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20-September-2008 09:55:50 - Triamterene Triamterene Systematic IUPAC name 6-phenylpteridine-2,4,7-triamine Identifiers CAS number 396-01-0 ATC code C03DB02 PubChem 5546 DrugBank APRD00079 Chemical data Formula C12H11N7 Mol. mass 253.263 g/mol Pharmacokinetic data Bioavailability 30-70% depending on formulation Protein binding 97% Metabolism Liver/renal Half life 1-2 hours, active metabolite 3 hours Excretion urine/bile/feces Therapeutic considerations Pregnancy cat. B manufacturer, D expert opinion Legal status prescription Routes oral Triamterene trade name Dyrenium is a potassium-sparing diuretic used in combination with thiazide diuretics for the treatment of hypertension and edema. This medication is best avoided in patients with chronic kidney disease due to the possibility of hyperkalemia. People using this drug should use salt substitute very cautiously.1 Contents 1 Mechanism of action 2 Side effects 3 Caution with certain disease states 4 Cost 5 Dosing 6 Use in Meniere's disease 7 References Mechanism of action Triamterene directly blocks the epithelial sodium channel ENaC on the lumen side of the kidney collecting tubule. Other diuretics cause a decrease in the sodium concentration of the forming urine due to the entry of sodium into the cell via the ENaC, and the concomitant exit of potassium from the principal cell into the forming urine. Blocking ENaC prevents this from happening. Amiloride works in the same way. Side effects Common side effects may include a depletion of sodium, folic acid and calcium, nausea, vomiting, diarrhea, headache, dizziness, fatigue, and dry mouth. Serious side effects may include heart palpitations, tingling/numbness, fever, chills, sore throat, rash, and back pain. Triamterene can also cause kidney stones through direct crystallization or by seeding calcium oxalate stones. Patients should be informed that triamterene may impart a blue fluorescent color to the urine. Caution with certain disease states Diabetes: Use with caution in patients with prediabetes or diabetes mellitus as there may be a change in glucose control. Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Kidney stones: Use with caution in patients with kidney stones. Cost While the patent for triamterene expired long ago, there is no generic form of triamterene available. According to prices at drugstore.com during the month of July 2008, the prices of Dyrenium are as follows... 50 mg 30: $39.99 100 mg 30: $53.54 Dosing Usual adult dosing is 50-100 mg/day 1-2 times a day. Maximum recommended dose is 300 mg/day. In children unlabeled use, the initial dose is 1-2 mg/kg/day in 2 divided doses with an ultimate maximum recommended dose of 3-4 mg/kg/day if this exceeds 300 mg/day, 300 mg/day is the maximum recommended dose. Avoid use if the creatinine clearance is less than 10 ml/minute. Use in Meniere's disease While there is a lack of RCT evaluating the use of triamterene in the treatment of Meniere's disease, the typical treatment is 37.5 mg of triamterene with 25 mg of hydrochlorothiazide 1-2 capsules daily. This recommendation was given a grade of C see http://www.aafp.org/afpsort.xml for information about the SORT evidence rating system. These recommendations were arrived at by evidence stated in References 1 http://www.losalt.com/docs/lo_salt_web_advice.pdf 2 Swartz R, Longwell P. Treatment of Vertigo. Am Fam Physician 2005 Mar 15;7161115-1122. 3 Sloane PD, Coeytaux RR, Beck RS, Dallara J. Dizziness: state of science. Ann Intern Med. 2001 May 1;134 9, part 2 suppl:823-832 4 www.uptodate.com triamterene drug section 5 http://gsm.about.com/compact/showmono.asp?cpnum=1087r=6078monotype=full 6 www.drugstore.com v d e Antihypertensives C02 and diuretics C03 Sympatholytic agents Centrally acting/antiadrenergics α2 agonist Clonidine, Guanfacine, Methyldopa imidazoline receptor agonist Moxonidine, Rilmenidine adrenergic uptake inhibitor Rescinnamine, Reserpine Ganglion-blocking/nicotinic antagonist Mecamylamine, Trimethaphan Peripherally acting/antiadrenergics α1 blockers: Prazosin Indoramin Trimazosin Doxazosin Urapidil Guanidine derivatives: Betanidine Guanethidine Guanoxan Debrisoquine Guanoclor Guanazodine Guanoxabenz Vasodilators Diazoxide hydrazinophthalazine Hydralazine, Dihydralazine, Endralazine, Cadralazine Minoxidil Nitroprusside Phentolamine Other antihypertensives serotonin antagonist Ketanserin endothelin receptor antagonist Bosentan, Ambrisentan, Sitaxsentan MAOI Pargyline THI Metirosine Diuretics Low ceiling Thiazides at DCT Bendroflumethiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide Polythiazide Trichlormethiazide Cyclopenthiazide Methyclothiazide Cyclothiazide Mebutizide Sulfonamides Quinethazone Clopamide Chlortalidone Mefruside Clofenamide Metolazone Meticrane Xipamide Indapamide Clorexolone Fenquizone Other Mersalyl Theobromine Cicletanine osmotic Mannitol, Urea carbonic anhydrase inhibitor at PT Acetazolamide High ceiling Loop diuretic at AL Bumetanide, Furosemide, Torasemide, Ethacrynic acid Potassium-sparing at CD ESC blockers Amiloride, Triamterene aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone Tablets This pharmacology-related article is a stub. Retrieved from http://en..org/wiki/Triamterene Categories: Potassium-sparing diuretics | Pharmacology stubs Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Hrvatski 日本語 This page was last modified on 24 July 2008, at 19:00
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