Triamterene + Frusemide Pharmacology
Triamterene + Frusemide
Triamterene
Excretion: Excreted through urine.
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
2.Renal impairment
3.Hyper kalemia
4.Along with other potassium sparing diuretics
5.Anuria
6.Hepatic impairment
2.Diabetes mellitus
3.Deliberate individuals
2.Liddle`s syndrome
3.Adjunctive in therapy of hypertension
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.
Children: 2mg/kg two times daily. Take after break fast & lunch. Reduce the dosage after one week in to alternate days.
Frusemide
It increase local prostaglandin synthesis and increases systemic venous capacitance and decreases left ventricular filling pressure. This causes relief in left ventricular failure and pulmonary edema. It causes renal and peripheral vasodilatation and decrease in peripheral resistance. It is preferred in the initial treatment of congestive heart failure for rapid mobilization of oedema fluid.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure.
Distribution: It is widely distributed in a plasma protein bound form and crosses placenta. Metabolism: It is partly metabolized by glucuronide conjugation.
Excretion: Excreted as unchanged drug mainly through urine. Some drug is excreted through faeces
I.V.: 2 to 5 minutes
I.M.: 10 to 20 minutes
I.V.: 2 hours
2. Headache
3. Diarrhoea
4. Anorexia
5. Nausea
6. Polyurea
7. Vomiting
8. Constipation
9. Frequent urination
10. Nocturea
11. Altered renal function tests
12. Weakness
13. Altered liver function tests
14. Dry mouth
15. Hypo calcaemia
16. Hypo kalaemia
17. Hypo natraemia
18. Transient deafness
19. Gastro intestinal disturbances
20. Visual impairment
21. Muscle cramps
22. Decreased tolerance to carbohydrates
23. Hyper uricaemia.
24. Electrolyte imbalance
25. Orthostatic hypotension
26. Aplastic anaemia
27. Agranulocytosis
28. Paraesthesia
29.Ototoxicity
2. Hypo kalaemia
3. Hypo volaemia
4. Hypotension
5. Hepatic coma
6. Hypersensitivity to the drug
7. Anuric renal failure
2. Renal impairment
3. Gout
4. Diabetes mellitus
5. Hypersensitivity to Sulfonamides
6. Fluid and electrolyte imbalance
7. Long term purgatives
8. Hepatic cirrhosis
9. Chronic Diarrhoea and dehydration.
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Acute pulmonary Oedema
5. Cerebral Oedema
6. Refractory Oedema
7. Hypercalcaemia
8. Oliguria
9. Forced diuresis in drug over dosage.
10. Vertigo
Aminoglycoside antibiotics: Frusemide increases potential for ototoxicity.
Cisplatin: Frusemide increases potential for ototoxicity.
Digitalis glycosides: Diuretics induced potassium loss may precipitate digitalis toxicity, increased frequency of cardiac arrhythmias.
NSAIDs: Effect of frusemide reduced.
Lithium: Therapeutic and toxic effects of lithium increased.
Metolazone: Profound diuresis and greater than predicted electrolyte loss related to the ability of metolazone to block proximal tubular sodium reabsorption useful in patients refractory to frusemide.
Non-depolarizing muscle relaxants: Action of succinylcholine & tubocurarine potentiated by low doses reversed by high doses.
Food: Efficacy reduced when administered with food.
Propranolol: Plasma propranolol level may be increased.
Clofibrate: Increased diuretic responses.
Hydantoins: May decrease the diuretic effects.
Oedema: 40mg in the morning. Increased if required; based on patient`s response up to 80mg.
Maintenance dosage: 20 to 40mg daily or on alternate days.
Maximum dose: 600mg/day.
Children: 3mg/kg/day.
I.V.:
Adult: 20 to 50mg as slow I.V. or I.M. injection. Increased by 20mg every 2hours. Higher I.V. doses must be infused
Children: 0.5 to 1.5mg/kg/day.
Maximum child dose: 20mg/day.
Oliguria: 250mg/day. Gradually increased; by 250mg at every 4 to 6 hours.
Maximum dose: 2gm
Hypertension: 40mg orally twice daily. Adjust the dosage according to patient`s response.
Hypercalcaemia: 120mg orally/day or 80 to 100mg I.V. every 1 to 2 hours
Acute pulmonary Oedema:
Adults: 40mg slow I.V. injection. Then 80mg within 1hour if required.
Children: 1mg/kg I.V.or I.M. Every 2 hours until desired response is gained.
Maximum dose: 6mg/kg/day.
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