triamterene

(trye am' ter een)

Dyrenium

Pregnancy Category B

Drug class
Potassium-sparing diuretic

Therapeutic actions
Inhibits sodium reabsorption in the renal distal tubule, causing loss of sodium and water
and retention of potassium.

Indications
• Edema associated with CHF, nephrotic syndrome, hepatic cirrhosis; steroid-
induced edema, edema from secondary hyperaldosteronism (alone or with other
diuretics for added diuretic or antikaliuretic effects)

Contraindications and cautions

• Contraindicated with allergy to triamterene, hyperkalemia, renal disease (except
nephrosis), liver disease, lactation.
• Use cautiously with diabetes mellitus, pregnancy.

Available forms
Capsules—50, 100 mg

Dosages
ADULTS
100 mg bid PO if used alone. Reduce dosage if added to other diuretic or
antihypertensive therapy. Maintenance dosage should be individualized, may be as low as
100 mg every other day. Do not exceed 300 mg/day.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak Duration
Oral 2–4 hr 6–8 hr 12–16 hr

Metabolism: Hepatic; T1/2: 3 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Headache, drowsiness, fatigue, weakness
• Dermatologic: Rash, photosensitivity
• GI: Nausea, anorexia, vomiting, dry mouth, diarrhea
• GU: Renal stones, interstitial nephritis
 • Hematologic: Hyperkalemia, blood dyscrasias

Interactions
Drug-drug
• Increased hyperkalemia with potassium supplements, diets rich in potassium,
ACE inhibitors
• Increased serum levels and possible toxicity with cimetidine, indomethacin
• Increased risk of amantadine toxicity
Drug-lab test
• Interference with fluorescent measurement of serum quinidine levels

Nursing considerations
Assessment
• History: Allergy to triamterene, hyperkalemia, renal or liver disease, diabetes
mellitus, pregnancy, lactation
• Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength;
pulses, baseline ECG, BP; R, pattern, adventitious sounds; liver evaluation, bowel
sounds; urinary output patterns; CBC, serum electrolytes, blood sugar, liver and
renal function tests, urinalysis

Interventions
• Administer with food or milk if GI upset occurs.
• Mark calendars or provide other reminders of drug days for outpatients if
alternate-day or 3- to 5-day/wk therapy is optimal for treating edema.
• Administer early in the day so that increased urination does not disturb sleep.
• Measure and record regular weights to monitor mobilization of edema fluid.
• Arrange for regular evaluation of serum electrolytes, BUN.

Teaching points
• Record alternate-day therapy on a calendar, or make dated envelopes. Take the
drug early in the day as increased urination will occur. The drug may be taken
with food or meals if GI upset occurs.
• Weigh yourself on a regular basis, at the same time and in the same clothing, and
record the weight on your calendar.
• These side effects may occur: Increased volume and frequency of urination;
drowsiness (avoid rapid position changes; do not engage in hazardous activities
[such as driving a car]; this problem is often made worse by the use of alcohol);
avoid foods that are rich in potassium (eg, fruits, Sanka); sensitivity to sunlight
and bright lights (wear sunglasses, use sunscreens and protective clothing).
• Report weight change of more than 3 lb in 1 day, swelling in ankles or fingers,
fever, sore throat, mouth sores, unusual bleeding or bruising, dizziness, trembling,
numbness, fatigue.

Adverse effects in Italic are most common; those in Bold are life-threatening.