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Hydrochlorothiazide and triamterene: Drug information

Hydrochlorothiazide and triamterene: Drug information
(For additional information see "Hydrochlorothiazide and triamterene: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Hyperkalemia:

Abnormal elevation of serum potassium levels (≥5.5 mEq/L) can occur with all potassium-conserving diuretic combinations, including hydrochlorothiazide/triamterene. Hyperkalemia is more likely to occur in patients with renal impairment and diabetes (even without evidence of renal impairment), or elderly or severely ill patients. Because uncorrected hyperkalemia may be fatal, serum potassium levels must be monitored at frequent intervals, especially in patients first receiving hydrochlorothiazide/triamterene, when dosages are changed, or with any illness that may influence renal function.

Brand Names: US
  • Dyazide [DSC];
  • Maxzide;
  • Maxzide-25
Brand Names: Canada
  • APO-Triazide;
  • TEVA-Triamterene/HCTZ
Pharmacologic Category
  • Antihypertensive;
  • Diuretic, Potassium Sparing;
  • Diuretic, Thiazide
Dosing: Adult
Hypertension, edema

Hypertension, edema: Oral:

Hydrochlorothiazide 25 mg/triamterene 37.5 mg: 1 to 2 tablets/capsules once daily.

Hydrochlorothiazide 25 mg/triamterene 50 mg: 1 to 2 capsules once daily.

Hydrochlorothiazide 50 mg/triamterene 75 mg: 1 tablet daily.

Meniere disease, chronic management

Meniere disease, chronic management (off-label use):

Note: Reserve pharmacotherapy for patients in whom lifestyle modifications do not result in sufficient response. Provide as-needed vestibular suppressants and antiemetics for acute relief of vertigo (Ref).

Oral: Hydrochlorothiazide 25 mg/triamterene 37.5 mg: 1 tablet or capsule once daily (Ref). May discontinue after 6 months of prolonged control (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. Contraindicated in patients with anuria, acute and chronic renal insufficiency, or significant renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution and monitor for precipitation of hepatic coma.

Dosing: Older Adult

Refer to adult dosing; use with caution.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified. Also see individual agents.

Frequency not defined:

Cardiovascular: Cardiac arrhythmia, orthostatic hypotension

Dermatologic: Skin rash, urticaria

Endocrine & metabolic: Acidosis, diabetes mellitus, hypercalcemia, hyperglycemia, hyperkalemia, hyperuricemia, hypochloremia, hypokalemia

Gastrointestinal: Abdominal pain, constipation, diarrhea, nausea, pancreatitis, sialadenitis, vomiting, xerostomia

Genitourinary: Glycosuria, impotence, urine sedimentation abnormality

Hematologic & oncologic: Leukopenia, megaloblastic anemia, purpuric disease, thrombocytopenia

Hepatic: Jaundice, liver enzyme disorder

Hypersensitivity: Anaphylaxis

Nervous system: Asthenia, dizziness, fatigue, headache

Neuromuscular & skeletal: Lupus-like syndrome (subacute cutaneous), muscle cramps

Renal: Acute kidney injury, increased blood urea nitrogen, increased serum creatinine, interstitial nephritis, nephrolithiasis

Postmarketing:

Dermatologic: Malignant neoplasm of lip (Friedman 2012), skin photosensitivity (Friedman 2012)

Endocrine & metabolic: Hyponatremia (Roberts 1984), nephrogenic diabetes insipidus (Macleod 1981), pseudoporphyria (Motley 1990)

Ophthalmic: Angle-closure glaucoma (Murphy 2016)

Contraindications

Hypersensitivity to hydrochlorothiazide, triamterene, sulfonamide-derived drugs, or any component of the formulation; anuria; acute and chronic renal insufficiency or significant renal impairment; patients receiving other potassium-sparing diuretics, potassium-containing salt substitutes, or potassium supplements (except in severe cases of hypokalemia); preexisting hyperkalemia.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged. See “Warnings/Precautions” for more detail.

Canadian labeling: Additional contraindications (not in US labeling): Severe or progressive hepatic dysfunction

Warnings/Precautions

Concerns related to adverse effects:

• Electrolyte disturbances: Hypokalemia, hypochloremic alkalosis, and hyponatremia may occur with hydrochlorothiazide.

