Drug Profile

Triamterene is a water pill (diuretic) that removes less potassium from your body than other types of diuretics do. Doctors sometimes prescribe it for high blood pressure, instead of another diuretic, in the hope that it will prevent a potassium imbalance. It should not be used by older adults. It can cause serious and sometimes fatal adverse effects such as kidney stones, kidney failure, retention of too much potassium in your body, and a drop in your body’s production of blood cells (bone marrow depression).[1],[2]

If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising, and decreasing your salt and alcohol intake. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE), a water pill, is the drug of choice, starting, with a low dose of 12.5 milligrams daily. It also costs less than other blood pressure drugs.

There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine.[3] Research now suggests that thiazide diuretics may protect against hip fracture.[4]

If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, another family of high blood pressure-lowering drugs may be added to your treatment. In this case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that combines the drug in a fixed combination.

If you are taking triamterene, ask your doctor about switching to hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE). If you need to replace potassium in your body because of potassium losses from other drugs, certain potassium supplements are less dangerous than a drug such as triamterene and are equally effective.[5]

Whatever drugs you take for high blood pressure, once your blood pressure has been normal for a year or more, a cautious decrease in dose and renewed attention to nondrug treatment may be worth trying, according to The Medical Letter.[6]

An editorial in the British Medical Journal (BMJ) stated: “Treatment of hypertension is part of preventive medicine and like all preventive strategies, its progress should be regularly reviewed by whoever initiates it. Many problems could be avoided by not starting antihypertensive treatment until after prolonged observation....Patients should no longer be told that treatment is necessarily for life: the possibility of reducing or stopping treatment should be mentioned at the outset.”[7]

The May 2012 issue of Worst Pills, Best Pills News highlighted a recent BMJ study indicating that patients taking several types of commonly used antihypertensive medications are at increased risk of developing gout, a type of arthritis.

The BMJ study also showed that a small number of other antihypertensive drugs appear to have the opposite effect, decreasing the risk of gout.

All patients should be informed of the risk of gout with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and non-lorsartan angiotensin II receptor blockers (ARBs) when starting these medications or whenever the dose of the medications is increased [8].

The April 2013 issue of Worst Pills, Best Pills News discusses another recent BMJ study. This study suggests that an increased risk of acute kidney injury (AKI) is associated with combining nonsteroidal anti-inflammatory drugs (NSAIDs) with two antihypertensive drugs: a diuretic plus either an ACE inhibitor or an ARB. The risk was found to be highest during the first 30 days of starting an NSAID in patients who also are already taking a diuretic plus an ACE inhibitor or an ARB.

The study found that patients currently using a triple-therapy combination — a diuretic, an ACE inhibitor or an ARB, and an NSAID — have a 31 percent greater risk of developing AKI compared with current users of a diuretic plus an ACE inhibitor or an ARB without an NSAID.[9]