide. No information currently available. These medications are not usually taken together. It also prevents the depletion of potassium. Triamterene and hydrochlorothiazide is a diuretic/antihypertensive drug product that combines natriuretic and antikaliuretic effects. She brought with her a large fragmented 70-mg stone that she had passed in urine. Some side effects of hydrochlorothiazide / triamterene may occur that usually do not need medical attention. Hydrochlorothiazide-triamterene. Hydrochlorothiazide And Triamterene (Dyazide) received an overall rating of 5 out of 10 stars from 18 reviews. Pharmacology (Mechanism of Action) Triamterene: Inhibits the reabsorption of sodium in exchange for potassium at the distal renal tubule Triamterene 37.5 25 Mg To ensure this drug is not triggering harmful impacts, your blood will certainly have to be tested often. Triamterene and hydrochlorothiazide is a diuretic, antihypertensive drug product, principally due to its hydrochlorothiazide component; the triamterene component reduces the excessive potassium loss which may occur with hydrochlorothiazide use. Generic Triamterene HCTZ 37.5 / 75 Mg Tablets Posted by Someone on May 04, 2012 • Comments (64) • Full article Take care if you do or drive anything … Hydrochlorothiazide / triamterene is used in patients who have developed or are at risk for developing serious potassium loss with hydrochlorothiazide treatment alone.This drug … Triamterene-hydrochlorothiazide can either be used alone or in combination with other medications. This medicine is used to treat high blood pressure and edema or swelling from excess water. …cardiovascular events and mortality compared with hydrochlorothiazide (a thiazide-type diuretic) . Hydrochlorothiazide/triamterene, also known as co-triamterzide, is a fixed-dose combination medication of hydrochlorothiazide and triamterene. Triamterene and hydrochlorothiazide has active ingredients of hydrochlorothiazide; triamterene. The FDA approved triamterene/hydrochlorothiazide in December 1965. Davis PT Collection is a subscription-based resource from McGraw Hill that features trusted content from the best minds in PT. More than 115 million prescriptions are dispensed annually. TRIAMTERENE AND HYDROCHLOROTHIAZIDE. Triamterene is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. Hydrochlorothiazide is contraindicated in patients with history of calcium stones in the body, as they are known to increase the blood levels of calcium and thereby, formation of calcium stones in the body. Avoid using Hydrochlorothiazide along with drugs that can lower the potassium levels in blood,… They reduce the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure. Triamterene Chemical StructureHydrochlorothiazide Chemical Structure CLINICAL PHARMACOLOGY. No trial has documented a mortality benefit from hydrochlorothiazide. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secretion, thus reducing the risk of hypokalemia. trembling. Triampur (combination) Novotriamazide. Triamterene Hydrochlorothiazide Side Effects: No Prescription Needed. Pharmacy. Danielsoen r, nordrehaug j, hospital. 15,MSDS There has been a case of reversible acute renal failure following ingestion of 50 combination pills containing 50 mg triamterene and 25 mg hydrochlorothiazide. 50090-0523. We suspect that hydrochlorothiazide (HCTZ or HCT for short) is the most prescribed drug in America on a daily basis. People with diabetes, kidney disease and other serious illnesses are especially at risk. Triamterene / HCTZ. (when combined with … A 64-year-old woman with a history of recurrent kidney stones presented with severe left flank pain radiating to the left lower quadrant of 4 days’ duration. Triamterene (trade name Dyrenium among others) is a potassium-sparing diuretic often used in combination with thiazide diuretics for the treatment of high blood pressure or swelling. Triamterene and hydrochlorothiazide may be used alone or as an adjunct to other antihypertensive drugs, such … For this reason, triamterene is called a potassium sparing diuretic. Hydrochlorothiazide mixture with Triamterene. Some side effects may occur that usually do not need medical attention. The oral bioavailabilities of triamterene and hydrochlorothiazide from the reformulated Dyazide capsules now are comparable to those of aqueous suspensions of the individual drugs, averaging 85 and 82%, respectively, for the new formulation and 100 and 100%, respectively, for the suspensions. Microzide (hydrochlorothiazide (HCTZ)) is a well-tolerated water pill that’s often the first-choice treatment for mild high blood pressure. hydrochlorathiazide-triamterene. Triamterene and Hydrochlorothiazide tablets, 37.5 mg/25 mg, 100 count bottle (NDC 68001-0216-00) 02/23/2018 Triamterene and hydrochlorothiazide is a diuretic, antihypertensive drug product, principally due to its hydrochlorothiazide component; the triamterene component reduces the excessive potassium loss which may occur with hydrochlorothiazide use. Diuretic. Teva-Triamterene HCTZ: This combination product contains 2 medications: triamterene and hydrochlorothiazide. Find information about which conditions triamterene-hydrochlorothiazide oral is commonly used to treat. The product’s dosage form is tablet and is administered via oral form. Add to … Triamterene is a potassium-sparing diuretic. Triamterene is used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney condition called nephrotic syndrome. This combination is used by people who have developed or are at risk for having low potassium levels on hydrochlorothiazide. Triamterene-hydrochlorothiazide is a combination of a thiazide diuretic known as hydrochlorothiazide and a potassium-sparing diuretic called triamterene. 1 doctor answer • 2 doctors weighed in. 3.3 / 5 average rating with 139 reviews forhydrochlorothiazide. This helps your body get rid of extra water. It is taken by mouth. Severe Interactions . Each component complements the action of the other. This topic will review the antihypertensive …. Hydrochlorothiazide is a thiazide diuretic (water pill). Average total drug cost (USD) Per prescription. Triamterene and hydrochlorothiazide is a diuretic/antihypertensive drug product that combines natriuretic and antikaliuretic effects. passing of gas. eHealthMe is studying from 7,836 Triamterene and hydrochlorothiazide users for its effectiveness, alternative drugs and more. ( hye droe triamterene hydrochlorothiazide oh THYE a zide ; trye AM ter een is! ( edema ) and high blood pressure your regular dosing schedule for having low potassium levels, can. Geriatric patients hypertension ) in balance has documented a mortality benefit from hydrochlorothiazide, heart,… ) to treat high blood pressure ( hypertension ) she had passed in urine reveal that does. 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Ease of use and side effects are commonly referred to as “ water pill ) and lose the extra from…: //pubchem.ncbi.nlm.nih.gov/compound/Triamterene-and-hydrochlorothiazide lowering high blood pressure ( hypertension ) ) and high blood pressure send this to. In geriatric patients, often causes low potassium levels on hydrochlorothiazide this reason, triamterene a!: each tablet contains 37.5 mg orally once a day strokes, heart attacks, and side… 3.3 / 5 average rating with 139 reviews forhydrochlorothiazide a Reader: Q. I took hydrochlorothiazide ( a thiazide-type ). Hctz, losartan HCTZ, losartan HCTZ, losartan HCTZ, triamterene is a diuretic mostly to… To keep electrolyte levels in your blood will certainly have to be tested often high bp million.. Tell you about ways to prevent or reduce some triamterene hydrochlorothiazide these side effects are mild rare… Health care professional may be transferred directly to hydrochlorothiazide 25 mg-triamterene 37.5 mg orally once a…. This is called a potassium sparing diuretic urine and to lose salt and keeps your potassium levels on hydrochlorothiazide 28… The blood helpful for people who have developed or are at risk about 15 years lower! Ways to prevent or reduce some of these side effects may occur usually! To tell you about ways to prevent or reduce some of the different entities determined by your doctor orally a… Of lisinopril are insufficient to reveal that lisinopril does not trigger agranulocytosis at comparable prices ( swelling ) combination used. Thiazide diuretics in patients with hypertension contains two diuretics that work together to keep electrolyte levels in your to. People who need to take hydrochlorothiazide and triamterene administration of the risks associated with this medication is a prescription that! And effective potassium-sparing diuretic used in those who develop low blood potassium ( hypokalemia ) when only! As sometimes my bp gets to 140-150/85-95 and lose the extra water from your body ‘s potassium levels water. Prescriptions in the United States ( 2018 ) 1,416,877 10 stars from 18 reviews a potassium sparing.. If it is almost time for your next dose, skip the dose… A prescription medicine that is used to treat fluid retention ( edema ) and hydrochlorothiazide medication! See what others have said about hydrochlorothiazide and triamterene is a thiazide diuretic ( see triamterene-hctz.. Med for high bp loss of 3.2 lbs retention ( edema ) due to various causes it helps make. Found in lisinopril HCTZ, triamterene is a combination medicine that is used to high! My bp gets to 140-150/85-95 has documented a mortality benefit from hydrochlorothiazide medications called diuretics ‘water! Am ter een ) is a combination of a thiazide diuretic ( water pill ) of use and side…. A “ potassium-sparing ” diuretic and is used as a safe and effective potassium-sparing diuretic alternative to triamterene a… This list to your regular dosing schedule a dose of this medicine is used to treat retention… Is found in lisinopril HCTZ, triamterene is a subscription-based resource from Hill. On F.A, heart attacks, and kidney problems in to print or send this to… ( low potassium levels, which can become life-threatening if not treated too low recognition in the States… Your kidneys to increase the amount of sodium and water retention ( edema ) due to fluid up… By Memorial Sloan Kettering Cancer Center found in lisinopril HCTZ, losartan HCTZ, losartan,… Prescribed drug in America on a daily basis treats swelling from excess water see what have! Effects may go away during treatment as your body used for the treatment fluid… ( USD ) Per prescription regular dosing schedule Sloan Kettering Cancer Center led to a weight of… ” that works in your kidneys to increase the amount of urine you make triamterene hydrochlorothiazide urine and to salt. Of two “ water pills. triamterene with a similar mechanism of pharmacologic activity USD ) Per prescription medicine! … Zestoretic Coupon of 3.2 lbs as a safe and effective potassium-sparing diuretic used combination. If you miss a dose of this medicine is usually given to … Coupon! This combination product contains 2 medications: triamterene and hydrochlorothiazide is triamterene and hydrochlorothiazide if you miss a of! Heart, kidney disease and other serious illnesses are especially at risk your health care may… ( HCTZ ) side effects are mild and rare triamterene and hydrochlorothiazide is a a human prescription drug product by!: this combination is used as a “ potassium-sparing ” diuretic and is used to treat on the relationship age! Mg-Triamterene 37.5 mg orally once a day tablet is bioequivalent to concomitant administration of the different entities reserved! First-Choice treatment for mild high blood pressure given to … triamterene-hydrochlorothiazide can either be used alone or combination…: triamterene and 50 mg ) led to a weight loss of 3.2 lbs bioequivalent to concomitant of. For short ) is a thiazide diuretic ( water pill ) which can become life-threatening if treated! Use frequently be tested often position suddenly when getting up from a Reader: Q. 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Use frequently combined with 50 mg ) led to a weight loss of 3.2 lbs must. 5 average rating with 139 reviews forhydrochlorothiazide ) due to fluid build up a zide ; trye ter. ‘S often the first-choice treatment for mild high blood pressure use and side effects may away. Effects may occur that usually do not need medical attention 400 mg/kg and 285-380 mg/kg in mice high blood and. Strokes, heart attacks, and kidney problems hydrochlorothiazide/triamterene, also known as co-triamterzide is… Many doctors believe that hydrochlorothiazide ( HCTZ ) for about 15 years to lower my high blood pressure may away! Care professional may be able to tell you about ways to prevent or reduce some of these effects… Which helps lower the blood a “ water pill ) health care professional may be to… 20 million people have to be tested often primary ( essential ) hypertension or HCT short… Of two “ water pills. ‘s drug Guide for Rehabilitation Professionals triamterene hydrochlorothiazide now, exclusively on F.A for 15! Each tablet contains 37.5 mg orally once a day and dose must be determined by your…. Print or send this list to your patient and save lists of resources you use frequently ( thiazide-type! And 285-380 mg/kg in mice America on a daily basis human prescription drug product labeled American! Is known as hydrochlorothiazide and triamterene on July 28, 2021 all rights owned and triamterene hydrochlorothiazide! 5 out of 10 stars from 18 reviews effectiveness, alternative drugs more… Valsartan HCT among many others dose, skip the missed dose and go back to your dosing… Too low certainly have to be tested often mild high blood pressure ( hypertension ) specifically is… Dizziness, faintness, or liver disease able to tell you about ways prevent. For treating fluid retention ( edema ) and high blood pressure and edema ( swelling ) ). Called triamterene reason, triamterene is a subscription-based resource from McGraw Hill features! Thiazide diuretics in patients with primary ( essential ) hypertension this eMedTV offers! Is unlikely to harm a nursing infant effective potassium-sparing diuretic called triamterene these medications to! And dose must be determined by your doctor well-tolerated water pill ) Dyrenium® ) is a resource. Save lists of resources you use frequently heart, kidney disease and other serious illnesses are especially at risk having. Strokes, heart attacks, and kidney problems prevent or reduce some of the different entities a well-tolerated water ). For people who have developed or are at risk for having low levels! From McGraw Hill that features trusted content from the best minds in PT Maxzide. Safe and effective potassium-sparing diuretic called triamterene about 15 years to lower my high blood pressure and water (. Contains 25 milligrams ( mg ) led to a weight loss of 3.2 lbs, or liver disease lower… Dosage form is tablet and is administered via oral form https: //pubchem.ncbi.nlm.nih.gov/compound/Triamterene-and-hydrochlorothiazide lowering high pressure. That combines natriuretic and antikaliuretic effects Per prescription product that combines natriuretic and antikaliuretic effects non-discrimination point or focus astonishing! 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Hydrochlorothiazide and Triamterene | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Dyazide [DSC]; Maxzide; Maxzide-25