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated by hydrochlorothiazide. This risk may be increased with doses ≥25 mg (Gurwitz 1997).

• Hyperkalemia: Hyperkalemia can occur with triamterene; patients at risk include those with renal impairment, diabetes (even without evidence of renal impairment), the elderly, and the severely ill. Serum potassium levels must be monitored at frequent intervals especially in patients first receiving hydrochlorothiazide/triamterene, when dosages are changed, or with any illness that may influence renal function. Avoid potassium supplements (except in severe cases of hypokalemia), potassium-containing salt substitutes, a diet rich in potassium, or other drugs that can cause hyperkalemia. Discontinue immediately if hyperkalemia develops. Patients who are severely ill may develop respiratory or metabolic acidosis which may be associated with rapid elevations in serum potassium concentrations; avoid use in these patients.

• Hypersensitivity reactions: Hypersensitivity reactions may occur with hydrochlorothiazide. Risk is increased in patients with a history of allergy or bronchial asthma.

• Ocular effects: Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma, typically occurring within hours to weeks following initiation; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain. Additional treatments may be needed if uncontrolled intraocular pressure persists. Risk factors may include a history of sulfonamide or penicillin allergy.

• Photosensitivity: Photosensitization may occur.

• Skin cancer, nonmelanoma: Prolonged use (≥3 years) may increase the risk for squamous cell carcinoma up to 4 times and increase the risk for basal cell carcinoma up to 1.25 times compared to patients not treated with hydrochlorothiazide (Pedersen 2018; Pottegård 2017).

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may alter glycemic control.

• Hepatic impairment: Use caution in patients with severe hepatic impairment. In progressive or severe liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercalcemia: Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported with thiazides.

• Kidney stones: Use triamterene with caution in patients with kidney stones.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use. Thiazides should be discontinued prior to tests for parathyroid function.

• Renal impairment: Cumulative effects of hydrochlorothiazide may develop, including azotemia, in patients with impaired renal function. Avoid hydrochlorothiazide in severe renal disease (ineffective). Triamterene may cause hyperkalemia in patients with renal impairment.

• Systemic lupus erythematosus (SLE): Hydrochlorothiazide may cause SLE exacerbation or activation.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Dyazide: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [DSC]

Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg

Tablet, Oral:

Maxzide-25: Hydrochlorothiazide 25 mg and triamterene 37.5 mg [scored; contains fd&c blue #1 (brilliant blue), quinoline yellow (d&c yellow #10)]

Maxzide: Hydrochlorothiazide 50 mg and triamterene 75 mg [scored; contains quinoline yellow (d&c yellow #10)]

Generic: Hydrochlorothiazide 25 mg and triamterene 37.5 mg, Hydrochlorothiazide 50 mg and triamterene 75 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Triamterene-HCTZ Oral)

37.5-25 mg (per each): $0.37 - $1.40

Tablets (Maxzide Oral)

75-50 mg (per each): $4.25

Tablets (Maxzide-25 Oral)

37.5-25 mg (per each): $1.89

Tablets (Triamterene-HCTZ Oral)

37.5-25 mg (per each): $0.36 - $0.39

75-50 mg (per each): $0.92 - $1.11

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: Hydrochlorothiazide 25 mg and triamterene 50 mg

Administration: Adult

Oral: Administer without regard to meals.

Use: Labeled Indications

Hypertension, edema: Treatment of hypertension or edema (not recommended for initial treatment) when hypokalemia has developed on hydrochlorothiazide alone or when the development of hypokalemia must be avoided.

Use: Off-Label: Adult

Meniere disease

Medication Safety Issues
Sound-alike/look-alike issues:

Dyazide may be confused with diazoxide, Dynacin

Maxzide may be confused with Maxidex, Microzide

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics (hydrochlorothiazide and triamterene) are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Ajmaline: Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy

Alcohol (Ethyl): May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Allopurinol: Thiazide and Thiazide-Like Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Ammonium Chloride: Potassium-Sparing Diuretics may enhance the adverse/toxic effect of Ammonium Chloride. Specifically the risk of systemic acidosis. Risk C: Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticholinergic Agents: May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider therapy modification

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. Management: Consider separating administraton of bile acid sequestrants and thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider therapy modification

