Hypertension, Oedema severe renal or hepatic impairment, preexisting or drug-induced hyperkalemia, patients at risk of respiratory or metabolic acidosis. Lactation.

Combined antihypertensive preparations

Triamterene directly inhibits the exchange of Na for K and hydrogen in the distal renal tubule. Hydrochlorothiazide increases the excretion of Na and Cl ions, and consequently of water, by reducing electrolyte reabsorption from the renal tubules.Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium and chloride in approximately equivalent amounts. Indirectly, the diuretic action of Hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so co-administration of anangiotensin converting enzyme (ACE) inhibitor tends to reverse the potassium loss associated with these diuretics.

Administration: Should be taken with food. Take after meals. Adult Dose: Hypertension 1-2 tablets/capsules (37.5-50 mg triamterene and 25 mg HCTZ) PO qDay 1 tablet (75 mg triamterene and 50 mg HCTZ) PO qDay Dosing considerations Monitor serum potassium Edema 1-2 tablets/capsules (37.5-50 mg triamterene and 25 mg HCTZ) PO qDay 1 tablet (75 mg triamterene and 50 mg HCTZ) PO qDay Child Dose: Safety and efficacy not established

May enhance toxicity of digitalis glycosides, neuromuscular-blocking action of competitive muscle relaxants, effect of antihypertensives. Increased risk of postural hypotension w/ alcohol, barbiturates, opioids. K-depleting effect enhanced by corticosteroids, lithium, ACTH, carbenoxolone.

severe renal or hepatic impairment, preexisting or drug-induced hyperkalemia, patients at risk of respiratory or metabolic acidosis. Lactation.

Triamterene Jaundice,Weaknes,Headache,Azotemia,Dizziness,Fatigue,Xerostomia,Photosensitivity,Rash,Diarrhea,Nausea,Vomiting,Hyperuricemia,Hyper/hypokalemia,Interstitial nephritis Hydrochlorothiazide Anorexia,Epigastric distress,Hypotension,Orthostatic hypotension,Photosensitivity,Anaphylaxis,Anemia,Confusion,Erythema multiforme,Stevens-Johnson syndrome,Exfoliative dermatitis including toxic epidermal necrolysis,Dizziness,Hypokalemia and/or hypomagnesemia,Hyperuricemia

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Precaution: Renal and hepatic impairment; cirrhosis; DM; hyponatraemia; hyperuricaemia; history of nephrolithiasis; depleted folic acid stores. Monitor electrolyte concentrations closely, especially potassium levels. Observe for signs of liver damage, blood dyscrasias or other idiosyncratic reactions. Discontinue treatment if urinary calculus is passed. Pregnancy and elderly. Lactation: Not recommended; discontinue drug or do not nurse

Symptoms: Electrolyte imbalance, nausea, vomiting, weakness, polyuria, lassitude, fever, flushed face, hyperactive deep tendon reflexes, hypotension, cardiac arrhythmias. Management: Induce immediate evacuation through emesis or gastric lavage. Pressor agents e.g. norepinephrine may be given in case of hypotension.

Store between 20-25°C. Protect from light.

Combined antihypertensive preparations

Hydrochlorothiazide inhibits the reabsorption of Na and chloride in the distal tubules causing increased excretion of Na and water K and hydrogen ions. Triamterene is a potassium sparing diuretic which appears to act mainly on the distal renal tubules. It increases the excretion of Na and reduces the excretion of potassium. It adds to the natriuretic but reduces the kaliuretic effects of other diuretics. It is structurally similar to folate and has anti-folate activity.

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.