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Pronunciation:

(trye AM ter een)

U.S. Brand Names:

Dyrenium®

Generic Available:

Use:

Alone or in combination with other diuretics in treatment of edema and hypertension; decreases potassium excretion caused by kaliuretic diuretics

Pregnancy Risk Factor:

B (manufacturer); D (expert analysis)

Pregnancy Implications:

No data available. Generally, use of diuretics during pregnancy is avoided due to risk of decreased placental perfusion.

Lactation:

Excretion in breast milk unknown

Contraindications:

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; pregnancy (expert analysis)

Warnings/Precautions:

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.

Adverse Reactions:

1% to 10%:

Cardiovascular: Hypotension, edema, CHF, bradycardia

Central nervous system: Dizziness, headache, fatigue

Gastrointestinal: Constipation, nausea

Respiratory: Dyspnea

<1% (Limited to important or life-threatening): Inability to achieve or maintain an erection, agranulocytosis, thrombocytopenia

Overdosage/Toxicology:

Symptoms of overdose include drowsiness, confusion, clinical signs of dehydration, electrolyte imbalance, and hypotension; chronic or acute ingestion of large amounts of potassium-sparing diuretics, may result in life-threatening hyperkalemia especially with decreased renal function.

If the ECG shows no widening of the QRS or an arrhythmia, discontinue triamterene and any potassium supplement and substitute a thiazide. Consider Kayexalate® to increase potassium excretion. If an abnormal cardiac status is obvious, treat with calcium or sodium bicarbonates as needed, pacing dialysis and/or Kayexalate®. Infusions of glucose and insulin are also useful.

Drug Interactions:

ACE inhibitors can cause hyperkalemia, especially in patients with renal impairment, potassium-rich diets, or on other drugs causing hyperkalemia; avoid concurrent use or monitor closely.

Potassium supplements may further increase potassium retention and cause hyperkalemia; avoid concurrent use.

Mechanism of Action:

Interferes with potassium/sodium exchange (active transport) in the distal tubule, cortical collecting tubule and collecting duct by inhibiting sodium, potassium-ATPase; decreases calcium excretion; increases magnesium loss

Pharmacodynamics/Kinetics:

Onset of action: Diuresis: 2-4 hours

Duration: 7-9 hours

Absorption: Unreliable

Dosage:

Adults: Oral: 100-300 mg/day in 1-2 divided doses; maximum dose: 300 mg/day; usual dosage range (JNC 7): 50-100 mg/day

Dosing comments in renal impairment: Clcr<10 mL/minute: Avoid use.

Dosing adjustment in hepatic impairment: Dose reduction is recommended in patients with cirrhosis.

Monitoring Parameters:

Blood pressure, serum electrolytes (especially potassium), renal function, weight, I & O

Test Interactions:

Interferes with fluorometric assay of quinidine

Dietary Considerations:

May be taken with food.

Patient Education:

Take as directed, preferably after meals. This diuretic does not cause potassium loss; avoid excessive potassium intake (eg, salt substitutes, low-salt foods, bananas, nuts). Weigh yourself daily at the same time, in the same clothes, and report weight loss greater than 5 lb/week. Urine may appear blue (normal). You may experience dizziness, drowsiness, headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); decreased sexual ability (reversible with discontinuing of medication); or postural hypotension (change position slowly when rising from sitting or lying). Report persistent fatigue, muscle weakness, paresthesia, confusion, anorexia, headaches, lethargy, hyper-reflexia, seizures, swelling of extremities or respiratory difficulty (eg, chest pain, rapid heartbeat or palpitations). Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. Consult prescriber if breast-feeding.

Nursing Implications:

Observe for hyperkalemia; assess weight and I & O daily to determine weight loss; if ordered once daily, dose should be given in the morning

Anesthesia and Critical Care Concerns/Other Considerations:

Abrupt discontinuation of therapy may result in rebound kaliuresis; taper off gradually. Triamterene may cause hyperkalemia particularly in diabetes mellitus and those patients with renal dysfunction.

Cardiovascular Considerations:

Triamterene is usually combined with other antihypertensive agents for the treatment of hypertension. Triamterene may cause hyperkalemia, the ECG manifestations of which include peaked T waves, QRS prolongation, and cardiac conduction abnormalities.

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 drowsiness or dizziness

Mental Health: Effects on Psychiatric Treatment:

Triamterene may increase the side effects of amantadine (dizziness, nausea, dry mouth) necessitating a decrease in dosage; monitor

Dosage Forms:

Capsule: 50 mg, 100 mg [contains benzyl alcohol]

International Brand Names:

Dytac® (BE, GB, NL); Triamteren Pharmavit® (HU); Triamteren® (PL); Triteren® (JP); Urocaudal® (ES)

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.

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