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Calcium Salts. Risk C: Monitor therapy

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor therapy

CycloSPORINE (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of CycloSPORINE (Systemic). Risk X: Avoid combination

Desmopressin: Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Dexketoprofen: May enhance the adverse/toxic effect of Sulfonamides. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy

Diazoxide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Dofetilide: HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. Risk X: Avoid combination

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Erdafitinib: May increase the serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Consider alternatives to this combination when possible. If combined, monitor for increased effects/toxicities of OCT2 substrates and consider OCT2 substrate dose reductions when appropriate. Risk D: Consider therapy modification

Fexinidazole: May increase the serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of fexinidazole with OCT2 substrates when possible. If combined, monitor for increased OCT2 substrate toxicities. Risk D: Consider therapy modification

Finerenone: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Heparin: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Monitor serum potassium concentrations closely. The spironolactone Canadian product monograph lists its combination with heparin or low molecular weight heparins as contraindicated. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indomethacin: Triamterene may enhance the adverse/toxic effect of Indomethacin. Specifically, the risk for renal failure and hyperkalemia may be increased. Management: Consider alternatives to concomitant treatment with triamterene and indomethacin. If the combination cannot be avoided, monitor for development of renal failure and hyperkalemia. Risk D: Consider therapy modification

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Ipragliflozin: May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor therapy

Ivabradine: Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Levosulpiride: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. Risk X: Avoid combination

Licorice: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Lithium: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Mecamylamine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider therapy modification

Methenamine: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Methenamine. Risk C: Monitor therapy

Methotrexate: HydroCHLOROthiazide may enhance the nephrotoxic effect of Methotrexate. Risk C: Monitor therapy

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Diuretics may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination

Potassium-Sparing Diuretics: May enhance the hyperkalemic effect of other Potassium-Sparing Diuretics. Risk X: Avoid combination

Pramipexole: Triamterene may enhance the hypotensive effect of Pramipexole. Triamterene may increase the serum concentration of Pramipexole. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Promazine: Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Tacrolimus (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Tafenoquine: May increase the serum concentration of OCT2 Substrates (Clinically Relevant with Inhibitors). Management: Avoid use of OCT2 substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the OCT2 substrate and consider a reduced dose of the OCT2 substrate according to that substrate's labeling. Risk D: Consider therapy modification

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Topiramate: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Risk C: Monitor therapy

Toremifene: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. Risk C: Monitor therapy

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. Risk C: Monitor therapy

Food Interactions

See individual agents.

Pregnancy Considerations

Hydrochlorothiazide and triamterene cross the placenta.

Refer to individual monographs for additional information.

Breastfeeding Considerations

Hydrochlorothiazide is present in breast milk; excretion of triamterene is not known.

Breastfeeding is not recommended by the manufacturer. Refer to individual monographs for additional information.

Monitoring Parameters

BP, serum electrolytes, BUN, creatinine, LFTs, signs of hyperkalemia.

Mechanism of Action

Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions.

