Dyazide tablets contain Hydrochlorothiazide and Triamterene. It is a combination of two diuretic drugs and is used in patients with hypertension and edema or excess fluid in the body. It is associated with electrolyte abnormalities and dehydration.

Hydrochlorothiazide and triamterene Uses:

• Hypertension and edema:

  • Not advised for first-line therapy, but advised when hydrochlorothiazide-treated edoema and hypertension have resulted in hypokalemia or when the occurrence of hypokalemia must be prevented.

Dyazide (Hydrochlorothiazide and Triamterene) Dose in Adults

Dyazide (Hydrochlorothiazide and Triamterene) Dose in the treatment of Hypertension and 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

Use in Children:

Not indicated.

Pregnancy Risk Factor C

• This product has not been used in animal reproduction studies.
• Talk to individual agents.

Use during breastfeeding:

• Breast milk excrets thiazide diuretics; triamterene excretion is unknown.
• It is not advised to breastfeed
• Talk to individual agents.

Dose in Kidney Disease:

• There are no dosage adjustments provided in the manufacturer’s labeling.
• Not recommended in CrCl<10ml.
• Patients with anuria, recent kidney damage, long-term renal failure, or severe renal impairment should not take this medication.

Dose in Liver disease:

There are no dosage adjustments provided by the manufacturer’s although it is advised to use with caution and monitor for precipitation of hepatic encephalopathy.

Side effects of Dyazide (Hydrochlorothiazide and Triamterene):

• Cardiovascular:

  • Angina Pectoris
  • Cardiac Arrhythmia
  • Necrotizing Angiitis
  • Orthostatic Hypotension
  • Tachycardia

• Central Nervous System:

  • Anxiety
  • Depression
  • Dizziness
  • Fatigue
  • Glossopyrosis
  • Headache
  • Insomnia
  • Paresthesia
  • Restlessness
  • Vertigo

• Dermatologic:

  • Skin Photosensitivity
  • Skin Rash
  • Urticaria

• Endocrine & Metabolic:

  • Acidosis
  • Diabetes Mellitus
  • Glycosuria
  • Hypercalcemia
  • Hyperglycemia
  • Hyperkalemia
  • Hyperuricemia
  • Hypochloremia
  • Hypokalemia
  • Hypomagnesemia
  • Hyponatremia

• Gastrointestinal:

  • Abdominal Pain
  • Anorexia
  • Constipation
  • Diarrhea
  • Dysgeusia
  • Gastric Distress
  • Nausea
  • Pancreatitis
  • Sialadenitis
  • Stomach Cramps
  • Tongue Discoloration (Bright Orange)
  • Vomiting
  • Xerostomia

• Genitourinary:

  • Impotence
  • Urine Discoloration
  • Urine Sedimentation Abnormality

• Hematologic & Oncologic:

  • Agranulocytosis
  • Aplastic Anemia
  • Hemolytic Anemia
  • Leukopenia
  • Megaloblastic Anemia
  • Purpura
  • Thrombocytopenia

• Hepatic:

  • Abnormal Liver Function Tests
  • Jaundice

• Hypersensitivity:

  • Anaphylaxis

• Neuromuscular & Skeletal:

  • Exacerbation Of Systemic Lupus Erythematosus
  • Lupus-Like Syndrome (Subacute
  • Cutaneous)
  • Muscle Cramps
  • Weakness

• Ophthalmic:

  • Transient Blurred Vision
  • Xanthopsia

• Renal:

  • Acute Renal Failure
  • Increased Blood Urea Nitrogen
  • Increased Serum Creatinine
  • Interstitial Nephritis
  • Nephrolithiasis

• Respiratory:

  • Dyspnea
  • Hypersensitivity Pneumonitis
  • Pulmonary Edema
  • Respiratory Distress

• Miscellaneous:

  • Fever

Contraindications to Dyazide (Hydrochlorothiazide and Triamterene):

• Hypersensitivity to triamterene, drugs derived from hydrochlorothiazide and sulfonamides, or any ingredient in the formulation of anuria;
  significant renal impairment or acute and chronic renal insufficiency.
• Patients who are taking potassium supplements, potassium-containing salt replacements, or potassium-sparing diuretics (except in severe hypokalemia)
• preexisting hyperkalemia

Notice: 

• The FDA-approved product labelling states that taking this medication with other sulfonamide-containing drug classes is contraindicated, but the validity of this claim has been questioned.

Warnings and precautions

• Electrolyte disturbances:

  • Hydrochlorothiazide can cause electrolyte imbalances such as:
    • Hypokalemia
    • Hypochloremic alkalosis
    • hyponatremia

• Gout

  • Hydrochlorothiazide may trigger gout in some patients, especially those with a history or chronic renal disease.
  • Doses greater than 25 mg pose a higher risk.

