Product Overview
Composition
pharmachologic effect
Pharmacodynamics
Combined drug. It has a diuretic and hypotensive effect. Contains hydrochlorothiazide - a thiazide diuretic, a diuretic effect, which is associated with a violation of the reabsorption of sodium, chlorine, potassium, magnesium and water ions in the distal nephron: it delays the excretion of calcium ions, uric acid.
It has an antihypertensive effect, which is due to the expansion of arterioles. Does not affect normal blood pressure (BP). 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 antihypertensive effect develops after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.
Triamterene 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, triamterene is able to reduce the hypokalemia caused by thiazide diuretics and enhance the diuretic effect of hydrochlorothiazide. The diuretic effect of triamterene 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. The connection with blood plasma proteins is 40%, the apparent volume of distribution is 3-4 l / kg. The maximum plasma concentration of hydrochlorothiazide is 2 μg / ml.
The half-life is about 3-4 hours. Hydrochlorothiazide is not significantly metabolized. The primary route of elimination is renal excretion (filtration and secretion) of the unchanged drug. Hydrochlorothiazide crosses the placental barrier.
Triamterene is rapidly, but not completely (30-70% of the dose taken) absorbed from the gastrointestinal tract. To a moderate extent (67%) binds to blood plasma proteins. The maximum concentration in blood plasma 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 the unchanged drug is normally 1.5-2 hours (with anuria 10 hours), metabolites - up to 12 hours. The main route of excretion of triamterene is through the intestine, the secondary route is through the kidneys.
Indications
- Edema syndrome of various origins (chronic heart failure; nephrotic syndrome, liver cirrhosis);
- arterial hypertension.
Application during pregnancy and lactation
Triampur Compositum is contraindicated for use during pregnancy.
If it is necessary to use Triampur Compositum during lactation, the question of stopping breastfeeding should be resolved.
Side effects
From the side of the central nervous system: uncoordinated movements, drowsiness, fatigue, headache, nervousness.
On the part of the musculoskeletal system: muscle tension, muscle weakness, cramps of the calf muscles.
From the side of the cardiovascular system: palpitations, decreased blood pressure, heart rhythm disturbances and circulatory disorders with dizziness, confusion or a tendency to fainting. Due to the large loss of fluid and a decrease in the volume of circulating blood, when using the drug in high doses and / or abundant excretion of urine, blood clots may form, embolism may develop, in rare cases - convulsions, confusion, vascular collapse and acute renal failure.
From the side of metabolism: a temporary increase in the concentration of nitrogen-containing substances excreted by the kidneys (urea, creatinine) in the blood (mainly at the beginning of treatment), violations of water-electrolyte balance, mainly a decrease in the content of sodium, magnesium, chlorides in the blood, a decrease or increase potassium content (with long-term continuous use of the drug), hypercalcemia, decreased glucose tolerance.
An increase in the content of uric acid in the blood is possible, on the basis of which gout attacks can be triggered in some especially 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, a latent form of diabetes may appear or an already existing form of diabetes may worsen. 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 existing myopia or a decrease in the production of tear fluid.
On the part of the hematopoietic 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 while using methyldopa.
Allergic reactions: skin redness, pruritus, urticaria, systemic lupus erythematosus, photoallergic exanthema, fever, hypersensitivity reactions (anaphylactoid reactions), severe inflammation of blood vessels and non-bacterial inflammation of kidney tissue (aseptic interstitial nephritis). In isolated cases, a sudden onset of pulmonary edema with symptoms of shock was described. The reason for this is probably the allergic reaction of patients to the active substance hydrochlorothiazide.
Others: icteric coloration of the skin, mucous membranes and sclera.
Interaction
The antihypertensive effect is enhanced by vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol.
Triampur enhances the neurotoxicity of salicylates, weakens the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-gout drugs, enhances the effects (including side effects) of cardiac glycosides, cardiotoxic and neurotoxic effects of lithium, the effect of curariform muscle relaxants, and reduces the excretion of quinidine.
When taken simultaneously with methyldopa, the risk of hemolysis increases. Cholestyramine reduces the absorption of Triampur.
Chlorpropamide, when taken simultaneously with Triampur, can lead to severe hypokalemia.
When combined with non-steroidal anti-inflammatory drugs, acute renal failure may develop.
How to take, course of administration and dosage
When compensating for edema, they switch to supportive therapy, 1-2 tablets in 1-2 days.
With 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 tablets.
In patients with impaired renal function (creatinine clearance - 30-50 ml / min), the maximum daily dose is 1 tablet.
Overdose
Treatment: symptomatic.
Special instructions
At the beginning of treatment with the drug, potentially dangerous activities that require increased attention and speed of psychomotor reactions should be avoided (against the background of a decrease in blood pressure - a slowdown in the reaction rate).
You cannot take two doses of the drug at the same time if the drug is missed.
Release form
Triampur compositum tablets are yellow, round, scored on one side, with beveled edges.
Storage conditions
Keep out of the reach of children.