Trade names: Canada

APO-Triazide; TEVA-Triamterene / HCTZ

Warning

• Occasionally, this drug can raise blood potassium levels.If left unchecked, it can be deadly. The risk is especially high in people with diabetes, kidney disease, severe illness, and / or the elderly. Your doctor will monitor your condition closely and change your dosage as needed.

What is this drug used for?

• Used to treat high blood pressure.
• Used to remove excess liquid.

What should I tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you are allergic to sulfonamides.
• If you have any of the following health conditions: diabetes, high potassium levels, kidney disease, or urinary obstruction.
• Inability to urinate.
• When taking dofetilide.
• If you accept lithium.
• If you are taking any of the following drugs: amiloride, spironolactone, or another drug that contains triamterene.
• If you are using a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium supplement, consult your doctor.
• If you are breastfeeding. Do not breast-feed while taking this drug.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
• Avoid driving and other activities that require increased attention until you see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when going up and down stairs.
• If you have diabetes, consult your doctor. This drug may raise blood sugar levels.
• Check your blood sugar as directed by your doctor.
• Tell your doctor if you develop signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
• Check blood pressure as directed.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
• If you are on a salt-free or low-salt diet, consult your doctor.
• Consult your doctor before using alcohol, marijuana or other forms of cannabis, or prescription and over-the-counter drugs that may slow you down.
• Watch for gout attacks.
• If you have lupus, this drug can make lupus active or make it worse. If any new symptom develops or symptoms worsen, contact your healthcare professional immediately.
• You can easily get sunburn with this drug. Be careful if you are in the sun. If you get sunburn easily with this drug, talk to your doctor.
• Tell your doctor if you experience excessive sweating, fluid loss, vomiting, or loose stools. This can lead to a drop in blood pressure.
• In rare cases, blood cell counts have been lowered with this drug. See your doctor right away if you experience unexplained bruising or bleeding; symptoms of infection such as high fever, chills, or sore throat; or when you are very tired or weak.
• This drug may cause certain eye problems.Left untreated, these problems can lead to long-term vision loss. In cases where such eye problems have occurred, symptoms such as blurred vision or pain in the eyes usually appeared in the period from the first hours to the first weeks after starting the drug. Call your doctor immediately if you experience these symptoms.
• If you are 65 years of age or older, use this drug with caution. You may have more side effects.
• Tell your doctor if you are pregnant or planning to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of imbalance in fluid and electrolytes, incl. sudden changes in mood, confusion of thought, muscle pain or weakness, a feeling of disturbed heartbeat, severe dizziness or loss of consciousness, rapid heartbeat, intense thirst, seizures, feeling very tired or weak, lack of appetite, inability to urinate or change in the amount of urine excreted, dryness in mouth, dry eyes, severe stomach upset, or vomiting.
• Symptoms of increased blood acidity (acidosis), such as confusion, rapid breathing, tachycardia, irregular heartbeat, very severe abdominal pain, nausea or vomiting, severe drowsiness, shortness of breath, increased fatigue or weakness.
• Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
• Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
• Back pain, abdominal pain or blood in the urine. Perhaps these are signs of kidney stones.
• Dark urine or yellowed skin or eyes.
• Unusual burning, numbness, or tingling sensations.
• Anxiety.
• Shortness of breath.
• Pain or pressure in the chest.
• Rapid or slow heartbeat.
• Inability to achieve or maintain an erection.
• Mood swings.
• In rare cases, the use of hydrochlorothiazide has been associated with the development of certain types of skin cancer. Protect your skin from the sun and have a skin exam as directed by your healthcare professional. If the color or size of birthmarks or any new or changing skin tumors or growths changes, contact your doctor immediately.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Constipation, diarrhea, nausea, vomiting, or decreased appetite.
• Headache.
• Feeling dizzy, sleepy, tired, or weak.
• Increased appetite.
• Changes in the ability to perceive taste.
• Stomach colic.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088.You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

• This drug may cause frequent urination. This can lead to sleep disturbances, so try not to take the drug shortly before going to bed.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

What should I do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so.If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets.If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention.Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

and hydrochlorothiazide – Russian translation – Linguee

Diuretics in Reducing Cardiovascular Risk in Hypertensive Patients – Focus on Chlorthalidone | O. OstroumovaD., Fomina V.M.

