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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. Cite uses deprecated parameters (help)
^ 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. Cite uses deprecated parameters (help)
^ Sloane PD; Coeytaux RR; Beck RS; Dallara J (May 2001). "Dizziness: state of the science". Ann. Intern. Med. 134 (9 Pt 2): 823–32. doi:10.7326/0003-4819-134-9_Part_2-200105011-00005. PMID 11346317. Cite uses deprecated parameters (help)

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. 利尿剤の作用機序 mechanism of action of diuretics
3. 腎集合管ナトリウムチャンネルの遺伝的障害：リドル症候群および偽性低アルドステロン症1型 genetic disorders of the collecting tubule sodium channel liddles syndrome and pseudohypoaldosteronism type 1
4. 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
5. 成人における高カリウム血症の原因および評価 causes and evaluation of hyperkalemia in adults

English Journal

Selective recognition of Triamterene in biological samples by molecularly imprinted monolithic column with a pseudo template employed.

Zhao XY, Zhang HW, Liang ZJ, Shu YP, Liang Y.SourceSchool of Chemistry and Environment, South China Normal University, Guangzhou, P.R.China.
Journal of separation science.J Sep Sci.2013 Feb 19. doi: 10.1002/jssc.201201104. [Epub ahead of print]
Melamine was employed as a pseudo template to prepare a molecularly imprinted polymer monolithic column which presents the ability of selective recognition to Triamterene, whose structure was similar to that of Melamine. Methacrylic acid and ethylene glycol dimethacrylate were applied as functional
PMID 23424016

Antidepressant-selective gynecomastia.

Kaufman KR, Podolsky D, Greenman D, Madraswala R.SourceRobert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), New Brunswick, NJ, USA. kaufmakr@umdnj.edu
The Annals of pharmacotherapy.Ann Pharmacother.2013 Jan;47(1):e6. doi: 10.1345/aph.1R491. Epub 2013 Jan 16.
OBJECTIVE: To describe what we believe is the first reported case of synergistic gynecomastia during treatment of depressive and anxiety disorders when sertraline was added to a stable medication regimen including duloxetine, rosuvastatin, and amlodipine.CASE SUMMARY: A 67-year-old male with major d
PMID 23324513

Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension.

Heran BS, Chen JM, Wang JJ, Wright JM.SourceDepartment of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada. bsheran@ti.ubc.ca
Cochrane database of systematic reviews (Online).Cochrane Database Syst Rev.2012 Nov 14;11:CD008167. doi: 10.1002/14651858.CD008167.pub3.
BACKGROUND: Potassium-sparing diuretics, which block the epithelial sodium channel (ENaC), are widely prescribed for hypertension as a second-line drug in patients taking other diuretics (e.g. thiazide diuretics) and much less commonly prescribed as monotherapy. Therefore, it is essential to determi
PMID 23152254

Japanese Journal

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葉酸代謝拮抗薬（トリメトプリム，トリアムテレン，抗けいれん剤等）は神経管閉鎖障害児妊娠等の危険を押し上げる．妊娠前からの葉酸サプリメント服用はこれら奇形の危険を減少させるとともに，ダウン症児妊娠を減少させる可能性がある．葉酸入りビタミン剤の長期服用は高血圧，大腸癌，乳癌の発症抑制の可能性が指摘されている．高ホモシスティン血症は血栓症，心筋梗塞，痴呆，鬱血性心不全，骨粗鬆症性骨折等の危険因子であるが …
NAID 130000129033

Determination of Losartan and Triamterene in Pharmaceutical Compounds and Urine Using Cathodic Adsorptive Stripping Voltammetry

ENSAFI Ali Asghar,HAJIAN Reza
Analytical sciences : the international journal of the Japan Society for Analytical Chemistry 24(11), 1449-1454, 2008-11-10
NAID 10025208177

Related Pictures

★リンクテーブル★

リンク元	「利尿薬」「急性尿細管間質性腎炎」「トリアムテレン」

「利尿薬」

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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