Triampur compositum pills, 50pcs

Composition

1 tablet contains: active ingredients: triamterene 25,000 mg, hydrochlorothiazide 12,500 mg; excipients: lactose monohydrate 63,000 mg, potato starch 20.725 mg, povidone K 25 3,900 mg, magnesium stearate 1,300 mg, colloidal silicon dioxide 0.975 mg, sodium carboxymethyl starch 2,600 mg

Pharmacological action

Pharmacodynamics

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

It has an antihypertensive effect, which is caused by the expansion of arterioles. It does not affect normal blood pressure (BP). The diuretic effect manifests itself in 1-2 hours and reaches a maximum in 4 hours, the duration of action, depending on the dose, is 10-12 hours. The hypotensive 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 distal tubule cell membranes 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 decreases.

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

Pharmacokinetics

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

The elimination half-life is about 3-4 hours. Hydrochlorothiazide is not significantly metabolized. The primary route of its elimination is renal excretion (filtration and secretion) of the unchanged drug. Hydrochlorothiazide penetrates the placental barrier.

Triamterene is rapidly, but not completely (30-70% of the dose taken) absorbed from the gastrointestinal tract. It binds to a moderate degree (67%) to plasma proteins. The maximum concentration in the blood plasma is reached in 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 of 10 hours), metabolites – up to 12 hours. The main route of elimination of triamterene is through the intestines, and the secondary route is through the kidneys.

Indications

• Edematous syndrome of various origins (chronic heart failure, nephrotic syndrome, cirrhosis of the liver);
• arterial hypertension.

Use 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 decided.

Side effects

From the digestive system:  nausea, vomiting and sometimes diarrhea (when taking the drug before meals), pain and discomfort in the epigastric region, colic – like abdominal pain, constipation, dry mouth, thirst, in some cases – hemorrhagic pancreatitis, and in the presence of gallstones-acute cholecystitis. From the central nervous system:  uncoordinated movements, drowsiness, fatigue, headache, nervousness. From the musculoskeletal system:  muscle tension, muscle weakness, calf cramps. From the cardiovascular system:  palpitations, decreased blood pressure, abnormal heart rate, and circulatory disorders with dizziness, confusion, or a tendency to faint. Due to a large loss of fluid and a decrease in the volume of circulating blood, when using the drug in high doses and/or copious urinary excretion, blood clots may form, embolism may develop, in rare cases – convulsions, confusion, vascular collapse and acute renal failure. From the side of metabolism:  temporary increase in the concentration of nitrogenous 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, and chlorides in the blood, a decrease or increase in the content of potassium (with prolonged continuous use of the drug), hypercalcemia, and a decrease in glucose tolerance. It is possible to increase the content of uric acid in the blood, on the basis of which some particularly predisposed patients may be provoked by attacks of gout, the formation of urinary stones may occur. In sensitive patients, depending on the total dose of the drug taken, an increase in blood lipids may occur. Due to an increase in the concentration of glucose in the blood, a latent form of diabetes mellitus may appear or worsen. The drug may contribute to the accumulation of non-volatile acids in the blood (metabolic acidosis). From the side of the visual organs:  visual disturbances, worsening of pre – existing myopia, or decreased production of tear fluid. From the hematopoietic system:  aplastic anemia, leukopenia, thrombocytopenia, agranulocytosis, megaloblastic anemia with a previous folic acid deficiency in the body, hemolysis resulting from the appearance of autoantibodies to the Active ingredient hydrochlorothiazide in the blood with simultaneous use of methyldopa. Allergic reactions:  redness of the skin, pruritus of the skin, 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 sudden developing pulmonary edema with shock symptoms was described. The reason for this is probably an allergic reaction of patients to the Active ingredient hydrochlorothiazide. Other services:  jaundice of the skin, mucous membranes and sclera.

Interaction

Drugs that intensively bind to blood proteins (indirect anticoagulants, clofibrate, nonsteroidal anti-inflammatory drugs) enhance the diuretic effect of the drug. The hypotensive effect is enhanced by vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, and ethanol. Triampur increases the neurotoxicity of salicylates, weakens the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-gouty agents, enhances the effects (including side effects) of cardiac glycosides, cardiotoxic and neurotoxic effects of lithium, curare-like muscle relaxants, reduces the excretion of quinidine. When taken concomitantly with methyldopa, the risk of developing hemolysis increases. Colestyramine reduces the absorption of Triampur. Chlorpropamide, when taken concomitantly with Triampur, can lead to severe hypokalemia. When combined with nonsteroidal anti-inflammatory drugs, acute renal failure may develop.

How to take, course of use and dosage

Inside, without chewing, with a small amount of water, after eating. With edematous syndrome, the initial dose is determined by the severity of water-electrolyte metabolism disorders and usually amounts to 1 tablet 2 times a day after meals, then it is possible to increase the dose to the maximum daily dose (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. In case of 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

Symptoms: marked decrease in blood pressure. Treatment: symptomatic.

Special instructions

With long-term treatment, it is necessary to periodically monitor the blood content of potassium, sodium, chlorine, urea, creatinine, glucose, uric acid, and the picture of peripheral blood (if a lack of folic acid is suspected). At the beginning of treatment with the drug, you should avoid potentially dangerous activities that require increased attention and speed of psychomotor reactions (against the background of a decrease in blood pressure – slowing down the reaction rate). You can not take two doses of the drug at the same time if you missed taking the drug.

Form of production

Triampur compositum tablets are yellow, round, with a risk on one side, with beveled edges.

Storage conditions

Store at a temperature not exceeding 25°C. Keep out of reach of children.

Shelf life

5 years

Active ingredient

Hydrochlorothiazide, Triamterene

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

Pregnant women in the second and third trimester as prescribed by a doctor, For adults

Indications

Cirrhosis of the liver, Heart failure, Hypertension