Hydrohlorotyazyd, Triamterene | Triampur compositum tablets 50 pcs.

packaging 50 pcs

Pharmacological action

Pharmacodynamics

Combined drug. It has a diuretic and hypotensive effect. It contains hydrochlorothiazide - a thiazide diuretic, a diuretic effect, which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium and water ions in the distal nephron: it delays the excretion of calcium ions, uric acid.

Has an antihypertensive effect, which is due to the expansion of arterioles. It does not affect normal blood pressure (BP). The diuretic effect is manifested after 1-2 hours and reaches a maximum - after 4 hours, the duration of action, depending on the dose - 10-12 hours. The antihypertensive effect develops after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.

Triamteren is a potassium-sparing diuretic that reduces the permeability of the cell membranes of the distal tubules for sodium ions and enhances their excretion in the urine without increasing the excretion of potassium ions. The secretion of potassium ions in the distal tubules decreases.

In combination with hydrochlorothiazide, triamteren is able to reduce the hypokalemia caused by thiazide diuretics and enhance the diuretic effect of hydrochlorothiazide. The diuretic effect of triamteren after oral administration is noted after 15-20 minutes. The maximum effect is after 2-3 hours, the duration of action is 12 hours.

Pharmacokinetics

Hydrochlorothiazide is not completely absorbed from the gastrointestinal tract (60-80% of the oral dose), but rather quickly. Communication with blood plasma proteins is 40%, the apparent volume of distribution is 3-4 l / kg. The maximum concentration of hydrochlorothiazide in blood plasma is 2 μg / ml.

The elimination half-life is about 3-4 hours. Hydrochlorothiazide does not undergo significant metabolism. The primary route of excretion is renal excretion (filtration and secretion) of the unchanged drug. Hydrochlorothiazide crosses the placental barrier.

Triamteren is rapidly but not completely (30-70% of the dose taken) absorbed from the gastrointestinal tract. To a moderate degree (67%) binds to plasma proteins. The maximum plasma concentration is reached after 2-4 hours.

It undergoes biotransformation in the liver with the formation of both active and inactive metabolites. The half-life of an unchanged drug is normally 1.5-2 hours (with anuria 10 hours), metabolites - up to 12 hours. The main route of elimination of triamteren is through the intestines, the secondary - by the kidneys.

Indications

Edematous syndrome of various origins (chronic heart failure, nephrotic syndrome, cirrhosis)

arterial hypertension.

Contraindications

Hypersensitivity to the drug or to sulfonamides, chronic renal failure, anuria, acute glomerulonephritis, severe liver failure, precoma and hepatic coma, hyperkalemia, lactation, age under 18 years (efficacy and safety have not been established), I trimester of pregnancy.

Precautions - diabetes mellitus, gout, patients with impaired liver and / or kidney function, folic acid deficiency (in patients with cirrhosis).

Special instructions

With prolonged treatment, it is necessary to periodically monitor the blood levels of potassium, sodium, chlorine, urea, creatinine, glucose, uric acid, and the picture of peripheral blood (if there is a suspicion of a lack of folic acid).

At the beginning of treatment with the drug, potentially hazardous activities should be avoided, requiring increased attention and speed of psychomotor reactions (against the background of a decrease in blood pressure - a slowdown in the reaction rate).

Do not take two doses of the drug at the same time if you missed the drug.

Dosage and administration

Inside, without chewing, with a little water, after a meal. In edematous syndrome, the initial dose is determined by the severity of disturbances in water-electrolyte metabolism and is usually 1 tablet 2 times a day after meals, then it is possible to increase the dose to the maximum daily (4 tablets per day): 2 tablets after breakfast and 2 tablets after lunch.

When compensating for edema, they switch to maintenance therapy for 1-2 tablets in 1-2 days.

For arterial hypertension - the initial dose of 1 tablet per day (in the morning, after breakfast), then the dose is gradually increased. The maximum daily dose is 4 tablets.

In patients with impaired renal function (creatinine clearance - 30-50 ml / min.), the maximum daily dose is 1 tablet.

