Triamterene 37.5mg/ HCTZ 25mg Caps

Hydrochlorothiazide (HCTZ) is a thiazide diuretic that inhibits the reabsorption of sodium and chloride ions in the distal convoluted tubule, leading to increased excretion of sodium, chloride, and water. It also increases potassium and magnesium excretion and decreases calcium excretion. Triamterene is a potassium-sparing diuretic that acts directly on the distal renal tubule to inhibit the reabsorption of sodium in exchange for potassium and hydrogen ions. It blocks epithelial sodium channels (ENaC) in the late distal tubule and collecting duct, thereby reducing sodium reabsorption and preventing potassium and hydrogen ion secretion. The combination provides additive diuretic and antihypertensive effects while minimizing potassium loss associated with HCTZ.

Serious Side Effects: Seek Medical Attention Immediately

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, such as:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or change in the amount of urine produced
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or throwing up
Signs of too much acid in the blood (acidosis), such as:
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ A heartbeat that does not feel normal
+ Very bad stomach pain, upset stomach, or throwing up
+ Feeling very sleepy
+ Shortness of breath
+ Feeling very tired or weak
Signs of kidney problems, such as:
+ Unable to pass urine
+ Change in how much urine is passed
+ Blood in the urine
+ A big weight gain
Signs of a pancreas problem (pancreatitis), such as:
+ Very bad stomach pain
+ Very bad back pain
+ Very bad upset stomach or throwing up
Signs of high blood sugar, such as:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Passing urine more often
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Back pain, belly pain, or blood in the urine (may be signs of a kidney stone)
Dark urine or yellow skin or eyes
Burning, numbness, or tingling feeling that is not normal
Restlessness
Shortness of breath
Chest pain or pressure
Fast, slow, or abnormal heartbeat
Unable to get or keep an erection
Mood changes
Rarely, low blood cell counts have occurred with this medication. Contact your doctor right away if you experience:
+ Unexplained bruising or bleeding
+ Signs of infection, such as fever, chills, or sore throat
+ Feeling very tired or weak
This medication can cause certain eye problems, which can lead to lasting eyesight loss if left untreated. If you experience any of the following symptoms, contact your doctor right away:
+ Change in eyesight
+ Eye pain (usually occurs within hours to weeks of starting this medication)
Rarely, certain types of skin cancer have occurred in people taking hydrochlorothiazide. Protect your skin from the sun and have your skin checked as directed by your doctor. Contact your doctor right away if you notice:
+ A change in color or size of a mole
+ Any new or changing skin lump or growth

Other Side Effects

All medications can cause side effects, but many people experience no side effects or only minor ones. If you experience any of the following side effects or any other side effects that bother you or do not go away, contact your doctor or seek medical help:

Constipation
Diarrhea
Upset stomach
Throwing up
Decreased appetite
Headache
Feeling dizzy, sleepy, tired, or weak
Increased appetite
Change in taste
Stomach cramps

These are not all the possible side effects that may occur. If you have questions about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following conditions to ensure safe treatment:

Any allergies you have, including allergies to this medication, its components, or other substances, and describe the symptoms you experienced.
A known sulfa allergy.
Certain health conditions, such as:
+ Diabetes
+ High potassium levels
+ Kidney disease
+ Urination problems
Inability to pass urine.
Current medications, including:
+ Dofetilide
+ Lithium
+ Amiloride
+ Spironolactone
+ Other medications containing triamterene
Use of salt substitutes with potassium, potassium-sparing diuretics, or potassium products.
* Breast-feeding, as you should not breast-feed while taking this medication.

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other treatments. Never start, stop, or change the dose of any medication without consulting your doctor first.

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and exercise caution when climbing stairs.

Special Considerations

If you have diabetes (high blood sugar), consult your doctor, as this medication may increase your blood sugar levels. Monitor your blood sugar as directed by your doctor.
Check your blood pressure as instructed by your doctor.
Regularly undergo blood work and other laboratory tests as recommended by your doctor. Inform all your healthcare providers and laboratory personnel that you are taking this medication, as it may affect certain lab tests.
If you are on a low-salt or salt-free diet, discuss this with your doctor.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that may cause drowsiness, consult your doctor.

