- Diltiazem and Hydrochlorothiazide/Triamterene as Initial Therapy for Mild to Moderate Essential Hypertension
- Medications for treating hypertension
- Triamterene and hydrochlorothiazide (Oral)
- Commonly used brand name(s)
- Uses for triamterene and hydrochlorothiazide
- Before using triamterene and hydrochlorothiazide
- Proper use of triamterene and hydrochlorothiazide
- Precautions while using triamterene and hydrochlorothiazide
- Triamterene and hydrochlorothiazide side effects
- Further information
- More about hydrochlorothiazide / triamterene
Diltiazem and Hydrochlorothiazide/Triamterene as Initial Therapy for Mild to Moderate Essential Hypertension
In a double-blind randomised parallel trial, diltiazem (120mg 2 or 3 times daily) was compared with hydrochlorothiazide/triamterene (25/50 or 50/100mg once daily) for 12 weeks, with regard to blood pressure lowering and adverse effects, in 61 evaluable patients with mild to moderate essential hypertension (diastolic blood pressure ⩾ 95mm Hg). The two treatments were equally effective in reducing blood pressure, and the proportion of responders did not differ.
Combined therapy (diltiazem + hydrochlorothiazide/triamterene) was begun in the ensuing 16 weeks (i.e. single-blind phase) in those patients where a diastolic blood pressure of ⩽ 90mm Hg (or a decrease of ⩾ 10mm Hg for those with a baseline of 95 to 99mm Hg) was not achieved. In this instance, a further relevant lowering of blood pressure occurred. An analysis of all patients (monotherapy and combined therapy) showed that goal blood pressure was achieved (p = 0.06) in more patients treated initially with diltiazem (22 of 28 patients, 78.6%) than with hydrochlorothiazide /triamterene (18 of 33 patients, 54.6%). Final mean daily doses were diltiazem 287mg, hydrochlorothiazide/triamterene 28/76mg, and combined therapy 300 + 37.5/75mg, respectively. The incidence of adverse events during treatment with hydrochlorothiazide/triamterene was almost double that observed with diltiazem (46 vs 24%). Headache was the most common complaint in both groups (17 and 14%, respectively). Oedema was also frequent with diltiazem therapy (10.3%), while nausea (11.4%), nervousness (8.6%), decreased libido (8.6%), and weakness (8.6%) were reported only with hydrochlorothiazide/triamterene. Combination therapy was associated with significantly lower mean serum potassium levels and significantly higher mean uric acid levels than was diltiazem monotherapy.
In conclusion, diltiazem is as effective as hydrochlorothiazide/triamterene in reducing blood pressure but produces fewer side effects. Combining the 2 treatments results in additional blood pressure reduction. To establish the long term usefulness of diltiazem, it will be essential to evaluate its ability to reduce the morbidity and mortality associated with hypertension, especially the development of congestive heart disease.
Medications for treating hypertension
Published: August, 2009
Doctors once hesitated to prescribe medication until a patient’s blood pressure reached 160/100. Anything below that level was deemed “mild hypertension” and not considered dangerous, so many doctors worried that the drugs’ potential side effects might outweigh their benefits. These perceptions turned out to be false. Research has firmly established the value of treating stage 1 hypertension (140/90 to 159/99 mm Hg) with drugs, if necessary.
For those with diabetes or kidney disease, medications may be necessary at pressures as low as 130/80. And today, blood pressure can be controlled with lower doses of medications, meaning there is less chance of side effects.
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Triamterene and hydrochlorothiazide (Oral)
Abnormal elevation of serum potassium levels (greater than or equal to 5.5 mEq/L (5.5 mmol/L)) can occur. Risk of hyperkalemia is increased in patients with renal impairment, diabetes (with or without renal impairment), the elderly, or severely ill. Serum potassium levels must be monitored at frequent intervals, especially in hydrochlorothiazide/triamterene-naive patients, when dosages are changed, or with any illness that may influence renal function
Medically reviewed by Drugs.com. Last updated on Nov 18, 2018.
