Triamzide

A pteridine that is used as a mild diuretic.

This fixed combination drug is not indicated for the initial therapy of edema or hypertension except in individuals in whom the development of hypokalemia cannot be risked.

Triamzide tablets, USP may be used alone or in combination with other antihypertensive drugs, such as beta-blockers. Since Triamzide tablets may enhance the actions of these drugs, dosage adjustments may be necessary.

Usage in Pregnancy

The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no satisfactory evidence that they are useful in the treatment of developed toxemia.

Edema during pregnancy may arise from pathological causes or from the physiologic and mechanical consequences of pregnancy. Thiazides are indicated in pregnancy when edema is due to pathologic causes, just as they are in the absence of pregnancy. Dependent edema in pregnancy, resulting from restriction of venous return by the expanded uterus, is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is illogical and unnecessary. There is hypervolemia during normal pregnancy which is harmful to neither the fetus nor the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema, in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances, this edema may cause extreme discomfort which is not relieved by rest. In these cases, a short course of diuretics may provide relief and may be appropriate.

Triamzide combination is used alone or with other medicines to treat water retention (edema) or high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Triamzide are both diuretic medicines (water pills). They reduce the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure. Triamterene (Triamzide) helps prevent your body from absorbing too much salt and keeps your potassium levels from getting too low.

Triamzide is available only with your doctor's prescription.

The usual dose of Triamzide MG is one or two tablets daily, given as a single dose, with appropriate monitoring of serum potassium. The usual dose of Triamzide is one tablet daily, with appropriate monitoring of serum potassium. There is no experience with the use of more than one Triamzide tablet daily or more than two Triamzide MG tablets daily. Clinical experience with the administration of two Triamzide MG tablets daily in divided doses (rather than as a single dose) suggests an increased risk of electrolyte imbalance and renal dysfunction.

Patients receiving 50 mg of Hydrochlorothiazide (Triamzide) who become hypokalemic may be transferred to Triamzide (Triamzide) directly. Patients receiving 25 mg Hydrochlorothiazide (Triamzide) who become hypokalemic may be transferred to Triamzide MG (37.5 mg Triamterene (Triamzide)/25 mg Hydrochlorothiazide (Triamzide)) directly.

In patients requiring Hydrochlorothiazide (Triamzide) therapy and in whom hypokalemia cannot be risked therapy may be initiated with Triamzide MG. If an optimal blood pressure response is not obtained with Triamzide MG, the dose should be increased to two Triamzide MG tablets daily as a single dose, or one Triamzide tablet daily. If blood pressure still is not controlled, another antihypertensive agent may be added.

Clinical studies have shown that patients taking less bioavailable formulations of Triamzide in daily doses of 25 mg to 50 mg Hydrochlorothiazide (Triamzide) and 50 mg to 100 mg Triamterene (Triamzide) may be safely changed to one Triamzide MG tablet daily. All patients changed from less bioavailable formulations to Triamzide should be monitored clinically and for serum potassium after the transfer.

See also:
What is the most important information I should know about Triamzide?

Antikaliuretic Therapy and Potassium Supplementation: Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) should not be given to patients receiving other potassium-sparing agents such as spironolactone, amiloride, or other formulations containing Triamterene (Triamzide). Concomitant potassium-containing salt substitutes should also not be used.

Potassium supplementation should not be used with Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) except in severe cases of hypokalemia. Such concomitant therapy can be associated with rapid increases in serum potassium levels. If potassium supplementation is used, careful monitoring of the serum potassium level is necessary.

Impaired Renal Function: Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) is contraindicated in patients with anuria, acute and chronic renal insufficiency or significant renal impairment.

Hypersensitivity: Hypersensitivity to either drug in the preparation or to other sulfonamide-derived drugs is a contraindication.

Hyperkalemia: Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) should not be used in patients with preexisting elevated serum potassium.

Use Triamzide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Triamzide by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
• Triamzide may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 PM.
• If you take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with Triamzide.
• Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.
• If you miss a dose of Triamzide, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Triamzide.

This drug is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. This medication is a combination of two "water pills" (diuretics): Triamzide. This combination is used by people who have developed or are at risk for having low potassium levels on Hydrochlorothiazide (Triamzide). It causes you to make more urine, which helps your body get rid of extra salt and water.

This medication also reduces extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, or kidney disease. This can lessen symptoms such as shortness of breath or swelling in your ankles or feet.

How to use Triamzide

Take this medication by mouth as directed by your doctor, usually once daily in the morning with or without food. It is best to avoid taking this medication within 4 hours of your bedtime to prevent having to get up to urinate.

If you also take certain drugs to lower your cholesterol (bile acid-binding resins such as cholestyramine or colestipol), take this product at least 4 hours before or at least 4 to 6 hours after these medications.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings increase).

See also:
What other drugs will affect Triamzide?

Angiotensin-converting Enzyme Inhibitors: Potassium-sparing agents should be used with caution in conjunction with angiotensin-converting enzyme (ACE) inhibitors due to an increased risk of hyperkalemia.

