Potassium-sparing diuretic, collecting duct sodium channel blocker
Brand names: Dyrenium, Dyazide (combo)
Updated · Methodology
Second line
Triamterene combined with hydrochlorothiazide is used for edema in heart failure, cirrhosis or nephrotic syndrome when thiazide alone causes marked hypokalaemia. SEC and AEMPS recommend checking potassium and creatinine at 1 and 4 weeks after initiation, especially in the elderly.
ICD-10: R60 · ICD-11: MG29
Blocks epithelial sodium channels (ENaC) in distal tubules and collecting ducts. Reduces sodium reabsorption and potassium/hydrogen secretion. Weak diuretic effect, usually given as a fixed-dose combination with a thiazide to prevent hypokalaemia. Renally excreted.
Limited data. Thiazides and K-sparing diuretics are avoided in pregnancy – risk of hypovolaemia and impaired placental flow.
Passes into milk in small amounts. Breastfeeding possible with infant electrolyte monitoring.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
2 pairs found. Sorted from critical to minor.
Mechanism
Both are potassium-sparing diuretics. Combined use produces dual potassium retention and severe hyperkalaemia with risk of fatal arrhythmia.
Symptoms
K+ above 6.5 mmol/L, muscle weakness, arrhythmia, ECG peaked T waves.
Management
Combination contraindicated. Choose one potassium-sparing diuretic.
Sources
Mechanism
Enalapril suppresses aldosterone – less potassium excreted. With triamterene additive hyperkalaemia, especially in CKD.
Symptoms
Hyperkalaemia within 2 weeks.
Management
Check potassium and creatinine at 1 and 4 weeks. Reduce triamterene if K+ above 5.0.
Sources
Verbatim lines from the interaction sections, in the language of the label
«CONTRAINDICATIONS: Dyrenium (triamterene) should not be used in patients with pre-existing elevated serum potassium, as is sometimes seen in patients with impaired renal function or azotemia, or in…»FDA, section 4 · Open on DailyMed
«CONTRAINDICATIONS: Dyrenium should not be given to patients receiving other potassium-sparing agents, such as spironolactone, amiloride hydrochloride, or other formulations containing triamterene…»FDA, section 4 · Open on DailyMed
«Drug Interactions: Dyrenium (triamterene) may raise blood glucose levels; for adult-onset diabetes, dosage adjustments of hypoglycemic agents may be necessary during and/FDA, section 7 · Open on DailyMed
«Drug Interactions: Caution should be used when lithium and diuretics are used concomitantly because diuretic-induced sodium loss may reduce the renal clearance of lithium and increase serum lithium…»FDA, section 7 · Open on DailyMed
«Drug Interactions: A possible interaction resulting in acute renal failure has been reported in a few subjects when indomethacin, a nonsteroidal anti-inflammatory agent, was given with triamterene…»FDA, section 7 · Open on DailyMed
«Drug Interactions: The effects of the following drugs may be potentiated when given together with triamterene: antihypertensive medication, other diuretics, preanesthetic and anesthetic agents…»FDA, section 7 · Open on DailyMed
«For Patients Treated for Hypertension: concomitant administration of potassium supplements or potassium-sparing diuretics (e.g., amiloride, spironolactone, or triamterene) [see Warnings and…»FDA, section 4 · Open on DailyMed
«CONTRAINDICATIONS: In patients with hyperkalemia (or who have conditions predisposing them to hyperkalemia), as a further rise in serum potassium concentration may produce cardiac arrest. Such…»FDA, section 4 · Open on DailyMed
«Diuréticos: Los factores de riesgo para el desarrollo de hipercalemia son: insuficiencia renal, diabetes mellitus y el uso concomitante de diuréticos ahorradores de potasio (ej. espironolactona…»AEMPS, section 4.5 · Open on CIMA
«Diuretics: Initiation of lisinopril in patients on diuretics may result in excessive reduction of blood pressure. The possibility of hypotensive effects with lisinopril can be minimized by either…»FDA, section 7 · Open on DailyMed
«Recomendaciones relativas a la a dministración simultánea: Debido a que el tratamiento con tacrólimus puede asociarse con hiperpotasemia, o puede elevar la hiperpotasemia previa, debe evitarse la…»AEMPS, section 4.5 · Open on CIMA
«Electrolitos: Si resulta necesario, la clortalidona puede combinarse con suplementos orales de potasio o diuréticos ahorradores de potasio (por ejemplo, triamtereno). En caso de terapia combinada…»AEMPS, section 4.4 · Open on CIMA
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): Los inhibidores de la ECA reducen la pérdida de potasio inducida por los diuréticos. Los diuréticos ahorradores de potasio (p. ej…»AEMPS, section 4.5 · Open on CIMA
«Agents Increasing Serum Potassium: Enalapril maleate attenuates potassium loss caused by thiazide-type diuretics. Potassium-sparing diuretics (e.g., spironolactone, triamterene, or amiloride)…»FDA, section 7 · Open on DailyMed
«Diuréticos ahorradores de potasio (amilorida, espironolactona, triamtereno): Mientras que las asociaciones racionales son útiles en algunos pacientes, aún puede producirse hipopotasemia o…»AEMPS, section 4.5 · Open on CIMA
«Agents Increasing Serum Potassium: Concomitant use of olmesartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Diuréticos ahorradores de potasio o suplementos de potasio: Los bloqueantes de los receptores de la angiotensina II, tales como telmisartán, disminuyen la pérdida de potasio debida a los diuréticos…»AEMPS, section 4.5 · Open on CIMA
«Agents Increasing Serum Potassium: Concomitant use of valsartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Drug-Drug Interactions: Cimetidine: (see WARNINGS, CONTRAINDICATIONS ) Concomitant use of cimetidine is contraindicated. Cimetidine at 400 mg BID (the usual prescription dose) co-administered with…»FDA, section 7 · Open on DailyMed
«Fármacos que influyen en los niveles de ácido fólico: Los anticonceptivos orales, anticonvulsivos, fármacos antituberculosos, el alcohol, la glucarpidasa y los antagonistas del ácido fólico como el…»AEMPS, section 4.5 · Open on CIMA
«Al igual que ocurre con otros medicamentos que bloquean la angiotensina II o sus efectos, el uso concomitante con medicamentos que retienen potasio (p. ej. diuréticos ahorradores de potasio…»AEMPS, section 4.5 · Open on CIMA
«Inducción farmacocinética de enzimas metabolizantes: Las pirazolonas también pueden interaccionar con anticoagulantes orales, captopril, litio y triamtereno. La eficacia de los antihipertensivos y…»AEMPS, section 4.5 · Open on CIMA
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Triamterene is evaluated for the following indications with varying evidence strength: Edema and fluid overload (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Triamterene (≥ 1 in 100): Hyperkalaemia, Nausea, Headache, Dry mouth, Photosensitivity. See the Safety section for uncommon and serious reactions.
Limited data. Thiazides and K-sparing diuretics are avoided in pregnancy – risk of hypovolaemia and impaired placental flow.
Passes into milk in small amounts. Breastfeeding possible with infant electrolyte monitoring.
Triamterene is contraindicated in: Hyperkalaemia (K+ above 5.5 mmol/L); Severe renal impairment (eGFR below 30 mL/min); Combination with spironolactone, eplerenone, amiloride; Combination with potassium supplements; Addison disease. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Chlortalidone, Eplerenone, Furosemide, Hydrochlorothiazide, Indapamide, Spironolactone, Torasemide