Triampur Compositum [Hydrochlorothiazide, Triamteren]

Brand Teva

In stock 1419 Items

Available since: 2019-09-19

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Clinical Pharmacology

Triampur compositum is a combined preparation, the action of which is caused by the properties of the components included in its composition; has a diuretic and hypotensive effect. Contains hydrochlorothiazide - a medium-acting diuretic and potassium-sparing diuretic triamterene.

Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, magnesium, and water in the distal nephron; delays the excretion of calcium ions, uric acid. It has an antihypertensive effect that develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect appears after 1-2 hours and reaches a maximum - after 4 hours, the duration of action depending on the dose is 10-12 hours. The anti-hypertensive effect is manifested longer (up to 24 hours).

Triamterene, a potassium-sparing diuretic, reduces the permeability of cell membranes of the distal tubules to 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 is reduced. In combination with hydrochlorothiazide, triamteren can reduce the hypokalemia caused by thiazide diuretics and enhance the diuretic effect of hydrochlorothiazide. The diuretic effect of triamterene after ingestion is noted in 15-20 minutes. The maximum effect is in 2-3 hours, the duration of action is 12 hours.

Pharmacokinetics

Hydrochlorothiazide

Suction

Rapidly absorbed from the gastrointestinal tract, the absorption is 80% of the ingested dose. Cmax in plasma after administration of 25 mg of hydrochlorothiazide is reached in 2-5 hours and is 142 ng / ml. Bioavailability is 70%.

Distribution

Binding to plasma proteins - 60-80%. In the therapeutic dose range, the average area under the AUC curve increases in direct proportion to the increase in dose. With a single daily appointment of hydrochlorothiazide cumulation is negligible. Gets through a placental barrier and is allocated with breast milk.

Removal

T1 / 2 - 6-8 hours. Not metabolized. Excreted through the kidneys - 95% unchanged and about 4% in the form of hydrolyzed 2-amino-4-chloro-m-benzenedisulfonamida by glomerular filtration and active tubular secretion in the proximal nephron.

60 minutes after ingestion, it is noted in the urine and within 24 hours up to 50-70% of the administered dose is excreted.

Triamteren

Suction

Triamterene is rapidly absorbed from the gastrointestinal tract (80% of the dose taken). Cmax in plasma is reached in 2-4 hours.

Distribution and metabolism

About 60% is bound to plasma proteins. Metabolized in the liver. The main active metabolite is 4-hydroxytriamterene.

Removal

T1 / 2 of the active metabolite is 2-3 hours, T1 / 2 of triamterene is 4-7 hours. With cirrhosis of the liver, T1 / 2 may increase 4 times.

Triamteren is excreted unchanged and in small quantities through urine and bile; active metabolite - mainly by the kidneys and a small part - with bile.

Indications

Arterial hypertension; edematous syndrome of various genesis (in chronic heart failure, nephrotic syndrome, liver cirrhosis).

Composition

1 tablet contains:

Active substances: triamteren25 mg; hydrochlorothiazide 12.5 mg;

Excipients: lactose monohydrate - 63 mg; potato starch - 20.725 mg; Povidone K25 - 3.9 mg; colloidal silicon dioxide - 0.975; sodium carboxymethyl starch - 2.6 mg; magnesium stearate - 1.3 mg.

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Dosage and Administration

For oral use, after eating, without chewing and washing down with a small amount of water.

Edematous syndrome: the initial dose is determined by the severity of violations of water-electrolyte metabolism and is usually 1 tablet 2 times a day after meals, then you can increase the dose to the maximum daily (4 pills): 2 pills after breakfast and 2 pills after lunch.

When compensating for edema, they switch to maintenance therapy 1–2 pills in 1–2 days.

Arterial hypertension: the initial dose is 1 tablet per day (in the morning, after breakfast), then the dose is gradually increased. The maximum daily dose is 4 pills. In patients with impaired renal function (Cl creatinine - 30–50 ml / min), the maximum daily dose is 1 tablet.

Adverse reactions

From the digestive system: nausea, vomiting and sometimes diarrhea (when taking the drug before meals), pain and discomfort in the epigastric region, colics pain in the abdomen, constipation, dry mouth, thirst, in rare cases - hemorrhagic pancreatitis; with cholelithiasis - acute cholecystitis.

