Dezide

• Hypertension:
• Used to treat high blood pressure to reduce the risk of cardiovascular events such as stroke and myocardial infarction.
• Edema:
• Management of edema associated with congestive heart failure, liver cirrhosis, nephrotic syndrome, or corticosteroid and estrogen therapy.
• Hypokalemia Prevention:
• Indicated for patients requiring diuretics who are at risk of potassium depletion; the combination balances potassium-sparing and potassium-wasting effects.
• Off-label uses:
• Adjunctive treatment in resistant hypertension or other fluid retention states under specialist guidance.

• Adults:
• Typical initial dose: One tablet containing 37.5 mg Hydrochlorothiazide and 37.5 mg Triamterene once daily or as prescribed.
• Maintenance dose: Usually 1 to 2 tablets daily, divided into one or two doses, depending on clinical response.
• Elderly:
• Start at the lower end of dosing; monitor renal function and electrolytes closely.
• Pediatrics:
• Safety and efficacy not established; use only if specifically directed by a pediatric specialist.
• Renal impairment:
• Contraindicated if severe impairment (creatinine clearance <30 mL/min). Use with caution in mild to moderate impairment; dosage adjustment may be necessary.
• Administration:
• Oral route, with or without food.
• Consistent daily timing is recommended for optimal blood pressure control.
• Duration:
• Long-term use is common in chronic hypertension and edema management; regular monitoring required.

Triamterene is a potassium-sparing diuretic that acts on the distal convoluted tubule and collecting duct of the nephron, blocking epithelial sodium channels (ENaC), which decreases sodium reabsorption and reduces potassium excretion. Hydrochlorothiazide is a thiazide diuretic that inhibits the Na+/Cl− symporter in the distal convoluted tubule, increasing excretion of sodium, chloride, and water, leading to decreased blood volume and blood pressure. The combination balances potassium loss from hydrochlorothiazide with potassium retention by triamterene, reducing hypokalemia risk while promoting effective diuresis and antihypertensive effects.

• Absorption:
• Both drugs are well absorbed orally; peak plasma concentrations reached within 2–4 hours.
• Distribution:
• Widely distributed; Hydrochlorothiazide does not significantly bind to plasma proteins; Triamterene is moderately bound.
• Metabolism:
• Hydrochlorothiazide is not metabolized significantly and is excreted unchanged by the kidneys.
• Triamterene undergoes hepatic metabolism via CYP450 enzymes to active metabolites.
• Elimination:
• Hydrochlorothiazide is eliminated primarily via renal excretion.
• Triamterene and its metabolites are excreted in urine and bile.
• Half-life:
• Hydrochlorothiazide: approximately 6–15 hours.
• Triamterene: approximately 4–6 hours.

• Pregnancy:
• Category C (FDA). Use only if potential benefits justify risks; diuretics are generally avoided during pregnancy due to potential effects on maternal and fetal fluid balance.
• Lactation:
• Both drugs are excreted in breast milk in small amounts. Caution advised; monitor infants for adverse effects if breastfeeding continues.

• Combination diuretic:
• Triamterene — Potassium-sparing diuretic
• Hydrochlorothiazide — Thiazide diuretic

• Known hypersensitivity to triamterene, hydrochlorothiazide, or sulfonamide-derived drugs.
• Anuria or severe renal impairment (creatinine clearance <30 mL/min).
• Hyperkalemia or conditions predisposing to high potassium levels.
• Acute renal failure.
• Addison’s disease or other conditions with elevated potassium levels.
• Concomitant use with potassium supplements or other potassium-sparing diuretics without medical supervision.

• Monitor serum electrolytes, especially potassium and sodium, during therapy.
• Risk of hyperkalemia, especially in renal impairment, diabetes, or with concomitant potassium-elevating drugs.
• Caution in patients with impaired renal or hepatic function.
• May cause hypotension, especially in volume-depleted patients.
• Monitor blood glucose and uric acid levels; hydrochlorothiazide may worsen hyperglycemia and hyperuricemia.
• Avoid in patients with systemic lupus erythematosus exacerbations.
• Photosensitivity reactions reported; protect skin from sunlight.

• Common:
• Dizziness, headache, fatigue
• Gastrointestinal upset (nausea, vomiting)
• Increased urination
• Electrolyte disturbances:
• Hyperkalemia (due to triamterene)
• Hyponatremia, hypomagnesemia (due to hydrochlorothiazide)
• Serious but rare:
• Severe hyperkalemia causing arrhythmias
• Stevens-Johnson syndrome or other severe skin reactions
• Acute kidney injury
• Others:
• Photosensitivity, rash, muscle cramps

• Potassium-elevating agents: ACE inhibitors, ARBs, potassium supplements — increased risk of hyperkalemia.
• CYP3A4 inhibitors: May increase triamterene levels, enhancing toxicity risk.
• Lithium: Increased lithium toxicity risk due to decreased renal clearance.
• NSAIDs: May reduce diuretic and antihypertensive effects; risk of renal impairment.
• Other antihypertensives: Additive blood pressure lowering effects, risk of hypotension.

• Guidelines emphasize cautious use of potassium-sparing diuretics to avoid hyperkalemia, especially in patients with renal impairment or diabetes.
• Monitoring protocols for serum electrolytes and renal function during therapy have been strengthened.
• Use in combination therapy is supported for resistant hypertension with careful electrolyte monitoring.
• Newer formulations aim to optimize balance between efficacy and safety.

• Store at controlled room temperature: 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light.
• Keep in tightly closed containers.
• Keep out of reach of children.