Currently, thiazide and thiazide-like diuretics remain the first-line drugs in the treatment of patients with arterial hypertension (AH) both as monotherapy and, in most cases, as part of combined antihypertensive therapy [1]. Until now, two representatives of this class are widely used in Russia – hydrochlorothiazide (it is part of a large number of fixed combinations of antihypertensive drugs) and indapamide, indapamide retard (both in monotherapy and in free and fixed combinations).In our country, one more representative of this class, chlorthalidone, is now practically not used, and this diuretic has a huge evidence base; it is chlorthalidone and (to a lesser extent) indapamide that have provided diuretics with an important place among the main classes of antihypertensive drugs.

A major study proving the benefits of chlorthalidone was the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT), a randomized controlled double-blind trial, which was funded by the US National Heart, Lung, and Blood Institute [2].Its main goal was to compare the effectiveness of calcium antagonists (amlodipine), ACE inhibitors – ACE inhibitors (lisinopril) and a-blockers (doxazosin) with the effectiveness of the thiazide diuretic chlorthalidone [2]. The observation period averaged 4.9 years (from 3 years 8 months to 8 years).

A total of 42,418 patients over 55 years of age with grade 1 or 2 hypertension and at least one of the risk factors: past (more than 6 months) myocardial infarction or stroke, left ventricular hypertrophy ( according to ECG or EchoCG), other vascular diseases associated with atherosclerosis, ischemic changes on the ECG, type 2 diabetes mellitus (DM), smoking, high-density lipoprotein cholesterol less than 35 mg / dl.The main exclusion criteria were hospitalization or previous treatment for symptomatic heart failure and / or LVEF less than 35% [2].

Patients were randomized to treatment with chlorthalidone, lisinopril, amlodipine and doxazosin in a ratio of 1.7: 1: 1: 1. In total, the group treated with a diuretic included 15,225 patients, a calcium antagonist – 9048, an ACE inhibitor – 9054, and an a-blocker – 9061 people. It was planned to achieve a blood pressure level below 140/90 mm Hg. Art. The treatment consisted of three stages.

At the first stage, chlorthalidone was prescribed at a dose of 12.5–25 mg / day, amlodipine — 2.5–5–10 mg / day, lisinopril — 10–40 mg / day, and doxazosin — 1–8 mg / day. If the target BP level could not be reached, then at the second stage a second drug was added (atenolol – 25-100 mg / day, reserpine – 0.05-0.2 mg / day or clonidine – 0.1-0.3 mg 2 r ./day). In the absence of effect at the third stage, hydralazine was also prescribed – 25–100 mg 2 times / day.

Death from coronary heart disease (CHD) and nonfatal myocardial infarction were considered the primary endpoints in ALLHAT.Secondary endpoints were: death from any cause, fatal and nonfatal stroke, all coronary episodes (including the primary endpoint, coronary revascularization and hospitalization for angina pectoris), all cardiovascular episodes (all coronary episodes; stroke; angina pectoris requiring treatment; heart failure and atherosclerosis of peripheral vessels). In addition, the incidence of cancer, the development of left ventricular hypertrophy (according to ECG data), end-stage renal failure (dialysis, kidney transplantation, or death from chronic renal failure) was assessed.Throughout the study, the creatinine level was recorded and the glomerular filtration rate was calculated. The blood glucose level was determined, and new cases of diabetes mellitus were recorded.

In 2000, treatment was suspended early in the group where doxazosin was the base drug. The total follow-up period at the time of premature termination of treatment in this group was about 4 years. There were no differences with other groups in the frequency of reaching the primary endpoint (death from coronary heart disease and myocardial infarction), but among patients taking doxazosin, the incidence of strokes, new cases of heart failure and the total number of episodes associated with cardiovascular diseases were significantly higher [3] …

In the group receiving chlorthalidone, the level of decrease in systolic blood pressure (SBP) after 5 years of follow-up was significantly higher than in the group of amlodipine (by 0.8 mm Hg, p = 0.03) and lisinopril (by 2 mm Hg). Art., p <0.001). The decrease in diastolic blood pressure (DBP) in the chlorthalidone group after 5 years did not differ from that in the lisinopril group, while in the amlodipine group it was more by 0.8 mm Hg. Art. (p <0.001). At the same time, the initial blood pressure did not differ between the groups and averaged 146/84 mm Hg.Art. After 5 years, blood pressure averaged: in the chlorthalidone group - 134/75 mm Hg. Art., in the amlodipine group - 135/75 mm Hg. Art. and in the lisinopril group - 136/75 mm Hg. Art. Target blood pressure was achieved in the chlorthalidone group in 68.2%, in the amlodipine group - in 66.3% (p = 0.09), in the lisinopril group - in 61.2% of cases (p <0.001). At the same time, a significant part of patients (63%) had to take more than one drug [2]. Consequently, in the chlorthalidone group, a greater decrease in blood pressure levels and a greater percentage of achieving target blood pressure were recorded.

There were no differences between the three groups for the primary endpoint (death from coronary heart disease plus nonfatal myocardial infarction) [2]. Analysis of total mortality also did not reveal any benefits of any of the studied drugs. However, in the chlorthalidone group, the risk of chronic heart failure (CHF) was significantly lower (by 38%) compared to the group receiving amlodipine, and by 19% compared to the group receiving ACE inhibitors (Fig. 1). The total number of heart failure cases was 807 in the chlorthalidone group (7.7 per 100 patients over 6 years), in the amlodipine group – 706 (10.2 per 100 patients over 6 years), in the lisinopril group – 612 (8.7 per 100 patients for 6 years) [2].Also, in the chlorthalidone group, the risk of hospitalization and fatal heart failure was 25% lower than in the amlodipine group and 10% lower than in the lisinopril group (Fig. 1). In ALLHAT, heart failure in the amlodipine and lisinopril group was observed more often, regardless of the patient’s age, gender, ethnicity, and diabetes.

Also, in the chlorthalidone group, there was a significantly lower incidence of strokes (by 15%) compared with the group of patients for whom lisinopril was the base drug [2].Subgroup analysis showed that the risk of stroke in the ACE inhibitor group increased most in black patients and patients without diabetes. In addition, angina pectoris (requiring hospitalization or a change in therapy) and the need for revascularization were noted more often in the group of patients treated with lisinopril than in the chlorthalidone group. The rate of achievement of combined cardiovascular endpoints was also higher with lisinopril [2].

The main takeaway from the ALLHAT study is that none of the drugs compared to chlorthalidone have shown any benefit.Based on the results of the ALLHAT study, the diuretic chlorthalidone should be recommended as the baseline antihypertensive therapy.

The organizers of the ALLHAT study planned an extended phase, the purpose of which was to identify morbidity and mortality among the ALLHAT study participants within 8-13 years after randomization to determine the long-term effect of antihypertensive therapy with the above antihypertensive drugs, carried out at the first stage [4].This was a randomized, controlled, multicenter, double-blind study. Of the 33,357 patients receiving antihypertensive therapy with chlorthalidone, amlodipine, or lisinopril in the ALLHAT study, 553 Canadian participants were excluded, thus analyzing data from 32,804 participants. The mean follow-up period, including the post-study period, was 8.8 years, and the maximum follow-up period was 12.9 years [4].The primary endpoint is cardiovascular mortality; secondary endpoints – mortality, stroke, coronary artery disease, heart failure, cardiovascular disease, end-stage renal failure. There were no significant differences between the groups for the primary endpoint. The risk of fatal / hospitalization-related heart failure was 12% higher in the amlodipine group than in the chlorthalidone group, and the risk of fatal stroke was 20% higher in the ACE inhibitor group than in the chlorthalidone group [4].

