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Hydrochlorothiazide and Triamterene


Pronunciation

 (hye droe klor oh THYE a zide & trye AM ter een)


U.S. Brand Names

 Dyazide®; Maxzide®; Maxzide®-25


Synonyms

 Triamterene and Hydrochlorothiazide


Generic Available

 Yes


Canadian Brand Names

 Apo-Triazide®; Novo-Triamzide; Nu-Triazide; Penta-Triamterene HCTZ; Riva-Zide


Use

 Management of mild to moderate hypertension; treatment of edema in congestive heart failure and nephrotic syndrome


Pregnancy Risk Factor

 C (per manufacturer)


Pregnancy Implications

 See individual agents.


Lactation

 Excretion in breast milk unknown/use caution


Contraindications

Based on hydrochlorothiazide component: Hypersensitivity to hydrochlorothiazide or any component of the formulation, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy

Based on triamterene component: Hypersensitivity to triamterene or any component of the formulation; patients receiving other potassium-sparing diuretics; anuria; severe hepatic disease; hyperkalemia or history of hyperkalemia; severe or progressive renal disease


Warnings/Precautions

Based on hydrochlorothiazide component: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Based on triamterene component: Avoid potassium supplements, potassium-containing salt substitutes, a diet rich in potassium, or other drugs that can cause hyperkalemia. Monitor for fluid and electrolyte imbalances. Diuretic therapy should be carefully used in severe hepatic dysfunction; electrolyte and fluid shifts can cause or exacerbate encephalopathy. Use cautiously in patients with history of kidney stones and diabetes. Can cause photosensitivity.

Safety and efficacy have not been established in pediatric patients.


Adverse Reactions

 Also see individual agents. Frequency not defined.

Central nervous system: Dizziness, fatigue

Dermatologic: Purpura, cracked corners of mouth

Endocrine & metabolic: Electrolyte disturbances

Gastrointestinal: Bright orange tongue, burning of tongue, loss of appetite, nausea, vomiting, stomach cramps, diarrhea, upset stomach

Hematologic: Aplastic anemia, agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia, megaloblastic anemia

Neuromuscular & skeletal: Muscle cramps

Ocular: Xanthopsia, transient blurred vision

Respiratory: Allergic pneumonitis, pulmonary edema, respiratory distress


Drug Interactions

 See individual agents.


Ethanol/Nutrition/Herb Interactions

 Food: Avoid food with high potassium content and potassium-containing salt substitutes.


Stability

 Protect from light


Mechanism of Action

Based on triamterene component: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium, chloride, and water excretion while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well

Based on hydrochlorothiazide component: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Adults: Oral:

Hydrochlorothiazide 25 mg and triamterene 37.5 mg: 1-2 tablets/capsules once daily

Hydrochlorothiazide 50 mg and triamterene 75 mg: 1 /2-1 tablet daily


Dietary Considerations

 Should be taken after meals.


Patient Education

 See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.


Nursing Implications

 Monitor blood pressure, serum electrolytes, BUN, creatinine, liver function tests, signs of hyperkalemia


Cardiovascular Considerations

 Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. The initial concern about thiazide diuretic-induced hypokalemia, glucose intolerance, and lipid profiles does not appear to be of substantial clinical consequence in the treatment of hypertension. The benefits of this class of agents in the treatment of hypertension is established and compares well with other first-line therapeutic agents. The combination of hydrochlorothiazide and triamterene may reduce the incidence of hypokalemia.

Diuretics are standard therapy for the management of edema in patients with heart failure.


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause lethargy or anorexia


Mental Health: Effects on Psychiatric Treatment

 May decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels


Dosage Forms

Capsule (Dyazide®): Hydrochlorothiazide 25 mg and triamterene 37.5 mg

Tablet:

Maxzide®: Hydrochlorothiazide 50 mg and triamterene 75 mg

Maxzide®-25: Hydrochlorothiazide 25 mg and triamterene 37.5 mg


References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report," JAMA , 2003, 289(19):2560-71.


International Brand Names

 Apo-Triazide® (CA); Novo-Triamzide (CA); Nu-Triazide (CA); Penta-Triamterene HCTZ (CA); Riva-Zide (CA)


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