Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
GENERIC NAME: triamterene and hydrochlorothiazide (HCTZ)
BRAND NAMES: Maxzide, Dyazide
DRUG CLASS AND MECHANISM: Triamterene/hydrochlorothiazide is an oral
diuretic (water pill) that is used for treating high blood pressure
(hypertension) and edema (water accumulation). It is a combination of two
different diuretics.
The kidneys control the amount of sodium and water within the body. Normally,
blood circulates through the kidneys where much of the water, sodium and other
small molecules are filtered out of the blood and into the tubules of the
kidney. Once in the tubules, much of the water and sodium are reabsorbed back
into the blood. The water and sodium that is not reabsorbed passes on through
the tubules and becomes urine that is eliminated from the body. Diuretics affect
the reabsorption of sodium and water from the tubules and thus, the amount of
sodium and water retained or eliminated by the body. In addition to controlling
sodium, the kidney also controls the amount of potassium that is retained or
eliminated from the body.
Diuretics eliminate salt (sodium) and water from the body.
Hydrochlorothiazide is a diuretic that can be used alone for treating high blood
pressure and edema. It works by blocking sodium and water reabsorption in the
kidneys, thereby reducing sodium and water in the body. (Whereas it is clear how
hydrochlorothiazide eliminates water from the body, its mechanism of action in
lowering high blood pressure is not well understood.) To compensate for the
increased amount of sodium and water in the tubules that will be lost as urine,
the kidney tries to reabsorb more sodium and water. It does this by removing
potassium from the blood and putting it into the tubules in exchange for sodium
(and water) in the tubules. As a result, blood potassium levels fall.
Triamterene is a diuretic that prevents reabsorption of sodium in exchange for
potassium. Thus, it reduces sodium and water in the body but also prevents the
depletion of potassium. For this reason, triamterene is called a potassium
sparing diuretic. By combining hydrochlorothiazide with triamterene, sodium and
water are eliminated from the body without the loss of potassium.
STORAGE: Triamterene/hydrochlorothiazide should be store at room
temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Triamterene/hydrochlorothiazide is used for treating
high blood pressure and edema.
DOSING: The recommended dose is 1-2 tablets or capsules daily. The
maximum dose is 75/50 mg daily. Like other diuretics, it should be taken in the
morning in order to avoid excessive trips to the bathroom at night.
DRUG INTERACTIONS: Triamterene increases potassium levels in the body.
Therefore, combining triamterene/hydrochlorothiazide with ACE inhibitors
[for
example, enalapril (Vasotec)],
angiotensin receptor blockers
[for example, losartan (Cozaar)],
aliskiren (Tekturna), eplerenone (Inspra), potassium supplements or other drugs
that also increase potassium may lead to
dangerous potassium levels in the body.
Salt substitutes (for example, Mrs Dash) contain potassium and may lead to
excessive potassium levels in the body if combined with
triamterene/hydrochlorothiazide.
Hydrochlorothiazide increases blood levels of
dofetilide (Tikosyn),
increasing the adverse effects of dofetilide.
Hydrochlorothiazide reduces the elimination of lithium (Lithobid) by the
kidneys, increasing blood levels of lithium and lithium toxicity.
Nonsteroidal
antiinflammatory drugs, for example, ibuprofen, may reduce the blood
pressure-reducing effects of triamterene/hydrochlorothiazide.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Cirrhosis is a complication of many liver diseases that
is characterized by abnormal structure and function of the liver. The diseases
that lead to cirrhosis do so because they injure and kill liver cells, and the
inflammation and repair that is associated with the dying liver cells causes
scar tissue to form. The liver cells that do not die multiply in an attempt to
replace the cells that have died. This results in clusters of newly-formed liver
cells (regenerative nodules) within the scar tissue. There are many causes of
cirrhosis; they include chemicals (such as alcohol, fat, and certain
medications), viruses, toxic metals
(such as iron and copper that accumulate in
the liver as a result of genetic diseases), and autoimmune liver disease in
which the body's immune system attacks the liver.
Why does cirrhosis cause problems?
The liver is an important organ in the body. It performs
many...
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