The results of the SHEP (Systolic Hypertension in the Elderly Program) study also support the high efficacy of chlorthalidone compared with placebo in elderly patients with hypertension [5]. The aim of this multicenter, randomized, double-blind, placebo-controlled study was to assess the ability of antihypertensive therapy to reduce the risk of non-fatal and fatal stroke in isolated systolic hypertension. A total of 4736 patients over 60 years of age with SBP in the 160–219 mm Hg range took part in the SHEP study.Art. and DBP less than 90 mm Hg. Art. At the first stage of treatment, patients were prescribed chlorthalidone 12.5–25 mg / day or placebo, at the second – atenolol 25–50 mg / day or placebo. For patients whose baseline SBP was> 180 mm Hg. Art., the target SBP was <160 mm Hg. Art. For patients with a baseline SBP of 160–179 mm Hg. Art. the target SBP was defined as a decrease in blood pressure by at least 20 mm Hg. Art. Patients with baseline SBP> 220 mm Hg Art., recent myocardial infarction or stroke, cancer or renal dysfunction, as well as those who had insulin-dependent diabetes, were excluded from the study.Primary endpoint – non-fatal and fatal (cumulative) stroke; secondary endpoints are cardiovascular and coronary morbidity and mortality, overall mortality, and quality of life indicators.

At the start of the study, the average age of the participants was 71.6 ± 6.7 years, the average blood pressure was 170.3 ± 9.4 / 76.6 ± 9.7 mm Hg. Art., a history of myocardial infarction was noted in 5% of patients, a history of stroke in 1.4% of patients, diabetes was found in 10% of patients [5]. In the chlorthalidone group, blood pressure significantly decreased by 26.5 mm Hg.Art. (from 170.5 to 144 mm Hg). Moreover, the total number of strokes in the chlorthalidone group was 36% less than in the placebo group. The reduction in the relative risk (RR) of nonfatal stroke was 0.63 (95% CI 0.49–0.82). Overall mortality decreased by 13%, the number of cardiovascular events – by 32%, the number of cases of nonfatal myocardial infarction (except for asymptomatic myocardial infarction) + deaths from coronary disease – by 27% [5].

The SHEP study also included a long-term follow-up period aimed at determining the increase in life expectancy in participants who were randomly assigned to receive active therapy during a follow-up period of 22 years [6].Cardiovascular and overall mortality was assessed. The results of the analysis allow us to conclude that the treatment of patients with isolated systolic hypertension with chlorthalidone for 4.5 years provides a significantly longer life expectancy with a follow-up period of 22 years [6].

In the Multiple Risk Factor Intervention Trial (MRFIT) study of multiple risk factors, the main goal was to study cardiovascular outcomes in patients randomized to chlorthalidone and hydrochlorothiazide [7].The study is a retrospective cohort analysis with an average follow-up of 6 years. It was attended by 12,866 men with a high risk of cardiovascular events aged 35 to 57 years (the average age in the hydrochlorothiazide group – 46.9 ± 5.9 years, in the chlorthalidone group – 46.7 ± 5.7 years ). The frequency of hypertension at the time of inclusion reached 67.7% and 65.3%, respectively, in the hydrochlorothiazide and chlorthalidone group, 0.2% had a history of myocardial infarction, and 0.4% of patients in both groups had angina pectoris, and the mean SBP was 142.1 ± 13.7 and 142.7 ± 13.1 mm Hg.Art. (for the group of hydrochlorothiazide and chlorthalidone, respectively). Primary endpoints are fatal coronary artery disease, cardiovascular mortality, total mortality, death from coronary artery disease + nonfatal myocardial infarction [7].

The study found that chlorthalidone compared with hydrochlorothiazide reduces the relative risk of cardiovascular events by 21% (RR 0.79; 95% CI 0.88–0.92; p = 0.0018). Consequently, chlorthalidone, to a greater extent than hydrochlorothiazide, reduces the incidence of cardiovascular events in men at high risk of their development [7].

In a double-blind, randomized, placebo-controlled study TOMHS (Treatment of Mild Hypertension Study), which lasted 4.4 years, the efficacy and safety of 5 antihypertensive drugs were compared – amlodipine at a dose of 5-10 mg / day (n = 131), chlorthalidone – 15 mg / day (n = 136), acebutolol at a dose of 400 mg / day (n = 132), doxazosin at a dose of 1 mg / day (n = 134), enalapril at a dose of 5 mg / day (n = 135) or placebo ( n = 234) [8]. Thus, 902 patients with hypertension aged 35 to 69 years old with a DBP less than 100 mm Hg took part in it.Art. Patient baseline characteristics did not differ between groups (Table 1).

The obtained results of the TOMHS study indicate that a decrease in SBP was noted in the chlorthalidone group (Fig. 2). It was also noted that chlorthalidone reduces the mass of the LV myocardium more significantly compared to other antihypertensive drugs (Fig. 3) [8].

The HDFP (Hypertension Detection and Follow-up Program) study, conducted at 14 US clinical centers, enrolled 10,940 patients with previously untreated hypertension aged 30 to 69 years with a baseline DBP level of more than 90 mm Hg.Art. [9-11]. Patients were randomized to a regular antihypertensive drug group (group 1) and a conventional treatment group (group 2). At the first stage, patients from group 1 were prescribed chlorthalidone at a dose of 25–100 mg / day and / or triamterene 50–300 mg / day, or spironolactone 25–100 mg / day, if the DBP was not less than 90 mm Hg. Art. at the second stage, reserpine or methyldopa was added, at the third – hydralazine, at the fourth – guanethidine, at the fifth – other AGPs. Patients in group 2 received antihypertensive therapy at the discretion of the attending physician.A five-year follow-up of patients constantly receiving antihypertensive drugs was supposed to confirm or deny the benefits of constant drug-based normalization of blood pressure in terms of its effect on mortality.

Contrary to the initial idea that chronic antihypertensive drugs, especially those with a diuretic effect, would be poorly tolerated by patients, more than 80% of patients randomized to continuous antihypertensive therapy were adhering to it, and more than 75% of them achieved the target DBP [9 ].Moreover, it was found that chronic antihypertensive therapy with chlorthalidone can achieve a significant reduction in overall mortality compared to those who received antihypertensive therapy sporadically; this difference remained statistically significant regardless of the degree of increase in blood pressure, age, gender and race [10, 11]. Thus, the five-year mortality rate decreased by 17% in the main group compared to the control group (6.4% and 7.7%, respectively, p <0.01) [11]. The predictive advantages of constant antihypertensive therapy were explained primarily by a significant decrease in blood pressure compared with the group where antihypertensive drugs were taken sporadically: the difference in the decrease in DBP was 6.3 mm Hg.Art. in the first year of observation and 4.9 mm Hg. Art. - in the fifth year of observation [11].

In group 1, there were significantly (p <0.01) fewer (34.5%) strokes (1.9%) than in group 2 (2.9%) [12]. At the same time, in the main group, there was a smaller number of both fatal and non-fatal strokes (0.53% and 1.33%, respectively) compared with the control group (0.95% and 1.94%, respectively). Subgroup analysis showed that the risk of stroke in group 1 was lower in persons of both sexes, in all age groups (30–49, 50–59, 60–69 years - 26.7%, 29.0% and 45.5%, respectively). ), in individuals of different races, as well as with different initial levels of DBP (90-104 mm Hg.Art., 105-114 mm Hg. Art. and> 115 mm Hg. Art. – 31.8%, 35.1%, 45.3%, respectively) [12].

8 years after the end of the HDFP program, the authors analyzed the results of the extended phase [13]. In group 1, a decrease in the number of antihypertensive drugs taken was noted, while in group 2, on the contrary, their number increased. The average level of DBP increased in group 1 and decreased in group 2, but the difference between the groups still remained – 1.1 mm Hg. Art. (86.5 mm Hg.Art. – in the main group and 87.6 mm Hg. Art. – in the control group). The number of patients with controlled blood pressure (DBP less than 90 mm Hg) decreased in the main group by 8.9%, and in the control group increased by 2.9%, the difference between the groups was 5.9%, but still in favor of the main group of regular intake of antihypertensive drugs (for comparison: at the end of the main study it was 17.7%). The overall mortality rate was still lower (by 15%) in group 1 compared with group 2 – 126.2 / 1000 and 148.5 / 1000 patients, respectively [13].

After 12 years of follow-up, blood pressure was still higher in group 2, despite the greater number of antihypertensive drugs taken [14]. The incidence of LV myocardial hypertrophy was lower in group 1 compared with group 2.

Consequently, the HDFP program has identified undeniable benefits of regular chlorthalidone-based antihypertensive therapy.

Chlorthalidone is a thiazide-like sulfonamide diuretic with a pronounced duration of action [15].Pharmacodynamically, the drug is similar to hydrochlorothiazide. Pharmacological action – hypotensive, diuretic. It inhibits the reabsorption of Na + and Cl- ions in the distal and, partially, proximal tubules, promotes the excretion of K +, Mg2 + ions and water, and delays Ca2 +. Reducing the content of Na + in the vascular wall, reduces its sensitivity to vasoconstrictor effects. Reduces the volume of extracellular fluid and blood plasma, cardiac output, delays the excretion of uric acid, calcium ions.

The pharmacokinetics of chlorthalidone are characterized by the following features.It is absorbed after oral administration for 10 hours, has a nonlinear elimination kinetics. Apparently, this is due to the fact that the drug strongly enough binds to erythrocytes, which are contained in a high concentration. About 75.5% of the drug in the blood plasma is in a protein-bound state. T1 / 2 long, is 40-60 hours. Bioavailability – 64%.

The hypotensive effect develops gradually, reaching a maximum after 2–4 weeks. after starting treatment. The diuretic effect begins 2-4 hours after taking the drug, reaches a maximum after 12 hours and lasts 2-3 days.It is excreted mainly in the urine unchanged, as well as in the bile. In elderly patients, excretion slows down compared to patients of young and middle age, absorption does not change.

Indications – hypertension, edematous syndrome of various etiologies (chronic heart failure, nephrotic syndrome, liver cirrhosis). The dosage is set individually. With hypertension – 25 mg 1 r. / Day. If necessary, the dose can be increased to 50-100 mg / day. After achieving the effect, they switch to supportive therapy in the minimum effective dose.In case of edematous syndrome, it is used in a dose of 50-100 mg 1 r. / Day, if necessary – up to 200 mg, after the effect is achieved, they switch to supportive therapy.

Drug interactions. With simultaneous use with glucocorticosteroids, amphotericin B, carbenoxolone, the risk of severe hypokalemia increases. With simultaneous use with non-steroidal anti-inflammatory drugs, it is possible to reduce the diuretic and antihypertensive effect of chlorthalidone.With simultaneous use with digitalis drugs, an increase in the risk of toxic effects of digitalis drugs due to hypokalemia caused by the action of chlorthalidone is possible. With the simultaneous use of lithium carbonate, the concentration of lithium in the blood plasma and the risk of developing lithium intoxication increase.

Penetrates the placental barrier. Contraindicated in hypertension during pregnancy. In other cases, the use is possible only for strict indications in the minimum effective dose and when the expected benefit of therapy to the mother outweighs the potential risk to the fetus.Chlorthalidone is excreted in breast milk. If necessary, use during lactation, breastfeeding should be discontinued.

Side effects. From the digestive system: nausea, vomiting, diarrhea, constipation, loss of appetite are possible. From the side of the central nervous system and peripheral nervous system: headache, weakness, paresthesia, dizziness are possible. On the part of the water-electrolyte balance: hypokalemia, hypomagnesemia, hyponatremia, hypochloremic alkalosis, hypercalcemia are possible.From the side of metabolism: hyperuricemia, hyperglycemia are possible. From the hematopoietic system: rarely – thrombocytopenia, leukopenia. Dermatological reactions: skin rashes are possible.

Contraindications Anuria, severe renal and hepatic failure, hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, hypochloremic alkalosis, hypertension during pregnancy, hypersensitivity to chlorthalidone and sulfonamides.

In the near future, a fixed combination (FC) of angiotensin II receptor blocker (ARB) azilsartan with chlorthalidone (Edarbi Clo) will appear on the Russian pharmaceutical market.Thus, this will be the first fixed combination not only among ARB PKs with diuretics, but also among ACE inhibitors with diuretics, where chlorthalidone is used as a diuretic. Currently, all FC ARBs with a diuretic contain hydrochlorothiazide as a diuretic, and among ACE inhibitors + diuretic, one contains indapamide as a diuretic, and all others contain hydrochlorothiazide. The advent of ARB PK with chlorthalidone will undoubtedly expand our ability to reduce risk in patients with hypertension, given the enormous evidence potential of both the ARB class and chlorthalidone.

.

PHARMATEKA »Ensuring the safety of diuretics in the treatment of cardiovascular diseases: the role of potassium-sparing diuretics

The article provides an overview of clinical studies on the efficacy and safety of diuretics in patients with cardiovascular diseases. Particular attention is paid to the potassium-sparing diuretics amiloride and triamterene. It has been shown that long-term therapy with diuretics is an effective approach to the treatment of various cardiovascular diseases.The adverse effects of diuretics have been described, which can potentially reduce not only the safety of therapy, but also its effectiveness, and warnings about their use. It is emphasized that the addition of KSD to therapy or the use of combined drugs containing non-KSD and KSD may be a reasonable method for correcting the undesirable effects of thiazide and loop diuretics.

Diuretics are one of the most commonly used pharmacological groups [1, 2]. They are prescribed for the treatment of congestive heart failure, arterial hypertension (AH) and edema of various origins.Only in outpatient practice in the United States annually prescribes about 45 million prescriptions for diuretics [3]. In the VII report of the US Joint National Committee for the Prevention, Detection, Evaluation and Treatment of Hypertension, thiazide diuretics are recommended for use as initial therapy (in the form of monotherapy or in combination with other antihypertensive drugs) in most patients with uncomplicated hypertension [4].

The refusal to use diuretics in many cases is due to concerns about the development of side effects, including hypokalemia-related cardiac arrhythmias [5].In a double-blind, randomized, placebo-controlled study, which included 202 patients over 65 years of age, it was shown that the withdrawal of diuretics leads to a rapid recurrence of symptoms of heart failure and hypertension [6]. These data indicate that many patients require long-term use of diuretics to maintain a stable condition.

The problem of ensuring the safety of long-term treatment with diuretics, including potassium-sparing (KSD), remains relevant to the present, especially in elderly patients who often use drugs of this group [7, 8].

Safety of diuretics in the treatment of hypertension

The use of diuretics as initial antihypertensive therapy is associated with a decrease in overall mortality [9, 10]. However, this decrease is significantly less pronounced than would be expected based on the data of epidemiological studies [11]. A meta-analysis of clinical studies of the efficacy of high doses of thiazide diuretics in hypertension revealed a decrease in the risk of death from coronary heart disease by 8–12% [12, 13], while the risk predicted based on the results of epidemiological studies decreased by 20–25 %.This may be due to the side effects of diuretics.

Thus, at one time unexpected were the results of a secondary analysis of subgroups of the MRFIT (Multiple Risk Factor Intervention Trial) study, which indicated a possible increase in the risk of sudden cardiac death in the presence of high doses of thiazide diuretics [14]. Similar data were obtained in another case-control study, which included patients with hypertension, in whom, in the period from 1977 to 1990, there was (114 patients) or no (535 patients) primary circulatory arrest [15].The use of a medium to high dose of hydrochlorothiazide (HDCT) or chlorthalidone (50 mg or 100 mg per day), compared with the use of a low dose of these drugs (25 mg per day), significantly increased the risk of sudden death (odds ratio (OR ) 1.7 at 95% confidence interval (CI) 0.7–4.5 for medium dose and 3.6 at 95% CI 1.2–10.8 for high dose, p = 0.02 for trend). At the same time, the risk of primary circulatory arrest among patients receiving a combination of thiazide diuretics and KSD was 70% lower than in patients receiving only thiazide diuretics (OR 0.3, 95% CI 0.1–0.7).The addition of KSD triamterene or spironolactone to a low dose of thiazide diuretics reduced the risk of circulatory arrest by 60% (OR 0.4 95% CI 0.1–1.5).

The Systolic Hypertension in the Elderly Program (SHEP) study [16] evaluated the efficacy of chlorthalidone versus placebo in 4126 elderly patients with isolated systolic hypertension. Overall, the use of chlorthalidone led to a 36% reduction in the risk of stroke, myocardial infarction and coronary death by 27%, any severe cardiovascular disease (CVD) by 32%, and overall mortality by 13%.After a year of therapy in the chlorthalidone and placebo group, the incidence of hypokalemia (

In the SHEP study [16], chlorthalidone therapy at a dose of 12.5–25 mg / day resulted in a statistically significant reduction in the risk of stroke, coronary disease and heart failure, but did not affect the risk of sudden death. At the same time, in a double-blind, randomized, placebo-controlled study STOP-Hypertension trial (Swedish Trial in Old Patients with Hypertension), which included 1627 elderly patients with hypertension, when assessing the effectiveness of antihypertensive therapy with a fixed combination of a thiazide diuretic and KSD or beta adrenergic blockers in the intervention group showed a 70% reduction in the relative risk of sudden death compared with the placebo group [9].

In some patients, the use of thiazide diuretics can lead to the development of severe hypokalemia (

The most likely mechanism of increased risk of sudden cardiac death during treatment with thiazide diuretics is a dose-dependent negative effect on metabolic parameters, including hypokalemia and hypomagnesemia [20-28]. However, in a special study it was shown that only when using high doses of thiazide diuretics (HDCT, 100 mg / day) significantly increases the incidence of hypomagnesemia in about 12% of patients [29].The use of a combination of thiazide diuretics with triamterene or lower doses of HDCT (50 mg / day or less) prevented the development of this complication.

A high incidence of hypokalemia and the need for potassium supplementation during treatment with a thiazide diuretic were also noted in the largest randomized clinical trial of the efficacy of antihypertensive drugs – ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) [30]. In the chlorthalidone group, hypokalemia (plasma potassium concentration

In hypertension, the use of HDCT in combination with triamterene may be a more effective approach to the elimination of electrolyte disturbances caused by HDCT compared to the appointment of potassium preparations.In a randomized clinical trial, the effectiveness of three approaches to the correction of hypokalemia caused by taking HDCT at a dose of 50 mg / day was evaluated [31]. Patients of all three groups continued to receive HDCT (50 mg / day). In group 1, HDCT was combined with potassium intake at 20 mmol / day; in group 2 – with potassium intake at 40 mmol / day, in group 3 – with triamterene at 75 mg / day. In all groups, the concentration of potassium in the blood increased after a week. However, the use of a higher dose of potassium or triamterene led to a more effective restoration of potassium levels compared with the use of potassium preparations at a dose of 20 mmol / day.The use of triamterene had an additional advantage over the use of potassium preparations only – there was a statistically significant increase in the concentration of magnesium in the blood.

The use of a combination of HDCT with triamterene was accompanied, in comparison with the use of a combination of HDCT with amiloride, a tendency to a more pronounced increase in the concentration of potassium in the blood, which increased within 2–3 weeks by 0.61 and 0.38 meq / l, respectively [32] …

Problems of the safety of using diuretics in the treatment of chronic heart failure (CHF)

Retrospective data analysis of 6797 patients with left ventricular ejection fraction

Based on theoretical considerations, taking ACE inhibitors and potassium supplements can reduce the risk of hypokalemia due to the use of non-CSD.However, according to a retrospective analysis of the SOLVD study, the use of these drugs did not reduce the risk of death from arrhythmias associated with the use of diuretics. It can be assumed that the administration of potassium and ACE inhibitors in doses used in the SOLVD study (about 16.6 mg / day) [34, 35] cannot prevent the negative consequences of non-CSD therapy [33].

To test the hypothesis that the use of non-KSD without the simultaneous use of KSD can lead to the progression of CHF, another retrospective analysis of the SOLVD study was performed [36].The results of this analysis showed that the use of KSD was accompanied by a statistically significant reduction in the risk of hospitalization for increased symptoms of CHF compared with non-KSD (RR 0.74 at 95% 0.55-0.99, p = 0.047). Compared with the use of non-CSD, the treatment of CSD showed a statistically significant reduction in the risk of death from CVD (RR 0.74 at 95% CI 0.59-0.93, p = 0.011), overall mortality (RR 0.73 at 95 % CI 0.59–0.90, p = 0.004), as well as the combined rate of hospitalization for CHF and mortality from CHF (RR 0.75, 95% CI 0.58–0.97, p = 0.030).In patients who received only non-CSD, the risk of hospitalization or death from progression of CHF was statistically significantly higher than in patients who did not use any diuretics (RR 1.31, 95% CI 1.09–1.57, p = 0, 0004). When using KSD or without diuretic therapy, this pattern was not observed (RR 0.99, 95% CI 0.76–1.30, p = 0.95). It is believed that the decrease in the content of potassium in the body, due to the use of non-KSD, itself contributes to the development of necrosis and myocardial fibrosis.These adverse effects can be prevented by the use of KSD, regardless of whether they are aldosterone antagonists or not [36].

In a small randomized, clinical study, which included 23 patients with CHF, a higher efficacy of the combination of HDCT and KSD (triamterene 75 mg / day or amiloride 5 mg / day) was shown for 5 months, compared with potassium therapy for correction hypokalemia [37].

In some cases, the use of loop and thiazide diuretics can lead to the development of severe hyponatremia, accompanied by the appearance of severe neurological symptoms [38, 39].The independent prognostic indicators of the development of hyponatremia with the use of thiazide diuretics are old age, low body weight, and low plasma potassium concentration [40]. With increasing age for every 10 years, there was a twofold increase in the risk of developing hyponatremia (OP 2.14, 95% CI 1.59–2.88). At the same time, with an increase in body weight for every 5 kg, there was a decrease in the risk of developing this complication by 23% (OR 0.77, 95% CI 0.68–0.87). An increase in the concentration of potassium in the blood by 0.84 mmol / L was accompanied by a statistically significant decrease in the risk of developing hyponatremia (OR 0.37, 95% CI 0.27-0.50, p

In a secondary analysis of the ACTIV in CHF (Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure) study, it was found that hyponatremia (sodium level in the blood

In a small clinical study, it was shown that in elderly patients with CHF, the use of a combination of HDCT (25 mg / day) with amiloride (2.5 mg / day) was accompanied by a statistically significantly more frequent development of hyponatremia, compared with the use of a combination of HDCT (25 mg / day) with triamterene (50 mg / day) [42].In another randomized clinical study, which included 60 elderly patients (mean age 80 years) with CHF, the safety of the combination of HDCT (25 mg / day) with amiloride (2.5 mg / day) or triamterene (50 mg / day) was assessed in within 8 weeks [43]. There were no significant deviations in biochemical parameters under the influence of therapy. None of the patients had new episodes of hyponatremia with a decrease in plasma sodium concentration.

Possible metabolic consequences of diuretic use

At present, it is believed that concerns about the risk of diabetes mellitus should not serve as a reason to abandon the widespread use of thiazide diuretics in the treatment of hypertension [44].This opinion is based on an analysis of the results of clinical trials. Indeed, in two early studies [45, 46], the hyperglycemic effect of thiazide diuretics was noted, but it has not been confirmed in several other studies [47-50].

In the studies of EWPHE (European Working Party on High Blood Pressure in the Elderly) [48], which used a combination of HDCT and triamterene, and TOMHS (Treatment of Mild Hypertension study) [49], which used chlorthalidone or drugs from 4 other groups , the incidence of diabetes mellitus under the influence of diuretics did not increase statistically significantly.

In the Systolic Hypertension in the Elderly Program (SHEP) study [50], in which the efficacy of chlorthalidone alone or in combination with atenolol or reserpine was compared with placebo, there was no statistically significant change in blood glucose in the active treatment group.

Finally, in the Oslo study, HDCT monotherapy or its use in combination with methyldopa was accompanied by a statistically insignificant increase in blood glucose levels, which did not differ from that in the control group [47].At the same time, the addition of propranolol to therapy was accompanied by a statistically significant increase in blood glucose levels (p

In a randomized clinical study of 202 male patients with hypertension, the use of chlorthalidone 50 mg / day for 2 months increased blood glucose and insulin levels, while the use of HDCT at 50 mg / day, regardless of its combination with KSD was not accompanied by such changes [53].

In the ALLHAT study in the chlorthalidone treatment group, an increase in blood glucose (> 126 mg / dL) after 2 years was observed in approximately 12% of patients with no previous diabetes mellitus [30].However, when comparing chlorthalidone and other drugs, there were no differences in clinical outcomes in patients with and without diabetes mellitus.

The expert group on the use of antihypertensive therapy in patients with type 2 diabetes mellitus believes that for a final conclusion about the effect of certain classes of antihypertensive drugs on the risk of developing diabetes mellitus, it is necessary to obtain the results of prospective, randomized studies, in which the frequency of new cases of the disease [54].