Triamterene: Blocks epithelial sodium channels in the late distal convoluted tubule (DCT) and collecting duct which inhibits sodium reabsorption from the lumen. This effectively reduces intracellular sodium, decreasing the function of Na+/K+ ATPase, leading to potassium retention and decreased calcium, magnesium, and hydrogen excretion. As sodium uptake capacity in the DCT/collecting duct is limited, the natriuretic, diuretic, and antihypertensive effects are generally considered weak.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Dyazide;
  • (AT) Austria: Dytide h | Triamteren comp | Triastad hydrochlorothiazid;
  • (AU) Australia: Dyazide | Hydrene;
  • (BD) Bangladesh: Dezide;
  • (BE) Belgium: Dytenzide | Maxzide;
  • (BG) Bulgaria: Diuretidin | Triampur comp;
  • (BR) Brazil: Iguassina;
  • (CH) Switzerland: Dyazide | T/h-basan;
  • (CL) Chile: Hidroronol t | Uren;
  • (CN) China: Da an | Fu fang an ben die ding;
  • (CO) Colombia: Dyazide;
  • (DE) Germany: Diuretikum Verla | Diutensat | Duradiuret | Dytide h | Esiteren | Hypertorr | Jenateren Comp | Nephral | Sali-puren | Thiazid-comp | Tri. thiazid | Triampur | Triamteren comp | Triamteren comp. | Triamteren hct al | Triamteren HCT Sandoz | Triamteren-h | Triarese | Triazid | Turfa;
  • (DO) Dominican Republic: Dyazide | Hidrotim | Kaldrene | Triamteren comp;
  • (EE) Estonia: Triam co | Triampur comp | Triamteren comp;
  • (EG) Egypt: Thiametren;
  • (FI) Finland: Triamtex;
  • (FR) France: Prestole;
  • (GB) United Kingdom: Co-triamterzid | Dyazide | Triam co | Triamaxco;
  • (HK) Hong Kong: Apo triazide | Dirazide | Dyazide | Trizid;
  • (HR) Croatia: Tiaren;
  • (IE) Ireland: Dyazide;
  • (IN) India: Maxide;
  • (JO) Jordan: Dyazide;
  • (KW) Kuwait: Dyazide;
  • (LT) Lithuania: Dytide h | Triampur comp | Triamteren comp;
  • (LU) Luxembourg: Dytenzide | Maxzide;
  • (LV) Latvia: Dytide h | Triam co | Triampur comp | Triamteren comp;
  • (MA) Morocco: Prestole;
  • (MX) Mexico: Dyazide;
  • (MY) Malaysia: Apo triazide | Dyazide;
  • (NL) Netherlands: Dytenzide | Triamtereen/Hydrochloorthiazide | Triamtereen/Hydrochloorthiazide A | Triamtereen/Hydrochloorthiazide Accord | Triamtereen/Hydrochloorthiazide Aurobindo | Triamtereen/Hydrochloorthiazide CF | Triamtereen/Hydrochloorthiazide Katwijk | Triamtereen/Hydrochloorthiazide Merck | Triamtereen/Hydrochloorthiazide PCH | Triamtereen/Hydrochloorthiazide Ratiopharm | Triamtereen/Hydrochloorthiazide Sandoz | Triamteren comp;
  • (NZ) New Zealand: Dyazide | Triamizide | Trizid;
  • (PA) Panama: Triacil;
  • (PE) Peru: Diuracet-k;
  • (PH) Philippines: Dyazide;
  • (PK) Pakistan: Dyazide;
  • (PL) Poland: Dytide h | Prestole;
  • (PR) Puerto Rico: Dyazide | Maxzide | Triamterene & hctz | Triamterene and hydrochlorothiazide | Triamterene hctz | Triamterene/hctz | Triamterene/hydrochlorothiazide;
  • (PT) Portugal: Dyazide | Triam tiazida r;
  • (RU) Russian Federation: Apo triazide | Triam co | Triampur comp | Triampur compositum | Triamtel | Triazid | Vero triamtezidin;
  • (SA) Saudi Arabia: Dyazide;
  • (SG) Singapore: Apo triazide;
  • (SI) Slovenia: Tiaren;
  • (TH) Thailand: Dazid | Dinazide | Dyazide | Hyazide | Triamzide;
  • (TR) Turkey: Triamteril | Trianseril;
  • (TW) Taiwan: Anjal | Dazid | Diuren | Dyazide | Edepress | Triamzide | Triazide | Urinis;
  • (UA) Ukraine: Diuretidin;
  • (UY) Uruguay: Diuretriam Compuesto | Modiur compuesto | Triamzid;
  • (VE) Venezuela, Bolivarian Republic of: Dyazide;
  • (ZA) South Africa: Dyazide | Renezide | Rolab-triamterene
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Apo-Triazide tablets (triamterene and hydrochlorothiazide) [product monograph]. Toronto, Ontario, Canada: Apotex; June 2019.
  3. Basura GJ, Adams ME, Monfared A, et al. Clinical practice guideline: Ménière's disease. Otolaryngol Head Neck Surg. 2020;162(2_suppl):S1-S55. doi:10.1177/0194599820909438 [PubMed 32267799]