Oral Hypoglycemic Drugs

Nonsteroidal Anti-inflammatory Drugs: A possible interaction resulting in acute renal failure has been reported in a few patients on Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) when treated with indomethacin, a nonsteroidal anti-inflammatory agent. Caution is advised in administering nonsteroidal anti-inflammatory agents with Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)).

Lithium: Lithium generally should not be given with diuretics because they reduce its renal clearance and increase the risk of lithium toxicity. Read circulars for lithium preparations before use of such concomitant therapy with Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)).

Surgical Considerations: Thiazides have been shown to decrease arterial responsiveness to norepinephrine (an effect attributed to loss of sodium). This diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use. Thiazides have also been shown to increase the paralyzing effect of nondepolarizing muscle relaxants such as tubocurarine (an effect attributed to potassium loss); consequently caution should be observed in patients undergoing surgery.

Other Considerations: Concurrent use of Hydrochlorothiazide (Triamzide) with amphotericin B or corticosteroids or corticotropin (ACTH) may intensify electrolyte imbalance, particularly hypokalemia, although the presence of Triamterene (Triamzide) minimizes the hypokalemic effect.

Thiazides may add to or potentiate the action of other antihypertensive drugs. See INDICATIONS AND USAGE for concomitant use with other antihypertensive drugs.

The effect of oral anticoagulants may be decreased when used concurrently with Hydrochlorothiazide (Triamzide); dosage adjustments may be necessary.

Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) may raise the level of blood uric acid; dosage adjustments of antigout medication may be necessary to control hyperuricemia and gout.

The following agents given together with Triamterene (Triamzide) may promote serum potassium accumulation and possibly result in hyperkalemia because of the potassium-sparing nature of Triamterene (Triamzide), especially in patients with renal insufficiency: blood from blood bank (may contain up to 30 mEq of potassium per liter of plasma or up to 65 mEq per liter of whole blood when stored for more than 10 days); low-salt milk (may contain up to 60 mEq of potassium per liter); potassium-containing medications (such as parenteral penicillin G potassium); salt substitutes (most contain substantial amounts of potassium).

Exchange resins, such as sodium polystyrene sulfonate, whether administered orally or rectally, reduce serum potassium levels by sodium replacement of the potassium; fluid retention may occur in some patients because of the increased sodium intake.

Chronic or overuse of laxatives may reduce serum potassium levels by promoting excessive potassium loss from the intestinal tract; laxatives may interfere with the potassium-retaining effects of Triamterene (Triamzide).

The effectiveness of methenamine may be decreased when used concurrently with Hydrochlorothiazide (Triamzide) because of alkalinization of the urine.

Drug/Laboratory Test Interactions

Triamterene (Triamzide) and quinidine have similar fluorescence spectra; thus, Triamzide (Hydrochlorothiazide (Triamzide) and Triamterene (Triamzide)) will interfere with the fluorescent measurement of quinidine.

See also:
What are the possible side effects of Triamzide?

Side effects observed in association with the use of Triamzide tablets, other combination products containing Triamterene (Triamzide)/Hydrochlorothiazide (Triamzide), and products containing Triamterene (Triamzide) or Hydrochlorothiazide (Triamzide) include the following:

Gastrointestinal: jaundice (intrahepatic cholestatic jaundice), pancreatitis, nausea, appetite disturbance, taste alteration, vomiting, diarrhea, constipation, anorexia, gastric irritation, cramping.

Central Nervous System: drowsiness and fatigue, insomnia, headache, dizziness, dry mouth, depression, anxiety, vertigo, restlessness, paresthesias.

Cardiovascular: tachycardia, shortness of breath and chest pain, orthostatic hypotension (may be aggravated by alcohol, barbiturates or narcotics).

Renal: acute renal failure, acute interstitial nephritis, renal stones composed of Triamterene (Triamzide) in association with other calculus materials, urine discoloration.

Hematologic: leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, hemolytic anemia and megaloblastosis.

Ophthalmic: xanthopsia, transient blurred vision.

Hypersensitivity: anaphylaxis, photosensitivity, rash, urticaria, purpura, necrotizing angiitis (vasculitis, cutaneous vasculitis), fever, respiratory distress including pneumonitis.

Other: muscle cramps and weakness, decreased sexual performance and sialadenitis.

Whenever adverse reactions are moderate to severe, therapy should be reduced or withdrawn.

Altered Laboratory Findings

Serum Electrolytes: hyperkalemia, hypokalemia, hyponatremia, hypomagnesemia, hypochloremia.

Creatinine, Blood Urea Nitrogen: Reversible elevations in BUN and serum creatinine have been observed in hypertensive patients treated with Triamzide.

Glucose: hyperglycemia, glycosuria and diabetes mellitus.

Serum Uric Acid, PBI and Calcium:.

Other: Elevated liver enzymes have been reported in patients receiving Triamzide.