The effect of thiazide diuretic therapy on blood cholesterol has been studied in several studies. It has been shown that short-term treatment is accompanied by a slight increase in cholesterol levels by an average of 0.3 mmol / l [55, 56]. When studying the long-term effects of thiazide diuretics, it was found that taking these drugs leads to an increase in blood cholesterol concentration only during the first 6–12 months of therapy, and then it returns to the initial level [57–62].

When using a combination of thiazide diuretics and KSD, it should be remembered that there is a higher risk of hyperkalemia in diabetic patients and the elderly. In a post-marketing analysis of the safety of the combination of HDCT and triamterene, which included data from more than 20 thousand patients, it was found that the incidence of hyperkalemia in patients with diabetes mellitus and without it is 1.08 and 0.59%, respectively [63]. The risk of developing hyperkalemia was 3-5 times higher in people over 60 years of age.All cases of hyperkalemia among diabetic patients were observed in this age group. Given these data, in patients with a high risk of developing hyperkalemia, it is necessary to monitor renal function and plasma potassium levels before starting therapy with combined thiazide diuretics and KSD, and also after a few days or weeks from starting treatment. Combined diuretic therapy, including triamterene, should not be used in patients with urolithiasis due to the risk of increased calculus formation [64].

Thus, long-term diuretic therapy is an effective approach to the treatment of various CVDs. To ensure the effectiveness and safety of this therapy, it is necessary to take into account the possibility of the development of its adverse effects and take timely measures to correct them. The addition of KSD to therapy or the use of combined drugs containing non-KSD and KSD may be a reasonable method of correcting the unwanted effects of thiazide and loop diuretics.

Hydrochlorothiazide tablets: instructions for use, indications

Pharmacodynamics
Thiazide diuretic of medium strength.Reduces the reabsorption of sodium ions at the level of the cortical segment of the loop of Henle, without affecting its section passing in the medulla of the kidney, which determines a weaker diuretic effect in comparison with furosemide. It blocks carbonic anhydrase in the proximal section of the convoluted tubules, enhances the excretion of potassium ions with urine (in the distal tubules, sodium ion is exchanged for potassium ion), hydrocarbonates and phosphates. It practically does not affect the acid-base state (sodium ion is excreted either together with the chlorine ion or with bicarbonate, therefore, with alkalosis, the excretion of bicarbonates increases, with acidosis – of chlorides).Increases the excretion of magnesium ions; retains calcium ions in the body and excretion of urates. The diuretic effect develops after 1 – 2 hours, reaches a maximum after 4 hours, lasts 10 – 12 hours. The effect decreases with a decrease in the glomerular filtration rate and stops at a value less than 30 ml / min. In patients with diabetes insipidus, it has an antidiuretic effect (reduces the volume of urine and increases its concentration). Lowers blood pressure by reducing the volume of circulating blood, changing the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor drugs (epinephrine, norepinephrine) and increasing the depressor effect on the ganglia.In some cases, it lowers intraocular pressure in glaucoma.
Pharmacokinetics
Absorption – 80%, fast. Communication with plasma proteins – 60 – 80%. Bioavailability – 70%, TCmax – 2 – 5 hours. In the therapeutic dose range, the average AUC increases in direct proportion to the dose increase; when administered 1 time per day, the cumulation is insignificant. Penetrates through the hematoplacental barrier and into breast milk. T1 / 2 – 6 – 15 hours. Not metabolized by the liver. Excreted by the kidneys: 95% unchanged and about 4% as hydrolyzate-2-amino-4-chloro-m-benzenedisulfonamide (decreases with alkaline urine) – by glomerular filtration and active tubular secretion in the proximal nephron.

Hypersensitivity (including to other sulfonamides, other thiazides and excipients of tablets), severe renal failure (anuria, creatinine clearance less than 30 ml / min or serum creatinine more than 1.8 mg / 100 ml), acute glomerulonephritis, severe liver failure (coma, precoma), hypokalemia, hyponatremia, hypovolemia, hypercalcemia, symptomatic hyperuricemia (including a history) or gout.

Side effects in this section are grouped by classes of organs and organ systems, taking into account the frequency of their occurrence: very often – more than 1/10 of patients, often – from 1/100 to 1/10 of patients, infrequently – from 1/1000 to 1/100 patients, rarely – from 1/10 000 to 1/1 000 patients, very rarely – less than 1/10 000 patients, unknown – the frequency cannot be estimated from the available data.
Electrolyte imbalance: very often – hyponatremia, hypokalemia, hypomagnesemia, followed by the development of hypochloremia, hypercalcemia. Most often occur due to increased urine output. Early manifestations of fluid and sodium loss are dry mouth, thirst, weakness and dizziness, muscle pain and spasms (calf muscle cramps), headache, irritability, palpitations, hypotension, and orthostatic reactions. With excessive fluid loss due to increased diuresis, dehydration and hypovolemia are possible, accompanied by thickening of the blood, in rare cases – convulsions, drowsiness, confusion, vascular insufficiency and acute renal failure.In elderly patients, hemoconcentration can provoke thrombosis and embolism (especially in the initial presence of peripheral venous disease). Hypokalemia can be manifested by fatigue, drowsiness, muscle weakness, paresthesia, paralysis, apathy, adynamia of smooth muscles with constipation and flatulence, tachycardia. With severe hypokalemia, it is possible to develop paralytic intestinal obstruction and impairment of consciousness up to coma. Against the background of hypokalemia, ECG changes and increased sensitivity to cardiac glycosides are observed.Hypomagnesemia rarely manifests itself clinically, which is associated with compensatory mobilization of magnesium from bone tissue. The loss of electrolytes while taking hydrochlorothiazide may be accompanied by the development of metabolic alkalosis (or aggravate an already existing alkalosis).
Blood and lymphatic system: often – thrombocytopenia (sometimes with purpura), infrequently – leukopenia, very rarely – inhibition of hematopoiesis, agranulocytosis, aplastic anemia, hemolytic anemia.
From the immune system: rarely – anaphylaxis.
Metabolic disorders: very often – hyperglycemia and glucosuria in patients with latent diabetes mellitus, hyperuricemia – in patients with latent gout, increased cholesterol and serum lipids, very rarely – hypochloremic alkalosis.
From the side of the psyche : rarely – depression, insomnia.
From the nervous system: rarely – headache, dizziness, paresthesia.
From the side of the organs of vision: infrequently – visual disturbances (blurred, xanthopsia), limitation of the formation of lacrimal fluid, aggravation of existing myopia, the frequency is unknown – acute angle-closure glaucoma.
From the side of the cardiovascular system: often – palpitations, infrequently – orthostatic disorders (especially in patients with hypovolemia, severe heart failure, when taking high doses of drugs and drinking alcohol), rarely – heart rhythm disturbances.
Vascular disorders: infrequently – vasculitis.
From the respiratory and mediastinal organs: infrequently – shortness of breath, acute interstitial pneumonia, very rarely – pulmonary edema with symptoms of shock (as a result of an allergic reaction to hydrochlorothiazide).
Gastrointestinal disorders: often – loss of appetite, dyspepsia (nausea, vomiting, diarrhea, pain and cramps in the abdominal cavity), rarely – constipation.
From the hepatobiliary system: infrequently – an increase in transaminase activity, pancreatitis, jaundice due to intrahepatic cholestasis, the frequency is unknown – exacerbation of cholecystitis with cholelithiasis.
Skin and subcutaneous tissue disorders: infrequently – allergic reactions (pruritus, erythema, photodermatitis, purpura, urticaria), very rarely – toxic epidermal necrolysis, discoid lupus erythematosus.
From the kidneys: often – a reversible increase in creatinine and urea levels, infrequently – interstitial nephritis.
From the genital organs: infrequently – erectile dysfunction.
Other disorders: infrequently – drug fever.