• Hyperkalemia: [US Boxed Warning]:

  • Triamterene may cause hyperkalemia. Patients who have renal disease, diabetes (even if they don't show signs of impairment), the elderly and the seriously ill are at higher risk.
  • The FDA-approved product labelling states that taking this medication with other sulfonamide-containing drug classes is contraindicated, but the validity of this claim has been questioned.
  • Avoid potassium-containing salt substitutes, potassium-rich diets and other drugs that may cause hyperkalemia. 
  • Some exceptions to hypokalemia can be made by closely monitoring serum potassium levels in severe cases.
  • Hyperkalemia can be treated with drugs that should be stopped immediately
  • Patients who are critically unwell may experience respiratory or metabolic acidosis. The serum potassium concentrations may quickly increase as a result of this.

• Hypersensitivity reactions

  • Hydrochlorothiazide may cause hypersensitivity reactions.
  • Patients who have a history of asthma or allergy are more likely to develop it.

• Ocular effects

  • Patients with acute transient myopia or acute angle-closure vision glaucoma may experience hydrochlorothiazide.
  • Treatment should be stopped immediately for patients experiencing severe visual impairments.
  • If uncontrolled intraocular pressure persists after discontinuation of treatment, additional treatments may need to be administered.
  • A history of penicillin allergy or sulfonamide allergy are major risk factors.

• Photosensitivity

  • Photosensitivity can occur.

• Allergy to sulfonamide ("sulfa")

  • FDA approved many medications that contain sulfonamides. Patients with an allergy to sulfonamides are advised not to use them.
  • Cross-reactivity is possible between members of the same group (e.g., two antibiotics sulfonamides).
  • Crossreactivity concerns have been raised for all compounds with the sulfonamide structural (SO NH). These drugs are also known as sulfa drug.
  • Cross-reactivity between non-antibiotic sulfonamides may not be possible, according to research on allergic processes (Brackett 2004, Johnson 2005, Slatore 2004, Tornero 2004).
  • Cross-reactions due to antibody production (anaphylaxis), are less likely to occur when using non-antibiotic sulfonamides.
  • T-cell-mediated (type IV), reactions (eg maculopapular skin rash) are less understood. It is difficult to exclude this possibility based on current knowledge.
  • Some clinicians will choose to avoid these classes in cases of Stevens-Johnson syndrome/TEN or other severe reactions.

• Diabetes:

  • Patients with diabetes mellitus or prediabetes should be cautious. It can cause a decrease in glycemic control.

• Hepatic impairment

  • Patients with severe hepatic impairment should be cautious
  • Avoid electrolyte imbalances and acid/base imbalances in progressive or severe liver disease. This could lead to hepatic emboli/coma.

• Hypercalcemia:

  • Patients with hypercalcemia should avoid Thiazide diuretics as they can decrease renal calcium excretion.

• Hypercholesterolemia:

  • Thiazides have been linked to impaired cholesterol and triglyceride levels. Patients with high or moderate cholesterol should not take thiazides.

• Kidney stones

  • Patients who have renal stones should utilise triamterene with caution.

• Parathyroid disease

  • Long-term use of Thiazide diuretics can reduce calcium excretion.
  • Parathyroid gland pathologies such as hypophosphatemia and hypercalcemia can be caused by prolonged exposure to the drug.
  • Before testing for parathyroid function, it is important to stop taking thiazides.

• Renal impairment

  • It is possible for hydrochlorothiazide and hydrochlorothiazide to affect the kidneys in combination, resulting in azotemia in people with compromised renal function.
  • Avoid taking hydrochlorothiazide if you have severe renal illness (ineffective).
  • In patients with renal impairment, triamterene might result in hyperkalemia.

• Systemic lupus erythematosus (SLE):

  • SLE activation or exacerbation may be caused by hydrochlorothiazide.

Monitoring parameters:

• Monitor blood pressure,
• serum electrolytes, BUN, creatinine, liver function tests,
• signs of hyperkalemia

How to administer Dyazide (Hydrochlorothiazide and Triamterene)?

• Administer without regard to meals.

Mechanism of action of Dyazide (Hydrochlorothiazide and Triamterene):

Hydrochlorothiazide:

• Decreases sodium reabsorption through the distal tubules, increasing sodium, water, potassium, and hydrogen ion excretion.

Triamterene

• Prevents sodium reabsorption from the lumen by blocking epithelial sodium channels in the collecting duct and late distal convoluted tube (DCT).
• As a result, intracellular sodium levels drop and Na+/K+ ATPase performance declines.
• Additionally, it causes less calcium, magnesium, and hydrogen to be excreted, as well as potassium retention.
• The restricted sodium absorption capacity within the DCT/collecting conduit results in sodium's generally modest natriuretic/diuretic and antihypertensive effects.

See individual agents.

International Brand Names of Hydrochlorothiazide and triamterene:

• Dyazide
• Maxzide
• Maxzide-25
• Anjal
• Apo-triazide
• Dezide
• Diuracet-K
• Dyazide
• Dyberzide
• Dytenzide
• Dytide H
• Hidronol T
• Hydrene
• Maxzide
• Prestole
• Renezide
• Thiazide T
• Triampur Compositum
• Triazide
• Turfa

Hydrochlorothiazide and triamterene Brand Names in Pakistan: