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Triamterene (trade name Dyrenium) is a potassium-sparing diuretic used in combination with thiazide diuretics for the treatment of hypertension and edema. In combination with hydrochlorothiazide, it is marketed under the names Maxzide and Dyazide.

Mechanism of action

Triamterene directly blocks the epithelial sodium channel^[1] (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. Sodium channel blockers directly inhibit the entry of sodium into the sodium channels.

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. Triamterene is best avoided in patients with chronic kidney disease due to the possibility of hyperkalemia. People using this drug should use salt substitute cautiously.^[2]

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.

Use should be avoided if the creatinine clearance is less than 10 ml/minute.

With Hydrochlorothiazide

Triamterene is commonly prepared in combination with hydrochlorothiazide for treatment of hypertension (high blood pressure) and edema (water retention). This combination is in a class of medications called diuretics or 'water pills', and causes the kidneys to get rid of the body's unneeded water and sodium through the urine.^[3] Dyazide is marketed by GlaxoSmithKline and Maxzide is marketed by Mylan.^{[citation needed]}

Use in Ménière's disease

While there is a lack of randomized controlled trials evaluating the use of triamterene in the treatment of Ménière's disease, the typical treatment is 37.5 mg of triamterene with 25 mg of hydrochlorothiazide 1–2 capsules daily.^[4]^[5] This recommendation was given a Strength of Recommendation Taxonomy (SORT) grade of C.^{[citation needed]}

References

^ Busch AE; Suessbrich H; Kunzelmann K; et al. (September 1996). "Blockade of epithelial Na+ channels by triamterenes - underlying mechanisms and molecular basis". Pflugers Arch. 432 (5): 760–6. doi:10.1007/s004240050196. PMID 8772124.
^ LoSalt Advisory Statement (PDF)^{[dead link]}
^ "Triamterene and Hydrochlorothiazide". MedlinePlus. U.S. National Library of Medicine. National Institutes of Health. September 1, 2008.
^ Swartz R; Longwell P (March 2005). "Treatment of vertigo". Am Fam Physician 71 (6): 1115–22. PMID 15791890.
^ Sloane PD; Coeytaux RR; Beck RS; Dallara J (May 2001). "Dizziness: state of the science". Ann. Intern. Med. 134 (9 Pt 2): 823–32. PMID 11346317.

External links

Dyazide Prescribing Information GlaxoSmithKline

UpToDate Contents

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1. トリアムテレン腎毒性 triamterene nephrotoxicity
2. まれな先天性副腎過形成 uncommon congenital adrenal hyperplasias
3. 利尿剤の作用機序 mechanism of action of diuretics
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5. 腎結石が確認された成人患者の評価および結石形成の有無が不明の患者の治療 evaluation of the adult patient with established nephrolithiasis and treatment if stone composition is unknown

English Journal

Occurrence and removal of frequently prescribed pharmaceuticals and corresponding metabolites in wastewater of a sewage treatment plant.

Gurke R1, Rößler M2, Marx C3, Diamond S4, Schubert S5, Oertel R5, Fauler J5.
The Science of the total environment.Sci Total Environ.2015 Nov 1;532:762-70. doi: 10.1016/j.scitotenv.2015.06.067. Epub 2015 Jun 27.
The present study determines removal rates (RR) of 56 pharmaceuticals and metabolites, respectively, in an urban sewage treatment plant using mass flow analysis by comparing influent and effluent loads over a consecutive ten-day monitoring period. Besides well investigated compounds like carbamazepi
PMID 26124013

Simultaneous Determination of 10 Adulterants in Antihypertensive Functional Foods Using Multi-Walled Carbon Nanotubes-Dispersive Solid-Phase Extraction Coupled with High Performance Liquid Chromatography.

Zeng L1, Li Y1, Wu X2, Zhang J1, Xie J1, Sun C3.
Journal of chromatographic science.J Chromatogr Sci.2015 Oct;53(9):1611-21. doi: 10.1093/chromsci/bmv031. Epub 2015 Apr 2.
Consumption of functional foods based on extracts from selected herbs to alleviate hypertension is an increasingly common practice in China. Adulteration of these foods with pharmaceuticals can significantly impact a consumer's health. To control the quality of the functional foods effectively, a me
PMID 25840433

Triamterene in the Treatment of Hypertension: More Than Just Potassium Sparing?

Smetana GW1.
Journal of general internal medicine.J Gen Intern Med.2015 Sep 18. [Epub ahead of print]
PMID 26385116

Related Pictures

Triamterene 50 MG Oral Capsule [Dyrenium Drugs reference index « Dyrenium » Dyrenium: Indications, Side Effects Dyrenium (triamterene) medical facts from DYRENIUM® (triamterene USP) Capsules 50 imprinted with dyrenium 100mg and dyrenium

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リンク元

「トリアムテレン」

Triamterene
Systematic (IUPAC) name
	6-phenylpteridine-2,4,7-triamine
Clinical data
Trade names	Dyrenium, Dyazide, Maxzide
AHFS/Drugs.com	monograph
MedlinePlus	a682337
Pregnancy cat.	C (US)
Legal status	℞-only (US)
Routes	oral
Pharmacokinetic data
Bioavailability	30-70%
Protein binding	67%
Metabolism	conjugated to hydroxytriamterene
Half-life	1-2 hours, active metabolite 3 hours
Excretion	renal <50%, 21% unchanged
Identifiers
CAS number	396-01-0
ATC code	C03DB02
PubChem	CID 5546
IUPHAR ligand	4329
DrugBank	DB00384
ChemSpider	5345
UNII	WS821Z52LQ
KEGG	D00386
ChEMBL	CHEMBL585
Chemical data
Formula	C12H11N7
Mol. mass	253.263 g/mol
	InChI InChI=1S/C12H11N7/c13-9-7(6-4-2-1-3-5-6)16-8-10(14)18-12(15)19-11(8)17-9/h1-5H,(H6,13,14,15,17,18,19) ; Key:FNYLWPVRPXGIIP-UHFFFAOYSA-N ;
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　　[★]

英: triamterene
ラ: triamterenum
商: Dyrenium、Maxzide、ジウテレン、トリテレン
関: 利尿薬

利尿薬
アルドステロン非存在下でも効果あることから、遠位側ネフロンのNa⁺輸送を直接抑制する (SPC.267)

[pmid8772124-1] Busch AE; Suessbrich H; Kunzelmann K; et al. (September 1996). "Blockade of epithelial Na+ channels by triamterenes - underlying mechanisms and molecular basis". Pflugers Arch. 432 (5): 760–6. doi:10.1007/s004240050196. PMID 8772124.

[2] LoSalt Advisory Statement (PDF)^{[dead link]}

[3] "Triamterene and Hydrochlorothiazide". MedlinePlus. U.S. National Library of Medicine. National Institutes of Health. September 1, 2008.

[pmid15791890-4] Swartz R; Longwell P (March 2005). "Treatment of vertigo". Am Fam Physician 71 (6): 1115–22. PMID 15791890.

[pmid11346317-5] Sloane PD; Coeytaux RR; Beck RS; Dallara J (May 2001). "Dizziness: state of the science". Ann. Intern. Med. 134 (9 Pt 2): 823–32. PMID 11346317.

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案内

Dyrenium