Side effects of the

From the digestive system: nausea, vomiting and sometimes diarrhea (when taking the drug before meals), pain and discomfort in the epigastric region, colicky abdominal pain, constipation, dry mouth, thirst, in isolated cases - hemorrhagic pancreatitis and in the presence of gallstones, acute cholecystitis.

From the central nervous system: uncoordinated movements, drowsiness, feeling tired, headache, nervousness.

From the musculoskeletal system: muscle tension, muscle weakness, spasms of the calf muscles.

From the cardiovascular system: palpitations, decreased blood pressure, cardiac arrhythmias and circulatory dysregulation with dizziness, confusion, or a tendency to faint. Due to the large loss of fluid and a decrease in the volume of circulating blood, when the drug is used in high doses and / or excessive excretion of urine, blood clots can form, embolism can develop, and in rare cases, convulsions, confusion, vascular collapse and acute renal failure.

From the side of metabolism: temporary increase in the concentration of nitrogen-containing substances secreted by the kidneys (urea, creatinine) in the blood (mainly at the beginning of treatment), disturbances in the water-electrolyte balance, mainly a decrease in the content of sodium, magnesium, chloride in the blood, decrease or increase in potassium (with prolonged continuous use of the drug), hypercalcemia, decreased glucose tolerance.

An increase in uric acid in the blood is possible, on the basis of which gout attacks can be triggered in some particularly predisposed patients, the formation of urinary stones can be noted. In sensitive patients, depending on the total dose taken, an increase in blood lipids may be observed.

In connection with an increase in the concentration of glucose in the blood, latent or the existing form of diabetes may become worse. The drug may contribute to the accumulation of non-volatile acids in the blood (metabolic acidosis).

From the side of the organs of vision: visual impairment, worsening of already existing myopia or a decrease in the production of tear fluid.

From the hemopoietic system: aplastic anemia, leukopenia, thrombocytopenia, agranulocytosis, megaloblastic anemia with a previous deficiency of folic acid in the body, hemolysis resulting from the appearance in the blood of autoantibodies to the active substance hydrochlorothiazide with the simultaneous use of methyl chloride.

Allergic reactions: redness of the skin, skin itching, urticaria, systemic lupus erythematosus, photoallergic exanthema, fever, hypersensitivity reactions (anaphylactoid reactions), severe inflammation of the blood vessels and non-bacterial inflammation of the kidney tissue (aseptic interstitial nephritis). In isolated cases, a suddenly developing pulmonary edema with shock symptoms was described. The reason for this is probably an allergic reaction of patients to the active substance hydrochlorothiazide.

Other: icteric coloration of the skin, mucous membranes and sclera.

Drug interactions

Drugs that bind strongly to blood proteins (indirect anticoagulants, clofibrate, non-steroidal anti-inflammatory drugs) enhance the diuretic effect of the drug.

The antihypertensive effect is enhanced by vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol.

Triampur enhances the neurotoxicity of salicylates, weakens the effects of oral hypoglycemic drugs, norepinephrine, epinephrine and antigout agents, enhances the effects (including side effects) of cardiac glycosides, the cardiotoxic and neurotoxic effects of lithium, the action of curariform muscle relaxants, reduces the excretion of quinidine.

Concomitant use with methyldopa increases the risk of hemolysis. Colestyramine reduces the absorption of triampur.

Chlorpropamide when taken concomitantly with Triampur may cause severe hypokalemia.

When combined with non-steroidal anti-inflammatory drugs, acute renal failure may develop.

overdose

Symptoms: marked decrease in blood pressure.

Treatment: symptomatic.

Storage conditions

Do not store above 25 РC.

Keep out of the reach and sight of children.

Deystvuyushtee substance

Gidrohlorotiazid, triamterene

Terms and conditions

prescription

Dosage form

tablets

Possible product names

TRIAMPUR COMPOSITE N50 TABLE

Triampur compositum tab x 50

Triampur Composite Tab. X50

TRIAMPUR COMPOSITE TAB. No. 50

Triampur compositum tab. N50 Croatia

Teva Pharmaceutical Enterprise Co., Ltd., Israel