  4. Brackett CC, Singh H, Block JH. Likelihood and mechanisms of cross-allergenicity between sulfonamide antibiotics and other drugs containing a sulfonamide functional group. Pharmacotherapy. 2004;24(7):856-870. [PubMed 15303450]
  5. Coelho DH, Lalwani AK. Medical management of Ménière's disease. Laryngoscope. 2008;118(6):1099-1108. doi:10.1097/MLG.0b013e31816927f0 [PubMed 18418279]
  6. Dyazide (hydrochlorothiazide and triamterene) [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; August 2020.
  7. Friedman GD, Asgari MM, Warton EM, et al, "Antihypertensive Drugs and Lip Cancer in Non-Hispanic Whites," Arch Intern Med, 2012, 6:1-6. [PubMed 22869299]
  8. Gurwitz JH, Kalish SC, Bohn RL, et al. Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol. 1997;50(8):953-959. [PubMed 9291881]
  9. Hunt SA, Abraham WT, Chin MH, et al, “ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).” Available at http://content.onlinejacc.org/cgi/reprint/46/6/e1 [PubMed 16168273]
  10. Johnson KK, Green DL, Rife JP, Limon L. Sulfonamide cross-reactivity: fact or fiction? [published correction appears in Ann Pharmacother. 2005;39(7-8):1373]. Ann Pharmacother. 2005;39(2):290-301. [PubMed 15644481]
  11. Macleod MD, Bell GM, Irvine WJ. Nephrogenic diabetes insipidus associated with Dyazide (triamterene-hydrochlorothiazide). Br Med J (Clin Res Ed). 1981;283(6300):1155-1156. doi:10.1136/bmj.283.6300.1155 [PubMed 6794799]
  12. Maxzide and Maxzide-25 (triamterene and hydrochlorothiazide) [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals Inc; August 2020.
  13. Moskowitz HS. Meniere disease: evaluation, diagnosis and management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 28, 2022.
  14. Motley RJ. Pseudoporphyria due to dyazide in a patient with vitiligo. BMJ. 1990;300(6737):1468. doi:10.1136/bmj.300.6737.1468-a [PubMed 2379016]
  15. Murphy RM, Bakir B, O'Brien C, Wiggs JL, Pasquale LR. Drug-induced bilateral secondary angle-closure glaucoma: a literature synthesis. J Glaucoma. 2016;25(2):e99-e105. doi:10.1097/IJG.0000000000000270 [PubMed 25943730]
  16. Pedersen SA, Gaist D, Schmidt SAJ, Hölmich LR, Friis S, Pottegård A. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a nationwide case-control study from Denmark. J Am Acad Dermatol. 2018;78(4):673-681. doi: 10.1016/j.jaad.2017.11.042. [PubMed 29217346]
  17. Pottegård A, Hallas J, Olesen M, et al. Hydrochlorothiazide use is strongly associated with risk of lip cancer. J Intern Med. 2017;282(4):322-331. doi:10.1111/joim.12629 [PubMed 28480532]
  18. Roberts CJ, Channer KS, Bungay D. Hyponatraemia induced by a combination of hydrochlorothiazide and triamterene. Br Med J (Clin Res Ed). 1984;288(6435):1962. doi:10.1136/bmj.288.6435.1962 [PubMed 6428623]
  19. Sbeih F, Christov F, Gluth MB. Newly diagnosed Meniere's disease: clinical course with initiation of noninvasive treatment including an accounting of vestibular migraine. Ann Otol Rhinol Laryngol. 2018;127(5):331-337. doi:10.1177/0003489418763224 [PubMed 29546771]
  20. Slatore CG, Tilles SA. Sulfonamide hypersensitivity. Immunol Allergy Clin North Am. 2004;24(3):477-490. [PubMed 15242722]
  21. Tornero P, De Barrio M, Baeza ML, Herrero T. Cross-reactivity among p-amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testing. Contact Dermatitis. 2004;51(2):57-62. [PubMed 15373844]
  22. Triamterene and hydrochlorothiazide [prescribing information]. Cranford, NJ: Viona Pharmaceuticals Inc; November 2019.
  23. van Deelen GW, Huizing EH. Use of a diuretic (Dyazide) in the treatment of Menière's disease. A double-blind cross-over placebo-controlled study. ORL J Otorhinolaryngol Relat Spec. 1986;48(5):287-292. doi:10.1159/000275884 [PubMed 3537899]
  24. Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6, pt 2):544-557. doi: 10.1016/S1262-3636(09)73464-0. [PubMed 20152742]
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