Triamterene and Hydrochlorothiazide

Brand Name(s): Dyazide® (as a combination product containing Triamterene, Hydrochlorothiazide), Maxzide® (as a combination product containing Triamterene, Hydrochlorothiazide); also available generically

WHY is this medicine prescribed?

The combination of triamterene and hydrochlorothiazide is used to treat high blood pressure and edema (fluid retention; excess fluid held in body tissues) in patients who have lower amounts of potassium in their bodies or for whom low potassium levels in the body could be dangerous. The combination of triamterene and hydrochlorothiazide is in a class of medications called diuretics ('water pills'). They work by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

HOW should this medicine be used?

The combination of triamterene and hydrochlorothiazide comes as a capsule and tablet to take by mouth. It usually is taken once a day. Take triamterene and hydrochlorothiazide at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take triamterene and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

This medication controls high blood pressure and edema but does not cure these conditions. Continue to take triamterene and hydrochlorothiazide even if you feel well. Do not stop taking triamterene and hydrochlorothiazide without talking to your doctor.

Are there OTHER USES for this medicine?

This medicine may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking triamterene and hydrochlorothiazide,

• tell your doctor and pharmacist if you are allergic to triamterene, hydrochlorothiazide, sulfonamide-derived medications ('sulfa drugs'), any other medications, or any ingredients in triamterene and hydrochlorothiazide capsules or tablets. Ask your pharmacist or check the patient information for a list of the ingredients.
• do not take triamterene and hydrochlorothiazide if you are taking amiloride (Midamor), spironolactone (Aldactone, in Aldactazide), or other medications containing triamterene. Your doctor will probably tell you not to take triamterene and hydrochlorothiazide if you are taking one of these medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amphotericin B (Abelcet, Ambisome, Amphotec); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril (Capoten), enalapril (Vasotec, Vaseretic), fosinopril, lisinopril (in Prinzide, in Zestoretic), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); barbiturates such as phenobarbital; corticosteroids such as betamethasone (Celestone), budesonide (Entocort), cortisone (Cortone), dexamethasone (Decadron, Dexpak, Dexasone, others), fludrocortisone (Floriner), hydrocortisone (Cortef, Hydrocortone), methylprednisolone (Medrol, Meprolone, others), prednisolone (Prelone, others), prednisone (Rayos), and triamcinolone (Aristocort, Azmacort); corticotropin (ACTH, H.P., Acthar Gel); digoxin (Lanoxin); laxatives; lithium (Lithobid); medications for diabetes, gout, or high blood pressure; methenamine (Hiprex, Urex); narcotic pain relievers; nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone , methylprednisolone (Medrol), and prednisone (Rayos); and potassium supplements or potassium-containing medication supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have kidney disease or high blood levels of potassium. Your doctor may tell you not to take triamterene and hydrochlorothiazide.
• tell your doctor if you have or have ever had kidney stones, systemic lupus erythematosus (SLE, a chronic inflammatory condition), diabetes, gout, or thyroid, heart, or liver disease.
• tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed if you are taking triamterene and hydrochlorothiazide. If you become pregnant while taking triamterene and hydrochlorothiazide, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking triamterene and hydrochlorothiazide.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Triamterene and hydrochlorothiazide may make your skin sensitive to sunlight.
• you should know that triamterene and hydrochlorothiazide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking triamterene and hydrochlorothiazide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. Alcohol can add to these side effects.

What SPECIAL DIETARY instructions should I follow?

If your doctor prescribes a low-salt or low-sodium diet, or to eat or drink increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice) in your diet, follow these instructions carefully.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Triamterene and hydrochlorothiazide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• frequent urination
• headache

• dry mouth; thirst; nausea; vomiting; weakness, tiredness; drowsiness; restlessness; confusion; muscle weakness, pain, or cramps; fast heartbeat and other signs of dehydration and electrolyte imbalance
• rash
• hives
• itching
• difficulty breathing or swallowing
• pain in the upper stomach area
• swelling or tenderness of stomach area
• upset stomach
• fever
• unusual bruising or bleeding
• loss of appetite
• yellowing of skin or eyes
• flu-like symptoms
• feelings of numbness, tingling, pricking, burning, or creeping on the skin
• inability to move arms and legs
• slow or irregular heartbeat

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• increased urination
• upset stomach
• vomiting
• weakness or tiredness
• fever

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to triamterene.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking triamterene and hydrochlorothiazide.

Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

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