Hydrochlorothiazide and triamterene

This fixed combination drug is not indicated for the initial therapy of edema or hypertension except in individuals in whom the development of hypokalemia cannot be risked.

DYAZIDE (hydrochlorothiazide and triamterene) is indicated for the treatment of hypertension or edema in patients who develop hypokalemia on hydrochlorothiazide alone.

DYAZIDE (hydrochlorothiazide and triamterene) is also indicated for those patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked.

DYAZIDE (hydrochlorothiazide and triamterene) may be used alone or as an adjunct to other antihypertensive drugs, such as beta-blockers. Since DYAZIDE (hydrochlorothiazide and triamterene) may enhance the action of these agents, dosage adjustments may be necessary.

Usage in Pregnancy: The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no satisfactory evidence that they are useful in the treatment of developed toxemia.

Edema during pregnancy may arise from pathological causes or from the physiologic and mechanical consequences of pregnancy. Diuretics are indicated in pregnancy when edema is due to pathologic causes, just as they are in the absence of pregnancy. Dependent edema in pregnancy resulting from restriction of venous return by the expanded uterus is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is illogical and unnecessary. There is hypervolemia during normal pregnancy which is harmful to neither the fetus nor the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances this edema may cause extreme discomfort which is not relieved by rest. In these cases a short course of diuretics may provide relief and may be appropriate.

Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and triamterene.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

Do not use potassium supplements, salt substitutes, or low-sodium milk while you are taking hydrochlorothiazide and triamterene, unless your doctor has told you to.

Hydrochlorothiazide and triamterene may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Triamterene is a potassium-sparing diuretic that also prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

Hydrochlorothiazide and triamterene is a combination medicine used to treat fluid retention (edema) and high blood pressure (hypertension).

This medicine is usually given to people in whom other diuretics have caused hypokalemia (low potassium levels in your blood).

Hydrochlorothiazide and triamterene may also be used for purposes not listed in this medication guide.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
• Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
• Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
• Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
• Dark urine or yellow skin or eyes.
• A burning, numbness, or tingling feeling that is not normal.
• Chest pain or pressure or a fast heartbeat.
• Fever or chills.
• Sore throat.
• Restlessness.
• Shortness of breath.
• Any unexplained bruising or bleeding.
• Feeling very tired or weak.
• Change in sex ability.
• This medicine can cause certain eye problems. If left untreated, this can lead to lasting eyesight loss. If eye problems happen, signs like change in eyesight or eye pain most often happen within hours to weeks of starting this medicine. Call your doctor right away if you have these signs.

• Antihypertensive
• Diuretic, Potassium-Sparing
• Diuretic, Thiazide

Hypertension, edema: Treatment of hypertension or edema (not recommended for initial treatment) when hypokalemia has developed on hydrochlorothiazide alone or when the development of hypokalemia must be avoided.

Also see individual agents. Frequency not defined.

Cardiovascular: Angina pectoris, cardiac arrhythmia, necrotizing angiitis, orthostatic hypotension, tachycardia

Central nervous system: Anxiety, depression, dizziness, fatigue, glossopyrosis, headache, insomnia, paresthesia, restlessness, vertigo

Dermatologic: Skin photosensitivity, skin rash, urticaria

Endocrine & metabolic: Acidosis, diabetes mellitus, glycosuria, hypercalcemia, hyperglycemia, hyperkalemia, hyperuricemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia

Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, dysgeusia, gastric distress, nausea, pancreatitis, sialadenitis, stomach cramps, tongue discoloration (bright orange), vomiting, xerostomia

Genitourinary: Impotence, urine discoloration, urine sedimentation abnormality

Hematologic & oncologic: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, megaloblastic anemia, purpura, thrombocytopenia

Hepatic: Abnormal liver function tests, jaundice

Hypersensitivity: Anaphylaxis

Neuromuscular & skeletal: Exacerbation of systemic lupus erythematosus, lupus-like syndrome (subacute, cutaneous), muscle cramps, weakness

Ophthalmic: Transient blurred vision, xanthopsia

Renal: Acute renal failure, increased blood urea nitrogen, increased serum creatinine, interstitial nephritis, nephrolithiasis

Respiratory: Dyspnea, hypersensitivity pneumonitis, pulmonary edema, respiratory distress

Miscellaneous: Fever

<1% (Limited to important or life-threatening): Malignant neoplasm of lip (Friedman 2012)

Abnormal elevation of serum potassium levels (5.5 mEq/L or more) can occur with hydrochlorothiazide/triamterene. Hyperkalemia is more likely to occur in patients with renal impairment and diabetes (even without evidence of renal impairment), or elderly or severely ill patients. Because uncorrected hyperkalemia may be fatal, serum potassium levels must be monitored at frequent intervals, especially in patients first receiving hydrochlorothiazide/triamterene, when dosages are changed, or with any illness that may influence renal function.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience diarrhea, dizziness, constipation, headache, lack of appetite, vomiting, or nausea. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, tachycardia, increased thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in amount of urine passed, dry mouth, dry eyes, nausea, or vomiting), signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), jaundice, dark urine, burning or numbness feeling, angina, tachycardia, chills, pharyngitis, agitation, shortness of breath, bruising, bleeding, severe loss of strength and energy, sexual dysfunction, vision changes, or eye pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Contraindicated in patients with anuria, acute and chronic renal insufficiency, or significant renal impairment.