Potential Side Effects and Interactions

Be aware of the risk of gout attacks.
If you have lupus, this medication may exacerbate or reactivate the condition. Immediately report any new or worsening symptoms to your doctor.
This medication may increase your susceptibility to sunburn. Exercise caution when exposed to the sun, and inform your doctor if you experience excessive sunburn.
If you experience excessive sweating, fluid loss, vomiting, or diarrhea, which may lead to low blood pressure, notify your doctor.

Special Populations

If you are 65 years or older, use this medication with caution, as you may be more prone to side effects.
* If you are pregnant or planning to become pregnant, discuss the benefits and risks of using this medication with your doctor.

• Potassium supplements
• Potassium-sparing diuretics (e.g., spironolactone, amiloride, eplerenone) other than the one in the combination
• Severe renal impairment (CrCl < 30 mL/min)

• ACE inhibitors (e.g., lisinopril, enalapril) and Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan): Increased risk of hyperkalemia.
• NSAIDs (e.g., ibuprofen, naproxen, indomethacin): May reduce diuretic and antihypertensive effects; increased risk of renal dysfunction.
• Lithium: Reduced renal clearance of lithium, leading to increased lithium toxicity.
• Digoxin: HCTZ-induced hypokalemia can increase digoxin toxicity.
• Cyclosporine: Increased risk of hyperkalemia and renal dysfunction.
• Amantadine: Increased plasma levels and toxicity of amantadine.

• Corticosteroids: Increased risk of hypokalemia (due to HCTZ).
• Antidiabetic agents (e.g., insulin, oral hypoglycemics): HCTZ may increase blood glucose levels, requiring dose adjustment of antidiabetics.
• Cholestyramine and Colestipol: May reduce absorption of HCTZ.
• Alcohol, Barbiturates, Opioids: Increased risk of orthostatic hypotension.
• Nondepolarizing muscle relaxants (e.g., tubocurarine): Enhanced muscle relaxation.
• Pressor amines (e.g., norepinephrine): Decreased arterial responsiveness.

• Allopurinol: Increased risk of hypersensitivity reactions to allopurinol.
• Calcium salts: Increased risk of hypercalcemia.

• Signs of hyperkalemia (muscle weakness, fatigue, bradycardia, paresthesias)
• Signs of hypokalemia (muscle cramps, weakness, irregular heartbeat)
• Signs of hyponatremia (nausea, headache, confusion, seizures)
• Signs of dehydration (excessive thirst, dry mouth, decreased urination, dizziness, lightheadedness)
• Orthostatic hypotension (dizziness or lightheadedness upon standing)
• Gout flares (sudden joint pain, swelling, redness)
• Photosensitivity (severe sunburn reaction)
• Unusual bleeding or bruising (rare, due to thrombocytopenia)

Category D. Should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Triamterene has been associated with adverse fetal effects in animal studies, and both components cross the placenta. Thiazides may cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions seen in adults.

Both hydrochlorothiazide and triamterene are excreted in breast milk. HCTZ can suppress lactation. Due to the potential for serious adverse reactions in the nursing infant (e.g., electrolyte disturbances, jaundice), a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Safety and effectiveness in pediatric patients have not been established. Use is generally not recommended.

Elderly patients may be more sensitive to the effects of diuretics and are at increased risk for electrolyte imbalances (especially hyperkalemia with triamterene and hyponatremia with HCTZ), dehydration, and orthostatic hypotension. Renal function should be monitored closely. Start with the lowest effective dose and titrate slowly.

• This combination is particularly useful for patients who develop hypokalemia (low potassium) when treated with a thiazide diuretic alone.
• Risk of hyperkalemia is increased in patients with renal impairment, diabetes, or those taking ACE inhibitors, ARBs, or NSAIDs.
• Advise patients to avoid potassium-rich foods, potassium supplements, and salt substitutes unless specifically instructed by their physician.
• May cause photosensitivity; advise patients to use sunscreen and wear protective clothing.
• Can increase serum uric acid levels, potentially precipitating gout attacks.
• Can increase blood glucose levels, requiring careful monitoring in diabetic patients.
• Take with food to minimize gastrointestinal upset.

• Other classes of antihypertensives (e.g., ACE inhibitors, ARBs, Calcium Channel Blockers, Beta-blockers)
• Other diuretics (e.g., loop diuretics, other thiazide diuretics)
• Lifestyle modifications (diet, exercise, weight management, sodium restriction)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.