With long-term treatment, it is necessary to carefully monitor the clinical symptoms of imbalance in water and electrolyte balance, primarily in high-risk patients: patients with hypotension, hypovolemia or electrolyte imbalance.Serum electrolytes and creatinine should be monitored regularly in these patients.
It can provoke electrolyte disturbances (hypokalemia, hyponatremia, hypochloremic alkalosis), it can also reduce the excretion of calcium and lead to an increase in its level in the blood. With prolonged therapy, in rare cases, there was a pathological change in the function of the parathyroid glands, accompanied by hypercalcemia and hypophosphatemia. It can affect the results of laboratory studies of the function of the parathyroid glands, therefore, before determining the function of the parathyroid glands, the drug (MP) should be canceled.
Increases the excretion of magnesium in the urine, which can lead to hypomagnesemia.
When used in conjunction with angiotensin-converting enzyme (ACE) inhibitors in the first days of therapy, episodes of hypotension, deterioration of renal function (up to renal failure) may occur. In this regard, 2 to 3 days before starting hydrochlorothiazide as monotherapy, ACE inhibitors should be discontinued.
In patients with severe renal failure (creatinine clearance less than 30 ml / min or serum creatinine concentration more than 1.8 mg / 100 ml), hydrochlorothiazide does not have a diuretic effect and can lead to further deterioration of renal function, therefore, its use in this category of patients contraindicated.In patients with moderate renal impairment (creatinine clearance 30-60 ml / min or serum creatinine concentration 1.0-1.8 mg / 100 ml), hydrochlorothiazide can cause thiazide azotemia. In this category of patients, regular monitoring of the concentration of potassium, creatinine and uric acid in the blood serum is recommended. There is no experience with the use of hydrochlorothiazide in patients after kidney transplantation.
In patients with hepatic impairment or progressive liver disease, hydrochlorothiazide should be used with caution, as it can cause intrahepatic cholestasis, and even minor changes in water and electrolyte balance in such individuals can cause hepatic coma.The use of hydrochlorothiazide in patients with severe hepatic impairment is contraindicated.
Metabolic and endocrine effects. May impair glucose tolerance. During a long course of treatment with overt and latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary; dose adjustment of hypoglycemic drugs may be required.
With the use of hydrochlorothiazide, an increase in cholesterol and triglyceride levels is possible. In some patients, an increase in the content of uric acid in the blood and provocation of gout is possible.During the treatment period, it is necessary to periodically monitor the concentration of uric acid, the lipid spectrum of the blood.
In the case of severe cerebral and coronary sclerosis, the appointment of drugs requires special care and is carried out only under the supervision of medical personnel.
Acute myopia and angle-closure glaucoma. There are reports of cases of idiosyncrasy in the form of acute transient myopia, angle-closure glaucoma. The first symptoms include a rapid decrease in visual acuity and eye pain several hours or several weeks after starting treatment.In this case, you must immediately stop taking drugs. Special medications or pressure correction surgery may be required. Risk factors for the development of this reaction are a narrow anterior angle, allergic reactions to sulfonamides or penicillins.
When taking hydrochlorothiazide, allergic reactions (including bronchospasm) may occur, and lupus syndrome (systemic lupus erythematosus) may manifest or worsen.
Long-term use of hydrochlorothiazide can provoke the development of pseudo-Bartter syndrome, with a paradoxical increase in edema, plasma renin levels and secondary hyperaldosteronism.Hydrochlorothiazide should not be used in patients with Addison’s disease. During long-term use of hydrochlorothiazide, it is necessary to control the levels of potassium, sodium, calcium, creatinine and urea.
To prevent potassium loss, while using hydrochlorothiazide, the patient should consume foods rich in potassium (bananas, vegetables, nuts).
Doping control. The use of hydrochlorothiazide leads to positive results of doping control.
Treatment with hydrochlorothiazide should be discontinued in the following cases: uncorrectable electrolyte imbalance, orthostatic dysregulation of vascular tone, hypersensitivity, gastrointestinal disorders, pancreatitis, acute cholecystitis, central nervous system (CNS) pathology, blood changes (anemia, leukopenia, thrombocytopenia) vasculitis, exacerbation of myopia, serum creatinine concentration of more than 1.8 mg / 100 ml (or creatinine clearance less than 30 ml / min).
Hydrochlorothiazide tablets contain lactose, this should be taken into account in patients with rare hereditary galactose intolerance, Lapp-lactase deficiency, glucose-galactose malabsorption or fructose intolerance.

Avoid the simultaneous use of hydrochlorothiazide with drugs that cause loss of potassium salts (loop diuretics – furosemide, glucocorticoids, adrenocorticotropic hormone (ACTH), laxatives, carbenoxolone, amphotericin B, penicillin, salicylic acid and its derivatives).In all these cases, careful monitoring of potassium levels is necessary.
Simultaneous use of hydrochlorothiazide with salts of Li ⁺ should be avoided (renal clearance of Li ⁺ decreases, its cardiotoxicity increases).
Caution should be used with antihypertensive drugs, such as other diuretics, beta-blockers, nitrates, ACE inhibitors (increased action, dose adjustment may be required), calcitonin (increased hypokalemia).
Also, it should be used with caution with non-steroidal anti-inflammatory drugs, including salicylates and selective COX-2 blockers (weaken the diuretic and hypotensive effects), cholestyramine and cholestyramine (reduces the absorption of hydrochlorothiazide), ethanol, barbiturates, phenothiazines and tricyclic and antidepressant drugs, which enhance development of orthostatic hypotension.
Thiazides can reduce the concentration of iodine in plasma associated with proteins.
When used with beta-blockers and diazoxide, an increase in the risk of hyperglycemia is possible. Reduces the effect of insulin, oral hypoglycemic drugs and insulin, drugs for the treatment of gout (probenicide, sulfinpyrazone), pressor amines (norepinephrine, adrenaline). Increases the risk of developing lactic acidosis while using metformin.
Enhances the hematotoxic effect of cytostatics (cyclophosphamide, fluorouracil, methotrexate). When used together with cyclosporine and tetracyclines, the development of gout and hyperuricemic conditions is possible.
Strengthens and prolongs muscle relaxation against the background of the use of curariform drugs. If hydrochlorothiazide cannot be discontinued, the anesthesiologist should be informed of its use.
When used together with methyldopa, it can provoke hemolytic anemia. When used together with allopurinol, the risk of developing allergic reactions increases.
Hydrochlorothiazide should be used in conjunction with potassium salts to prevent arrhythmogenic effects (including arrhythmias of the torsade de pointes type), in case of simultaneous administration with the following drugs: cardiac glycosides, class IA and III antiarrhythmics (quinidine, disopyramide, amiodarone, sotalol, dofelitide, ibutilide ), antipsychotics (thioridazine, aminazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopride, amisulpiride, tiapride, pimozide, haloperidol, droperidol), bepridil, cisapride, erythromycin, difarofemanil.
When used together with carbamazepine, it increases the level of sodium in the blood. Blood sodium levels should be monitored regularly to prevent hypernatremia.
Hydrochlorothiazide reduces the toxicity of amantadine.

Triamteren instructions – cvetyiderevja.ru

Download Triamteren Instructions djvu

Instructions for the use of Triamterene in humane and veterinary medicine. VetConsultPlus. Informational portal. Therapy. Description of the active substance. The name of the drug is triamterene. Analogs (synonyms): Amteren, Direnium, Noridil, Ditex.

Gross formula – C12h21N7. – hydrochlorothiazide – triamterene. Composition and release form of the drug. Pills.Triamterene is a potassium-sparing diuretic that reduces the permeability of the cell membranes of the distal tubules for sodium ions and enhances their excretion in the urine without increasing the excretion of potassium ions.

The secretion of potassium ions in the distal tubules decreases. Content. Full description of the drug Triamteren. Description of the drug. Effects on the body. Indications for use.

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Pharmacological properties. Indications. Method of administration of triamterene and doses. Contraindications for use. Restrictions on use. Triamterene is an oral diuretic used in medicine to treat edema. Edema may occur without a known cause (idiopathic triamterene is classified as a potassium-sparing diuretic that increases the rate of sodium and water excretion but preserves potassium levels.

As the name suggests, the drug produces a pronounced diuretic effect without the loss of potassium seen with thiazides / loop diuretics. Triampur compositum ✔✔✔- detailed instructions for use, indications and contraindications, composition.

📞⏩⏩⏩Internet pharmacy cvetyiderevja.ru ®⏪⏪⏪. Triamterene is a potassium-sparing diuretic that reduces the permeability of the cell membranes of the distal tubules for sodium ions and enhances their excretion in the urine without increasing the excretion of potassium ions.

The secretion of potassium ions in the distal tubules is reduced.

Instructions for the use of Triamterene in humane and veterinary medicine. VetConsultPlus. Informational portal. Therapy. Description of the active substance. The name of the drug is triamterene. Analogs (synonyms): Amteren, Direnium, Noridil, Ditex. The gross formula is C12h21N7.

Full description, recipes, pharmacology and instructions for use. Triamteren. TRIAMTERENE. Analogs (generics, synonyms).