Triamterene ( * ) -@- Potassium sparing diuretics- (FDC- List )- (Oct 1975)
Drug Name:Triamterene ( * ) -@- Potassium sparing diuretics- (FDC- List )- (Oct 1975)
List Of Brands:
Indication Type Description:
Drug Interaction
Indication
Adverse Reaction
Contra-Indications
Dosages/ Overdosage Etc
Patient Information
Pharmacology/ Pharmacokinetics
Pregnancy and lactation
Drug Interaction:
Interacting drugs - summary
Triamterene +
Amantadine
Amantadine plasma level increase and urinary excretion decrease,
increasing the risk for developing adverse effects.
Potass.prepn
concurrent admininstration result in severe hyperkalemia, with
cardiac arrhythmias and cardiac arrest. Avoid concurrent administration
+ Triamterence
ACE inhibitors
use of ACE inhibitors elevate serum potassium . Concurrent use
with traimterence lead to significant hyperkalemia
Cimetidine
cimetidine increase the bioavailability and decrease the renal
clearance and hydroxylation of triamterene
Indomethicin
rapid progress into acute renalfailure has occured with concurrent use.
Use the combination only when clearly needed.
Indication:
FIXED DOSE COMBINATIONS APPROVED BY DCG(I)
FROM JANUARY 1961 TILL NOVEMBER 2014
Name of Drug Indication Date of Approval
Triamterene 50mg + Oct 1975
HCTZ 25mg tablet
Edema asociated with congestive heart failure,Hepatic cirrhosis, Nephrotic syndrome, steroid induced edema.
Adverse Reaction:
GI- diarrhea, nasea, vomiting, jaundice, liver enzyme abnormalities. Nausea can usaually be prevented by giving the drug after meals.
Renal- azetoma, elevated BUN and creatinine.Triamterene has been found in renal stones
Interstitial nephritis- has been reported rarely in patients on a hydrochlorothiazide/triamterene combination and with triamterene alone.
Onset was immediate to 10 weeks after initiation of therapy,
Resolution began upon discontinuation of the drug.
In patients predisposed to gouty arthiritis, serum uric acid levels may increase.
Hematologic- thrombocytopenia, megaloblastic anemia.
Body as a whole- electrolyte inbalance, hyperkalemia, fatigue, dizziness, hypokalemia, headache, dry mouth ,anaphylaxis photosentivity, rash.
Contra-Indications:
Hyperkalaemia,renal failure.
Special precautions:
Gout/hyperuricaemia, nephrolithiasis, hepatic cirrhosis.
Electrolyte imbalnce- in CHF, renal diseases, or cirrhosis, electrolyte imbalance may be aggravated or caused by diuresis.The use of full doses of a diuretic when salt intake is restricted can result in a low salt syndrome.
Triamterene can cause mild nitrogen retention which is revesible upon withdrawal , this seldom is observed with intermittant therapy
Renal stones- traimterene has been found in renal stones with other calculus components. Therefore use triamterene cautiously in patients with histories of stone formation.
Hematologic effects- traimterene is a weak folic acid antagonist. Since cirrhosis with splenomegaly may have marked variations in hematological staus, it may contribute to the appearance of megablastosis in case where folic acid stores have been depleted.
Perform periodic blood studies in these patients.
Metabolic acidosis- traimterene may cause decreasing alkali reserve with a possibility of metabolic acidosis.
Diabetes mellitus-traimterene may raise blood glucose levels for adult-onset diabetes , dosage adjustment of hypoglycemic agents may be necessary. Concurent use with cholrpropamide may inccrease the risk of severe hyponatremia.
Photosensitivity- photosentizatin may occur. Caution patients to take protective measures against exposure to ultraviolet or sunlight until tolerance is determined.
Warnings-
Hypersentivity- monitor patients regularly for blood dyscrasias, liver damage or other idiosyncratic reactions.
Renal function impairment- perform periodic BUN and serum potassium determinatin to check kidney function especially in patients with suspected or confirmed renal insufficiency and in elderly or diabetic patients with nephropathy are especially prone to develop hyperkalemia
Hepatic function impairment- traimterene is extensively metabolised in the liver.One study revealed that the clearance of triamterene is markedly decreased in patients with cirrhosis and ascites. However, the overall diuretic response may not be affected.
Pregnancy- use only when clearly needed and when the potential benefits outweigh the potential hazards to the fetus.
Lactation- if the drug is essential the patient should stop nursing
Children- safety and efficacy have not been established.
Dosages/ Overdosage Etc:
Date of Approval October 1975
Indications:
Edema asociated with congestive heart failure,Hepatic cirrhosis, Nephrotic syndrome, steroid induced edema. Edema due to secondary hyperdosteronism.
Dosage:
Individualise dosage.
Initial 100 mg twice daily after meals. Do not exceed 300 mg/day.
Overdosage-
Symptoms
Electrolyte imbalance is the major concern, particularly hyperlkalemia. Other symptoms
include nausea, vomiting, GI disturbances and weakness.
Hypotension may occur.
Triamterene may induce reversible acute renal failure
Treatment
1. Induce immediate evaculation of the stomach throughemesis and and gastric lavage .
2. Carefully evaluate electrolute and fluid balance.
3. Dialysis may be of some benefit
4. Treatment usual supportive measures
Missed dose-
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is time for your next dose, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses.
Patient Information:
1. May cause GI upset; take after meals.
2. May cause weakness,headache, nausea, vomiting, and dry mouth; notify physician if these
become severe.
3. Avoid prolonged exposure to sunlight; photosensitivity may occur.
4. If single daily dose is prescribed, take in morning to minimise effect of increased frequency of urination on nighttime sleep.
5. If dose is missed, do not take more than prescribed dose at next interval.
Pharmacology/ Pharmacokinetics:
Pharmacolgy-
In the kidney potassium is filtered at the glmerulus and then absorbed parallel to sodium throughout the proximal tubule and thick asending limb of the loop of Henle, so that only minor amounts reach the distal convoluted tubule and collecting duct. The potassium sparing diuretics interfere with the sodium reabsorption at the distal tube, thus decreasing the potassium secretion.
Pregnancy and lactation:
Pregnancy:
Triamterene crosses thr placental border and appears in the cord of animals; this may appear in humans. No adequate well documented studies conducted. Use only when required.
Lactation:
Triamterene appears in the milk of animals receiving the drug; this may occur in humans also. If the drug is essential the patient should stop nursing. Children: Safety and efficacy in children have not been established.