From the side of the central nervous system: uncoordinated movements, drowsiness, fatigue, headache, nervousness.

From the musculoskeletal system: muscle tension, muscle weakness, calf muscle cramps.

Since the cardiovascular system: heartbeat, lowering blood pressure, heart rhythm disturbances, and circulatory dysregulation with dizziness, stupor of consciousness, or a tendency to faint. Due to the large loss of fluid and a decrease in the volume of circulating blood during the use of the drug in high doses and abundant excretion of urine, thromboembolism may occur; in rare cases, convulsions, confusion, vascular collapse and acute renal failure.

Metabolism: a temporary increase in the blood (mainly at the beginning of treatment) concentration of nitrogen-containing substances secreted with urine (urea, creatinine); violations of water and electrolyte balance, mainly a decrease in the content of sodium, magnesium, chlorides in the blood, hypo-or hyperkalemia (with prolonged continuous use of the drug), hypercalcemia, a decrease in glucose tolerance. An increase in the uric acid content in the blood is possible, in connection with which some predisposed patients may experience gout attacks, and urinary stones may be observed. In predisposed patients, depending on the accepted total dose of the drug, an increase in blood lipids may be observed. Due to the increase in glucose concentration in the blood, a latent form may appear or aggravate the already existing diabetes mellitus. The drug can contribute to the accumulation of non-volatile acids in the blood (metabolic acidosis).

On the part of the organ of vision: visual impairment, worsening of existing myopia or a decrease in the production of tear fluid.

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

Allergic reactions: skin redness, pruritus, urticaria, systemic lupus erythematosus, photoallergic rash, fever, anaphylactoid reactions, severe vascular inflammation and non-bacterial inflammation of the kidney tissue (aseptic interstitial nephritis). In isolated cases, suddenly developing pulmonary edema was described. The reason for this is probably the allergic reaction of patients to hydrochlorothiazide.

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

WITHcaution: the drug should be used in case of impaired renal function and / or liver, urolithiasis, gout, diabetes mellitus and in case of suspected folic acid deficiency in the body (for example, liver cirrhosis caused by chronic alcohol abuse), patients under the age of 18 years (efficacy and safety not established), at risk of developing acidosis.

Drug interactions

With the simultaneous use of Triampur Compositum and other antihypertensive drugs, diuretics, barbiturates, phenothiazines, tricyclic antidepressants, vasodilators, and also ethanol-containing drugs, an increase in the antihypertensive effect of Triampur Compositum is observed.

With the simultaneous use of Triampur Compositum with ACE inhibitors at the beginning of treatment, a sharp decrease in blood pressure is possible.

With simultaneous use with NSAIDs (for example, indomethacin, salicylates), it is possible to reduce the diuretic and antihypertensive effects of Triampura Compositum. With the simultaneous use of Triampura Compositum with indomethacin increases the risk of renal failure. With the simultaneous use of Triampur Compositum with salicylates increases the risk of toxic manifestations from the central nervous system.

With simultaneous use Triampur Compositum can enhance the cardiotoxic and neurotoxic effects of lithium.

With simultaneous use of Triampur Compositum with colestipol or colestiramine, the absorption of hydrochlorothiazide from the gastrointestinal tract is reduced.

With the simultaneous use of methyldopa and Triampura Compositum, hemolysis may develop.

With the simultaneous use of Triampur Compositum with potassium salts, potassium-sparing diuretics (for example, Verochpyrone), as well as with ACE inhibitors, hyperkalemia may occur.

With the simultaneous use of Triampur Compositum and glucocorticoids, laxatives may develop hypokalemia.

With the simultaneous use of Triampur Compositum with chlorpropamid may develop severe hypokalemia.

With the simultaneous use of Triampur Compositum enhances the action of curariform muscle relaxants.

With the simultaneous use of Triampur Compositum enhances the action and side effects of cardiac glycosides in the presence of potassium and / or magnesium deficiency in the body.

Triampur Compositum reduces the effects of hypoglycemic and anti-gout agents, as well as norepinephrine (norepinephrine) and epinephrine (adrenaline).

Triampur Compositum slows down the excretion of quinidine, increases the effect of cytostatics on the bone marrow.

With the simultaneous use of Triampur Compositum with beta-blockers increases the risk of reducing potency.