Based on hydrochlorothiazide component: Hypersensitivity to hydrochlorothiazide or any component of the formulation, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy
Based on triamterene component: Hypersensitivity to triamterene or any component of the formulation; patients receiving other potassium-sparing diuretics; anuria; severe hepatic disease; hyperkalemia or history of hyperkalemia; severe or progressive renal disease
Based on hydrochlorothiazide component: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.
Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.
Based on triamterene component: Avoid potassium supplements, potassium-containing salt substitutes, a diet rich in potassium, or other drugs that can cause hyperkalemia. Monitor for fluid and electrolyte imbalances. Diuretic therapy should be carefully used in severe hepatic dysfunction; electrolyte and fluid shifts can cause or exacerbate encephalopathy. Use cautiously in patients with history of kidney stones and diabetes. Can cause photosensitivity.
Safety and efficacy have not been established in pediatric patients.
Also see individual agents. Frequency not defined. Central nervous system: Dizziness, fatigue
Dermatologic: Purpura, cracked corners of mouth
Endocrine & metabolic: Electrolyte disturbances
Gastrointestinal: Bright orange tongue, burning of tongue, loss of appetite, nausea, vomiting, stomach cramps, diarrhea, upset stomach
Hematologic: Aplastic anemia, agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia, megaloblastic anemia
Neuromuscular & skeletal: Muscle cramps
Ocular: Xanthopsia, transient blurred vision
Respiratory: Allergic pneumonitis, pulmonary edema, respiratory distress
Based on triamterene component: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium, chloride, and water excretion while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well
Based on hydrochlorothiazide component: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions
Adults: Oral: Hydrochlorothiazide 25 mg and triamterene 37.5 mg: 1-2 tablets/capsules once daily
Hydrochlorothiazide 50 mg and triamterene 75 mg: 1/2-1 tablet daily
Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. The initial concern about thiazide diuretic-induced hypokalemia, glucose intolerance, and lipid profiles does not appear to be of substantial clinical consequence in the treatment of hypertension. The benefits of this class of agents in the treatment of hypertension is established and compares well with other first-line therapeutic agents. The combination of hydrochlorothiazide and triamterene may reduce the incidence of hypokalemia. Diuretics are standard therapy for the management of edema in patients with heart failure.
Capsule (Dyazide®): Hydrochlorothiazide 25 mg and triamterene 37.5 mg
Tablet:
Maxzide®: Hydrochlorothiazide 50 mg and triamterene 75 mg
Maxzide®-25: Hydrochlorothiazide 25 mg and triamterene 37.5 mg
Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.
