Hydrochlorothiazide / Triamterene	(high-droe-klor-oh-THIGH-uh-zide/try-AM-tur-een)
Trade Name(s):	Maxzide-25MG   ·Tablets 37.5 mg triamterene/25 mg hydrochlorothiazide   Dyazide   ·Capsules 37.5 mg triamterene/25 mg hydrochlorothiazide   Maxzide   ·Tablets 75 mg triamterene/50 mg hydrochlorothiazide Apo-Triazide Nu-Triazide Indicates Canadian Trade Name.
Class:	Diuretic combination
Action:	Hydrochlorothiazide inhibits reabsorption of sodium and chloride in ascending loop of Henle and early distal tubules. Triamterene interferes with sodium reabsorption at distal tubule. Combination provides additive diuretic activity and antihypertensive effects and minimizes potassium depletion.
Indications:	Treatment of edema or hypertension in patients who have or are at risk of developing hypokalemia.
Contraindications:	Anuria; renal decompensation; severe hepatic disease; hypersensitivity to thiazides, triamterene, or sulfonamide-derived drugs; patients receiving spironolactone, amiloride, or potassium supplements; hyperkalemia; metabolic or respiratory acidosis.
Interactions:
	Angiotensin-converting enzyme inhibitors May result in severely elevated serum potassium levels.
	Allopurinol May increase incidence of hypersensitivity reactions to allopurinol.
	Amantadine May increase amantadine plasma levels and risk for adverse reactions.
	Anticoagulants May diminish anticoagulant effects.
	Bile acid sequestrants May reduce thiazide absorption; give thiazide at least 2 h before sequestrant.
	Diazoxide May cause hyperglycemia.
	Digitalis glycosides Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.
	Indomethacin May cause rapid progression into acute renal failure.
	Lithium May decrease renal excretion of lithium; monitor lithium levels.
	Loop diuretics May cause synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.
	Methenamines, NSAIDs May decrease effectiveness of thiazide.
	Potassium preparations May severely increase serum potassium levels, possibly resulting in cardiac arrhythmias or cardiac arrest. Monitor serum potassium closely if potassium is coadministered.
	Sulfonylureas, insulin May decrease hypoglycemic effect of sulfonylureas. May need to adjust dosage of sulfonylureas or insulin.
Lab Test Interferences:	May interfere with the fluorescent measurement of quinidine serum levels. May decrease serum protein-bound iodine levels without signs of thyroid disturbance.
Adverse Reactions:
	cardiovascular: Orthostatic hypotension.
	cns: Dizziness; lightheadedness; vertigo; headache; paresthesias; weakness; restlessness; insomnia; fatigue.
	dermatologic: Purpura; photosensitivity; rash; urticaria; necrotizing angiitis, vasculitis, cutaneous vasculitis; alopecia; exfoliative dermatitis; toxic epidermal necrolysis; erythema multiforme; Stevens-Johnson syndrome.
	eent: Blurred vision; xanthopsia (yellow vision).
	gi: Anorexia; gastric irritation; nausea; vomiting; abdominal pain or cramping; bloating; diarrhea; constipation; pancreatitis; sialadenitis; dry mouth.
	gu: Impotence; reduced libido; interstitial nephritis; azotemia; elevated BUN and creatinine.
	hematologic: Leukopenia; thrombocytopenia; agranulocytosis; aplastic or hypoplastic anemia; hemolytic anemia; megaloblastic anemia.
	hepatic: Jaundice; liver enzyme abnormalities.
	metabolic: Hyperglycemia; glycosuria; hyperuricemia; hyperkalemia; electrolyte imbalance; hypochloremia; hyponatremia.
	miscellaneous: Muscle cramp or spasm; fever; anaphylactic reactions.
Precautions:
	Pregnancy: Category C .
	Lactation: Excreted in breast milk.
	Children: Safety and efficacy have not been established.
	Hypersensitivity: May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may also occur.
	Renal function impairment: May precipitate azotemia or hypermagnesemia; use drug with caution.
	Hepatic function impairment: Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use drug with caution.
	Electrolyte imbalances and BUN increase Hyperkalemia (serum potassium greater than 5.5 ? mEq/L), hyponatremia, hypochloremia, and increases in BUN may occur.
	Hematologic effects Triamterene is a weak folic acid antagonist and may contribute to megaloblastosis.
	Lipids May affect total serum cholesterol, total triglycerides, and LDL in some patients.
	Postsympathectomy Antihypertensive effects may be enhanced.
	Renal stones Triamterene has been found in renal stones; use drug with caution in patients with histories of stone formation.
Overdosage:	Signs & symptoms Orthostatic or general hypotension, tachycardia, syncope, electrolyte abnormalities, potassium deficiency, vomiting, nausea, shock, weakness, confusion, dizziness, cramps of calf muscles, thirst, polyuria, anuria, lethargy.
Patient/Family Education:	Instruct patient to take medication early in day to avoid diuretic effect at night. Tell patient to take drug with food or milk and to report GI symptoms. Advise patient to limit sodium intake for optimal drug effect. Advise patient to limit exposure to sun and to use sunscreen or wear protective clothing to avoid photosensitivity reaction. Instruct diabetic patients to report increased levels of blood glucose. Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Tell patient to report these symptoms to health care provider: decrease in urinary output, jaundice, muscle cramps, weakness, nausea, blurred vision, dizziness. Instruct patient to drink 2 to 3 L/day of water unless contraindicated. Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.