- Side Effects
Commonly used brand name(s)
In the U.S.
Available Dosage Forms:
Therapeutic Class: Diuretic, Potassium Sparing/Thiazide Combination
Pharmacologic Class: Diuretic, Potassium Sparing
Chemical Class: Thiazide
Uses for triamterene and hydrochlorothiazide
Triamterene and hydrochlorothiazide combination is used alone or with other medicines to treat water retention (edema) or high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Triamterene and hydrochlorothiazide are both diuretic medicines (water pills). They reduce the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure. Triamterene helps prevent your body from absorbing too much salt and keeps your potassium levels from getting too low.
Triamterene and hydrochlorothiazide is available only with your doctor’s prescription.
Before using triamterene and hydrochlorothiazide
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For triamterene and hydrochlorothiazide, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to triamterene and hydrochlorothiazide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of triamterene and hydrochlorothiazide combination in the pediatric population. Safety and efficacy have not been established.
No information is available on the relationship of age to the effects of triamterene and hydrochlorothiazide combination in geriatric patients. However, elderly patients are more likely to have kidney problems and high blood potassium (hyperkalemia), which may require caution in patients receiving triamterene and hydrochlorothiazide.
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking triamterene and hydrochlorothiazide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using triamterene and hydrochlorothiazide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using triamterene and hydrochlorothiazide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amtolmetin Guacil
- Arsenic Trioxide
- Choline Salicylate
- Enalapril Maleate
- Flufenamic Acid
- Mefenamic Acid
- Niflumic Acid
- Nimesulide Beta Cyclodextrin
- Salicylic Acid
- Sodium Salicylate
- Tiaprofenic Acid
- Tolfenamic Acid
Using triamterene and hydrochlorothiazide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using triamterene and hydrochlorothiazide with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use triamterene and hydrochlorothiazide, or give you special instructions about the use of food, alcohol, or tobacco.
Using triamterene and hydrochlorothiazide with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use triamterene and hydrochlorothiazide, or give you special instructions about the use of food, alcohol, or tobacco.
- Potassium Containing Food
Other medical problems
The presence of other medical problems may affect the use of triamterene and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:
- Anuria (not able to pass urine) or
- Hyperkalemia (high potassium in the blood) or
- Kidney problems (e.g., kidney failure), severe or
- Sulfa drug allergy (e.g., sulfamethoxazole, Bactrim®, Septra®)—Should not be used in patients with these conditions.
- Diabetes or
- Weakened immune system, severe—May increase risk for more serious medical problems (e.g., hyperkalemia, metabolic acidosis).
- Electrolyte imbalance or
- Glaucoma, secondary angle closure or
- Gout or
- Heart failure or
- Heart rhythm problems (e.g., arrhythmia), history of or
- Hyperuricemia (high uric acid in the blood) or
- Hypochloremia (low chloride in the blood) or
- Hypokalemia (low potassium in the blood) or
- Hyponatremia (low sodium in the blood) or
- Kidney stones, history of or
- Liver disease (including cirrhosis) or
- Parathyroid disease—Use with caution. May make these conditions worse.
Proper use of triamterene and hydrochlorothiazide
Triamterene and hydrochlorothiazide should not be the first medicine you use to treat your condition. It is meant to be used only after you have tried other medicines that have not worked or have caused unwanted side effects.
In addition to the use of triamterene and hydrochlorothiazide, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that triamterene and hydrochlorothiazide will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
The dose of triamterene and hydrochlorothiazide will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of triamterene and hydrochlorothiazide. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (capsules):
- For hypertension or edema:
- Adults—One or two capsules once a day.
- Children—Use and dose must be determined by your doctor.
- For hypertension or edema:
If you miss a dose of triamterene and hydrochlorothiazide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using triamterene and hydrochlorothiazide
It is very important that your doctor check your progress at regular visits to make sure triamterene and hydrochlorothiazide is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.
Make sure your doctor knows if you are also taking potassium supplements or salt substitutes containing potassium, or certain diuretics such as amiloride (Midamor®, Moduretic®), spironolactone (Aldactazide®, Aldactone®), or other products containing triamterene. Using these medicines together may cause serious problems.
