triamterene (Rx)

Brand and Other Names:Dyrenium
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 50mg
  • 100mg

Edema

100-300 mg/day PO qDay or divided q12hr

Hypertension (Off-label)

50-100 mg PO qDay or divided q12hr

Renal Impairment

CrCl <10 mL: Do not use

Hepatic Impairment

Reduce dose in patients with cirrhosis

Other Information

Monitor serum potassium

See also combo with HCTZ

Dosage Forms & Strengths

capsule

  • 50mg
  • 100mg

Hypertension (Off-label)

Safety & efficacy not established

1-2 mg/kg/day PO divided q12hr  

Maximum dose: 3-4 mg/kg/day PO divided q12hr up to 300 mg/day

Consider lower initial doses

Edema

50-300 mg/day PO qDay or divided q12hr

Hypertension

50-300 mg/day PO qDay or divided q12hr

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Interactions

Interaction Checker

and triamterene

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      Serious - Use Alternative

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            Adverse Effects

            1-10%

            CHF

            Edema

            Hypotension

            Dizziness

            Fatigue

            HA

            Photosensitivity

            Rash

            Diarrhea

            Nausea

            Vomiting

            Hyperuricemia

            Nephrotoxicity

            Frequency Not Defined

            GI upset

            Thrombocytopenia

            Nephrolithiasis

            Folic acid antagonism

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            Warnings

            Contraindications

            Hypersensitivity to triamterene

            Anuria, severe liver disease, renal failure

            Hyperkalemia

            Concomitant use with K+-sparing diuretic, or K supplementation

            Cautions

            Use caution in acid-base imbalance, electrolyte abnormalities, hyperuricemia or gout, liver disease, renal impairment, renal stones

            Patients should be observed regularly for possible occurrence of blood dyscrasias, liver damage or other idiosyncratic reactions

            Periodic BUN and serum potassium determinations should be made to check kidney function, especially in patients with suspected or confirmed renal insufficiency; particularly important to make serum potassium determinations in elderly or diabetic patients receiving drug; these patients should be observed carefully for possible serum potassium increases

            Electrolyte imbalance often encountered in diseases such as congestive heart failure, renal disease or cirrhosis may be aggravated or caused independently by any effective diuretic agent including triamterene; 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 reversible upon withdrawal of drug and is seldom observed with intermittent (every-other-day) therapy

            Therapy may cause a decreasing alkali reserve, with possibility of metabolic acidosis

            By the very nature of their illness, cirrhotics with splenomegaly sometimes have marked variations in their blood; since triamterene is a weak folic acid antagonist, it may contribute to appearance of megaloblastosis in cases where folic acid stores have been depleted; periodic blood studies in these patients recommended; observe also for exacerbations of underlying liver disease

            Triamterene has elevated uric acid, especially in persons predisposed to gouty arthritis

            Triamterene reported in renal stones in association with other calculus components; drug should be used with caution in patients with histories of renal stones

            Interferes with fluorescent assay of quinidine

            Not recommended for pregnancy-induced HTN; use during pregnancy may increase risk of cardiovascular defects and oral cleft in child

            Hyperkalemia

            • Drug tends to conserve potassium rather than to promote excretion as do many diuretics and, occasionally, can cause increases in serum potassium which, in some instances, can result in hyperkalemia; in rare instances, hyperkalemia has been associated with cardiac irregularities
            • If hyperkalemia present or suspected, obtain an electrocardiogram; if tECG shows no widening of QRS or arrhythmia in presence of hyperkalemia, it is usually sufficient to discontinue therapy and any potassium supplementation, and substitute a thiazide alone
            • Sodium polystyrene sulfonate may be administered to enhance excretion of excess potassium; presence of a widened QRS complex or arrhythmia in association with hyperkalemia requires prompt additional therapy
            • For tachyarrhythmia, infuse 44 mEq of sodium bicarbonate or 10 mL of 10% calcium gluconate or calcium chloride over several minutes; for asystole, bradycardia or A-V block transvenous pacing is also recommended
            • Effect of calcium and sodium bicarbonate is transient and repeated administration may be required; when indicated by clinical situation, excess K+ may be removed by dialysis or oral or rectal administration of Kayexalate®. Infusion of glucose and insulin has also been used to treat hyperkalemia
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Discontinue drug or nursing

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Direct effect on renal distal tubule to inhibit Na+ reabsorption

            Inhibits Na/K-ATPase, decreases Ca++ , Mg++ and hydrogen excretion

            Pharmacokinetics

            Half-Life: 1.5-2.5 hr

            Duration: 7-9 hr

            Onset: Initial effect: 2-4 hr; Max effect: diuresis: several days, HTN: 2-3 months

            Peak Plasma Time: 1.5-3 hr

            Bioavailability: 30-70%

            Protein Bound: 55-67%

            Metabolism: Liver

            Metabolites: hydroxytriamterene sulfate (active)

            Excretion: urine 21%

            Dialyzable: Yes (hemodialysis)

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.