Classification: POTASSIUM-SPARING DIURETIC
Therapeutic: POTASSIUM-SPARING DIURETIC
Prototype: Spironolactone
ACTION & THERAPEUTIC EFFECT
Has weak diuretic action with a potassium-sparing
effect. Promotes excretion of sodium, chloride, and carbonate. Blocks potassium
excretion by direct action on distal renal tubule rather than by inhibiting aldosterone.
Has a diuretic action and a potassium-sparing effect.
Hypersensitivity to triamterene; anuria, severe or
progressive kidney disease or dysfunction; severe liver disease; diabetic
neuropathy; elevated serum potassium; severe electrolyte or acid-base
imbalance; pregnancy (category D).
Impaired kidney or liver function; gout; history
of gouty arthritis; DM; history of kidney stones; older adults; lactation.
Adult: PO 50–100 mg b.i.d. (max:300 mg/day)
Renal Impairment Dosage Adjustment
CrCl less than 10
mL/min: Avoid use
- Empty capsule and give with fluid or mix with
food, if patient cannot swallow capsule.
- Give drug with or after meals to prevent or
minimize nausea.
- Schedule doses to prevent interruption of sleep
from dieresis (e.g., with or after breakfast if a single dose is taken, or no
later than 6 p.m. if more than one dose is prescribed). Consult prescriber.
- Withdraw drug gradually in patients on prolonged
or high-dose therapy in order to prevent rebound increased urinary excretion of
potassium.
- Store in tight, light-resistant containers at
15°–30° C (59°–86° F) unless otherwise directed.
GI: Diarrhea, nausea, vomiting, and other GI disturbances. CNS: Dizziness, headache, dry mouth, anaphylaxis, weakness, muscle
cramps. Skin: Pruritus, rash, photosensitivity. CV: Hypotension (large doses). Metabolic: Hyperkalemia
and other electrolyte imbalances,
elevated BUN, elevated uric acid (patients predisposed to gouty arthritis),
hyperchloremic acidosis. Hematologic:
Blood dyscrasias:
Granulocytopenia, eosinophilia, megaloblastic anemia in patients with reduced
folic acid stores (e.g., hepatic cirrhosis).
DIAGNOSTIC TEST INTERFERENCE
Pale blue fluorescence in urine interferes with fluorometric assay of quinidine and lactic dehydrogenase activity.
Treatment of edema,
ascites, hypokalemia, hyperaldosteronism.
Drug: May increase lithium levels, thus increasing its toxicity; indomethacin may decrease renal elimination of triamterene; ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS, other POTASSIUM- SPARING DIURETICS may cause hyperkalemia. Food: High potassium foods may increase risk of hyperkalemia.
Absorption: Rapidly but variably from GI tract. Onset: 2–4 h. Duration:
7–9 h. Metabolism: In liver to active and inactive
metabolites. Elimination: In urine. Half-Life: 100–150 min.
Triamterene has been
associated with increased risk of hyperkalemia.
Assessment & Drug Effects
- Monitor BP during periods of dosage adjustment.
Hypotensive reactions, although rare, have been reported. Take care with ambulation,
particularly for older adults.
- Weigh patient under standard conditions, prior
to drug initiation and daily during therapy.
- Diuretic response usually occurs on first day of
therapy; maximum effect may not occur for several days.
- Monitor and report oliguria and unusual changes
in I&O ratio. Consult prescriber regarding allowable fluid intake.
- Be alert for S&S of kidney stone formation;
reported in patients taking high doses or who have low urine volume and
increased urine acidity.
- Observe for S&S of hyperkalemia (see
Appendix F), particularly in patients with renal insufficiency, on high-dose or
prolonged therapy, older adults, and those with diabetes.
- Monitor diabetics closely for loss of glycemic
control.
- Monitor lab tests: Baseline and periodic serum
potassium and other electrolytes; periodic kidney function tests with known or suspected
renal insufficiency; periodic blood studies with prolonged therapy or with
cirrhosis to monitor for megaloblastic anemia.
Patient & Family Education
- Do not use salt substitutes; unlike most diuretics,
triamterene promotes potassium retention.
- Do not restrict salt; there is a possibility of
low-salt syndrome (hyponatremia). Consult prescriber.
- Report significant fatigue or weakness, malaise,
fever, sore throat, or mouth and unusual bleeding or bruising to prescriber.
- Be aware that drug may cause photosensitivity;
avoid exposure to sun and sunlamps.
- Drug may impart a harmless pale blue
fluorescence to urine.
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