Triamterene and hydrochlorothiazide may increase the amount of potassium in your blood (hyperkalemia). Stop using triamterene and hydrochlorothiazide and check with your doctor right away if you are having abdominal or stomach pain; confusion; difficulty with breathing; irregular heartbeats; nausea or vomiting; nervousness; numbness or tingling in the hands, feet, or lips; shortness of breath; or weakness or heaviness of the legs.
Stop using triamterene and hydrochlorothiazide and check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Triamterene and hydrochlorothiazide may affect blood sugar levels. Check with your doctor if you notice a change in the results of your blood or urine sugar tests.
Triamterene and hydrochlorothiazide may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. Dizziness may be worse if you lose too much water from your body. You can lose water by sweating, having diarrhea, or vomiting. Tell your doctor if triamterene and hydrochlorothiazide makes you feel lightheaded or dizzy after you have been vomiting or had diarrhea.
Check with your doctor right away if you experience drowsiness, fainting, confusion, muscle pain, weakness, and/or a fast heartbeat. Use extra care if you exercise or if the weather is hot. Heavy sweating can cause dehydration (loss of too much water) or electrolyte imbalances (loss of sodium, potassium, or magnesium in the body).
Make sure any doctor or dentist who treats you knows that you are using triamterene and hydrochlorothiazide. You may need to stop using triamterene and hydrochlorothiazide several days before having surgery or medical tests. The results of some tests may be affected by triamterene and hydrochlorothiazide.
Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.
Triamterene and hydrochlorothiazide side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
- Abdominal or stomach pain
- back or leg pains
- black, tarry stools
- bleeding gums
- blisters, hives, or itching
- blood in the urine or stools
- blue lips and fingernails
- blurred vision
- burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
- chest pain
- clay-colored stools
- cloudy urine
- cold sweats
- cough or hoarseness
- coughing that sometimes produces a pink frothy sputum
- dark urine
- decreased urine output
- difficult, fast, noisy breathing, sometimes with wheezing
- difficulty swallowing
- dizziness, faintness, or lightheadedness when getting up from lying or sitting position
- dry mouth
- fast, slow, or irregular heartbeat
- fever with or without chills
- flushed, dry skin
- fruit-like breath odor
- general body swelling
- general feeling of discomfort, illness, or weakness
- greatly decreased frequency of urination or amount of urine
- incoherent speech
- increased hunger
- increased sweating
- increased thirst
- increased urination
- joint pain, stiffness, or swelling
- loss of appetite
- loss of consciousness
- lower back or side pain
- metallic taste
- mood changes
- muscle pain, cramps, weakness, or twitching
- nausea or vomiting
- numbness or tingling in the hands, feet, or lips
- pain in the groin or genitals
- painful or difficult urination
- pains in the stomach, side, or abdomen, possibly radiating to the back
- pale skin
- pinpoint red or purple spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rapid weight gain
- sharp back pain just below the ribs
- shortness of breath
- skin rash
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- sugar in the urine
- swelling of the face, ankles, hands, feet, or lower legs
- swollen or painful glands
- thickening of bronchial secretions
- tightness in the chest
- troubled breathing
- unexplained weight loss
- unpleasant breath odor
- unusual bleeding or bruising
- unusual tiredness or weakness
- vomiting of blood
- weak pulse
- weakness or heaviness of the legs
- yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- Face is warm or hot to touch
- frequent urination
- increased volume of pale, dilute urine
- loss of strength or energy
- pain or weakness in the hands or feet
- redness to face
- reflexes are unusually strong
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
- Decreased interest in sexual intercourse
- feeling of constant movement of self or surroundings
- inability to have or keep an erection
- increased sensitivity of the skin to sunlight
- loss in sexual ability, desire, drive, or performance
- redness or other discoloration of the skin
- sensation of spinning
- severe sunburn
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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More about hydrochlorothiazide / triamterene
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- En Español
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- Drug class: potassium sparing diuretics with thiazides
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