Triamterene + Hydrochlorothiazide Pharmacology

Triamterene + Hydrochlorothiazide

About Triamterene + Hydrochlorothiazide
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Mechanism of Action of Triamterene + Hydrochlorothiazide
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Pharmacokinets of Triamterene + Hydrochlorothiazide
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Onset of Action for Triamterene + Hydrochlorothiazide
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Duration of Action for Triamterene + Hydrochlorothiazide
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Half Life of Triamterene + Hydrochlorothiazide
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Side Effects of Triamterene + Hydrochlorothiazide
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Contra-indications of Triamterene + Hydrochlorothiazide
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Special Precautions while taking Triamterene + Hydrochlorothiazide
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Pregnancy Related Information
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Old Age Related Information
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Breast Feeding Related Information
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Children Related Information
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Indications for Triamterene + Hydrochlorothiazide
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Interactions for Triamterene + Hydrochlorothiazide
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Typical Dosage for Triamterene + Hydrochlorothiazide
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Schedule of Triamterene + Hydrochlorothiazide
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Storage Requirements for Triamterene + Hydrochlorothiazide
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Effects of Missed Dosage of Triamterene + Hydrochlorothiazide
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Effects of Overdose of Triamterene + Hydrochlorothiazide
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Triamterene

About Triamterene
A potassium-sparing diuretic, Diuretic,Antioedema, Adjunctive in therapy of hypertension.
Mechanism of Action of Triamterene
Triamterene exerts its diuretic action by interacting with renal epithelial Na+ channels in distal tubules and collecting duct and prevent sodium reabsorption. It prevents potassium and magnesium loses. It also increases chloride, bicarbonate, and water excretion. The drug augment the natriuretic and anti hypertensive response of other diuretic drugs. It is used in the management of edema associated with congestive heart failure, hepatic cirrhosis with ascites, nephrotic syndrome, and idiopathic edema. It is used mainly in combination with other drugs in the management of hypertension and to correct hypokalemia caused by other diuretic drugs
Pharmacokinets of Triamterene
Absorption: Rapidly but incompleately absorbed orally, Distribution: It is distributed in a protein bound form, Metabolism: It metabolized in to an active metabolite in the body,
Excretion: Excreted through urine.
Onset of Action for Triamterene
2 to4hours
Duration of Action for Triamterene
12 to 16 hours
Half Life of Triamterene
100 to 150minutes
Side Effects of Triamterene
1.Headache
2.Dizziness
3.Nausea
4.Diarrhoea
5.Vomiting
6.Dry mouth
7.Weakness
8.Hyper kalemia
9.Hyponatremia
10.Thrombocytopenia
11.Agranulocytosis
12.Photosensitivity
13.Reduce glucose tolerance
14.Altered liver function tests
15.Altered kidney function tests
16.Gastro intestinal disturbances
17.Interstitial nephritis
18.Kidney stones
19.Rashes
20.Ototoxicity
Contra-indications of Triamterene
1.Hypersensitivity to the drug
2.Renal impairment
3.Hyper kalemia
4.Along with other potassium sparing diuretics
5.Anuria
6.Hepatic impairment

Special Precautions while taking Triamterene
1.Gout
2.Diabetes mellitus
3.Deliberate individuals

Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Indications for Triamterene
1.Oedema
2.Liddle`s syndrome
3.Adjunctive in therapy of hypertension

Interactions for Triamterene
Amantadine: Triamterene increases the toxic effects of Amantadine.
ACE inhibitors: May result in significant hyperkalaemia.
Indomethacin: May produce unexpectedly high incidence of nephrotoxicity.
Potassium preparations: May result in hyperkalaemia, possibly with cardiac arrhythmias or cardiac arrest, particularly in those with impaired renal function.
Lab tests: Since both triamterene and quinidine have similar fluorescene spectra, triamterene will interfere with fluoroscent measurement of Quinidine serum levels.
Typical Dosage for Triamterene
100 to 250mg/day in divided doses.
Children: 2mg/kg two times daily. Take after break fast & lunch. Reduce the dosage after one week in to alternate days.
Schedule of Triamterene
H
Storage Requirements for Triamterene
Store at controlled room temperature at a range of 20 to 25 degree C. in a well closed container and protects from light.




Effects of Missed Dosage of Triamterene
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Triamterene
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and support electrolyte balance and blood acidosis. Reduce serum potassium with I.V. sodium bicarbonate or glucose with insulin. Potassium level is also reduced by a cation exchange resins like sodium polystyrene sulfonate given orally or as retention enema.

Hydrochlorothiazide

About Hydrochlorothiazide
Thiazide derivatibve, Diuretic.
Mechanism of Action of Hydrochlorothiazide
It is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure

Pharmacokinets of Hydrochlorothiazide
Absorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.

Onset of Action for Hydrochlorothiazide
1 to 3 hours
Duration of Action for Hydrochlorothiazide
12 to 16 hours
Half Life of Hydrochlorothiazide
5 to 15 hours
Side Effects of Hydrochlorothiazide
1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity

Contra-indications of Hydrochlorothiazide
1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance

Special Precautions while taking Hydrochlorothiazide
1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis

Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
May be used
Indications for Hydrochlorothiazide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for Hydrochlorothiazide
Cholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for Hydrochlorothiazide
Adults:
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Oedema:
Adults:
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses



Schedule of Hydrochlorothiazide
G
Storage Requirements for Hydrochlorothiazide
Store at room temperature in a well closed container and protected from light.
Effects of Missed Dosage of Hydrochlorothiazide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydrochlorothiazide
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.

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