Generic Name: triamterene

Brand Name: Dyrenium

Drug Class: Diuretics, Potassium-Sparing

What is triamterene, and what is it used for?

Triamterene is a medication used in the management and treatment of fluid retention and swelling (edema) associated with various conditions including heart failure, liver or kidney disease, and edema induced by certain medications.

Triamterene may be used alone or with other diuretics such as hydrochlorothiazide, either to enhance their diuretic effect, or for its potassium-sparing property.

Triamterene is a potassium-sparing diuretic that reduces edema by increasing the excretion of sodium and water in the urine, but unlike some of the other classes of diuretics, it does not increase the excretion of potassium and other electrolytes such as calcium, magnesium, and hydrogen. The sodium excretion (natriuresis) and increased urine output (diuresis) reduce water retention and the associated edema. Triamterene can increase blood potassium levels which may sometimes result in hyperkalemia.

Nephron is a functioning unit of the kidneys which filters out waste and reabsorbs minerals like sodium, potassium, and calcium. Triamterene blocks the sodium channels in the cells lining (epithelial) the distal convoluted tubule and collecting duct parts of the nephron, which prevents the reabsorption of sodium and water. The sodium uptake in the distal tubule and connecting duct is limited, hence, triamterene is generally considered to have only weak natriuretic, diuretic and antihypertensive effects.

The uses of triamterene include:

FDA-approved:

  • Management of edema in the following conditions:
    • Congestive heart failure
    • Liver cirrhosis
    • Nephrotic syndrome, a kidney disorder that causes excessive protein excretion
    • Steroid-induced edema
    • Edema from an unidentified cause (idiopathic)
    • Edema due to secondary hyperaldosteronism, a condition with high levels of aldosterone, a steroid hormone that inhibits sodium excretion

Off-label

Warnings

  • Do not use in patients with hypersensitivity to triamterene or any of its components.
  • Do not use in patients with the following conditions:
  • Do not use concurrently with other potassium-sparing diuretics or other formulations containing triamterene.
  • Triamterene can cause hyperkalemia, and the risk is higher in patients with impaired kidney function or diabetes, elderly or severely ill patients. Monitor potassium levels at frequent intervals. Discontinue triamterene in patients who develop hyperkalemia, evaluate for irregular heart rhythm conditions (arrhythmia), and treat appropriately.
  • Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease).
  • Do not use triamterene to treat edema normally associated with pregnancy that does not have any pathological cause. Do not use in breastfeeding women.
  • There have been isolated reports of hypersensitivity reactions. Monitor patients for blood disorders, liver damage or other reactions.
  • Triamterene can cause fluid and electrolyte loss. Monitor patients, particularly those with heart disease, renal disease or liver cirrhosis, for electrolyte disturbances and dehydration, and adjust dose appropriately.
  • Use with caution in patients with diabetes mellitus, triamterene may increase blood glucose levels.
  • Triamterene may increase uric acid levels, use with caution in patients with high uric acid levels in blood (hyperuricemia) or gout.
  • Use with caution in patients with kidney function impairment or a history of kidney stones.
  • Use with caution in patients with severe liver dysfunction. Monitor and maintain electrolyte and acid/base balance to prevent brain damage related to liver disease (hepatic encephalopathy).
  • Abrupt discontinuation of triamterene after prolonged therapy may cause rebound excretion of potassium in urine (kaliuresis). Withdraw gradually in patients who have received triamterene therapy for prolonged periods.

SLIDESHOW

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What are the side effects of triamterene?

Common side effects of triamterene include:

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

What are the dosages of triamterene?

Capsule

  • 50 mg
  • 100 mg

Adult:

Edema

  • 100-300 mg/day orally every day or divided every 12 hours

Hypertension (Off-label)

  • 50-100 mg orally every day or divided every 12 hours

Renal Impairment

  • Creatinine clearance (CrCl) less than 10 mL: Do not use

Hepatic Impairment

  • Reduce dose in patients with cirrhosis

Other Information

  • Monitor serum potassium

Geriatric:

Consider lower initial doses

Edema

  • 50-300 mg/day orally every day or divided every 12 hours

Hypertension

  • 50-300 mg/day orally every day or divided every 12 hours

Pediatric:

Hypertension (Off-label)

  • Safety and efficacy not established
  • 1-2 mg/kg/day orally divided every 12 hours
  • Maximum dose: 3-4 mg/kg/day orally divided every 12 hours up to 300 mg/day

Overdose

  • Triamterene overdose is likely to cause electrolyte imbalance, particularly hypokalemia. Symptoms may include hypotension, weakness, and gastrointestinal disturbances including nausea and vomiting.
  • There is no specific antidote for triamterene. Treatment may include stomach emptying with induced vomiting and gastric lavage, and correction of fluid and electrolyte balance.

QUESTION

In the U.S., 1 in every 4 deaths is caused by heart disease. See Answer

What drugs interact with triamterene?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

  • Animal reproductive studies on the safety of triamterene do not indicate fetal harm, however, there are no adequate and well-controlled studies of triamterene use in pregnant women. Triamterene should be used in pregnancy only if clearly needed.
  • Triamterene is present in animal milk, and there are no studies in nursing mothers. If triamterene is required for use in nursing mothers, breastfeeding should be discontinued.

What else should I know about triamterene?

  • Take triamterene exactly as prescribed, preferably after meals to avoid stomach upset.
  • If only one dose is prescribed per day, taking it in the morning will help avoid excessive night time urination.
  • Contact your physician if you experience any heart-related symptoms such as irregular or rapid heartbeat.
  • Fluid loss can occur with triamterene, drink adequate fluids to avoid dehydration.
  • Store safely out of reach of children.
  • in case of overdose, seek medical help or contact Poison Control.

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Summary

Triamterene is a medication used in the management and treatment of fluid retention and swelling (edema) associated with various conditions including heart failure, liver or kidney disease, and edema induced by certain medications. Common side effects of triamterene include nausea, vomiting, diarrhea, dry mouth (xerostomia), liver enzyme abnormalities, jaundice, headache, dizziness, fatigue, weakness, skin rash, skin photosensitivity, severe allergic reaction (anaphylaxis), and others. Consult your doctor if pregnant or breastfeeding.

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Medically Reviewed on 10/17/2022
References
https://www.rxlist.com/consumer_triamterene_dyrenium/drugs-condition.htm

https://reference.medscape.com/drug/dyrenium-triamterene-342408

https://www.uptodate.com/contents/triamterene-drug-information

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ebb177c0-d45d-4443-a85a-e76bd9931a42