- Potassium-sparing agents, including triamterene can cause abnormal elevation of serum potassium levels [US Black Box Warning]
- Hyperkalameia can cause cardiac irregularities, which can be fatal. Monitor serum potassium levels frequently, if hyperkalemia is suspected obtain an ECG and discontinue the triamterene/hydrochlorothiazide therapy and substitute with thiazide alone. If serum potassium exceeds 6.5 mEq/L administer calcium chloride solution, sodium bicarbonate solution, or the oral or parenteral glucose with a rapid-acting insulin preparation and also sodium polystyrene sulfonate can be orally or rectally administered. Persistent hyperkalemia may require dialysis
- Avoid potassium-conserving therapy in severely ill patients as respiratory or metabolic acidosis can occur with rapid elevations in serum potassium levels. If hydrochlorothiazide/triamterene is to be administered in these patients, consider frequent evaluations of acid/base balance and serum electrolytes
- Therapy can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms manifested as decreased visual acuity or ocular pain occurs within hours to weeks of drug initiation. Treatments include discontinuation of drug and prompt medical or surgical treatments, if the intraocular pressure remains uncontrolled. Patient with history of sulfonamide or penicillin allergy are at higher risk
- Monitor all the patients for evidence of fluid or electrolyte imbalance, e.g., hypomagnesemia, hyponatremia, hypochloremic alkalosis, and hypokalemia or hyperkalemia. Evaluate serum and urine electrolyte frequently especially when the patient is vomiting or receiving parenteral fluids
- Warning signs or symptoms of fluid and electrolyte imbalance, include dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting
- Dilutional hyponatremia manifested by dryness of the mouth, thirst, lethargy, and drowsiness and confirmed by a low serum sodium level can occur in edematous patients in hot weather. Appropriate therapy includes water restriction and sodium administration in life-threatening hyponatremia
- Profound diuresis can cause hypokalemia with thiazide therapy, particularly when used concomitantly with loop diuretics, glucocorticoids, or ACTH, or severe cirrhosis or after prolonged therapy. However hypokalemia is usually prevented by the triamterene component
- Elevation of BUN, creatinine level or both has been reported with triamterene and hydrochlorothiazide therapy, more frequent in patients receiving divided dose of diuretic therapy. Monitor BUN and creatinine periodically especially in elderly patients, patients with suspected or confirmed hepatic disease or renal insufficiencies. Discontinue the therapy if azotemia increases
- Minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Use with extreme caution in patients with impaired hepatic function
- Megaloblastosis has been observed in patients with low folic acid, as triamterene is a weak folic acid antagonist. Perform blood studies periodically in these patients
- Thiazides treatment can cause hyperuricemia or precipitation of acute gout
- Suspend therapy before carrying out tests for parathyroid function because marked hypercalcemia may be evidence of hidden hyperparathyroidism. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported in patients on prolonged thiazide therapy
- Carefully adjust dosage of insulin or oral hypoglycemic agents when administering hydrochlorothiazide in diabetic patients
- Hypersensitivity reactions to thiazides can occur in patients with or without a history of allergy or bronchial asthma
- Thiazide therapy can exacerbate or activate systemic lupus erythematosus
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Progressive hepatic diseases
- Electrolyte abnormalities
- Volume depletion
- Diabetes mellitus
- Co-administration of ACE inhibitors
- Co-administration of indomethacin
- SLE
- History of gout
- History of renal lithiasis
Pregnancy Category:C
Breastfeeding: Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production. Triamterene: It is not a reason to discontinue breastfeeding, if triamterene is required by the mother. However an alternate drug may be preferred, as no information is available on the use of triamterene during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 May 2011). Hydrochlorothiazide maternal medication usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 24 May 2011).
US Trade Name(s)
US Availability
hydrochlorothiazide/triamterene (generic)
- TABS: 25 mg/37.5 mg
- TABS: 50 mg/75 mg
- CAPS: 25 mg/50 mg
- CAPS: 25 mg/37.5 mg
Dyazide (hydrochlorothiazide/triamterene)
Maxzide (hydrochlorothiazide/triamterene)
Maxzide-25 (hydrochlorothiazide/triamterene)
Canadian Trade Name(s)
- APO Triazide
- NU-Triazide
- PRO-Triazide
- RIVA-Zide
Canadian Availability
hydrochlorothiazide/triamterene (generic)
APO Triazide, NU-Triazide, PRO-Triazide, RIVA-Zide (hydrochlorothiazide/triamterene)
UK Trade Name(s)
UK Availability
Dyazide (hydrochlorothiazide/triamterene)
Australian Trade Name(s)
Australian Availability
Hydrene 25/50 (hydrochlorothiazide/triamterene)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Dyazide 37.5-25 MG CAPS [Bottle] (GLAXO SMITH KLINE)
30 mg = $45.99
90 mg = $110.97 - Maxzide-25 37.5-25 MG TABS [Bottle] (MYLAN)
30 mg = $43.99
90 mg = $109.97 - Maxzide 75-50 MG TABS [Bottle] (MYLAN)
30 mg = $87.99
90 mg = $241.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
5.5 mEq/L). Patients with renal impairment and diabetes and elderly or severely ill patients are at higher risk of hyperkalemia. As uncorrected hyperkalemia can be fatal, monitor serum potassium levels at frequent intervals especially when dosages are changed or with any illness that may influence renal function