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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Triamterene (Dyrenium) is another potassium-sparing diuretic. Of 271 pregnant women included in the Collaborative Perinatal Project who were treated with this diuretic (Heinonen et al., 1977), only a few received this diuretic in the first months of pregnancy. The frequency of congenital malformations was not increased in the offspring of these women; neither was the frequency of malformations increased in the offspring of animals who received triamterene (Ellison and Maren, 1972). Triamterene was not included in the Swedish Birth Defects Registry (Kallen, 2019). Notably, triamterene is a folic acid antagonist, and may require supplementation.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Spironolactone has a slow onset of action, requiring 2–3 days for maximum effect. Spironolactone crosses the placenta and is secreted into breast milk. Canreonate-potassium has similar actions to those of spironolactone. It is available for IV administration. Amiloride is incompletely absorbed from the gastrointestinal tract. It is excreted unchanged in the urine. Its half-life is prolonged in patients with hepatic or renal failure. Triamterene is unreliably absorbed. It is metabolised by hepatic conjugation.
An Overview of Drug-Induced Nephropathies *
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Jean Paul Fillastre, Michel Godin
In spite of the wide use of diuretics, only a small number of patients have been described with diuretic-related interstitial nephritis. In the majority of the cases, thiazides were implicated, but triamterene was often associated, and certain observations suggest a potentiating role for this drug. No biopsy-proven allergic interstitial nephritis has been described with the widely used furosemide.
Effect of mechanochemical inclusion of triamterene into sulfobutylether-β-cyclodextrin and its improved dissolution behavior
Published in Drug Development and Industrial Pharmacy, 2021
Hideko Maeda, Ryoma Shiobara, Masafumi Tanaka, Akihiko Kajinami, Hirokazu Nakayama
Triamterene [TT; Figure 1(a)] is a mild potassium-sparing diuretic used to treat essential hypertension; however, it has poor solubility in water, organic acids, and inorganic acids [1–3]. The bioavailability of TT in normal subjects following oral administration has been reported to be 30–70%, with wide variation between individuals [4]. Poor solubility in water represents a significant bottleneck in drug delivery and drug development [5–7]. More than 40% of drug candidate compounds have poor solubility in water and that could be a major factor limiting drug bioavailability [8]. Biopharmaceutical classification system (BCS) for TT is classified as class II. For drugs of BCS class II have low water solubility and high permeability. Therefore, increasing their aqueous solubility can allow to increase their oral bioavailability. Many approaches, such as salt, co-crystal, and solid dispersion formation [9–13]; prodrug strategy [14,15]; and grinding technique [16,17] have been investigated to improve drug solubility. For example, grinding is often used to reduce the particle size of powders to increase the bioavailability of drugs with poor water solubility. This is because the particle size and physicochemical properties of powdered drugs affect their dissolution rate. This method is simple and easy to perform.
Preparation and characterization of triamterene complex with ascorbic acid derivatives
Published in Drug Development and Industrial Pharmacy, 2020
Hirotaka Onoda, Yutaka Inoue, Toshinari Ezawa, Isamu Murata, Takron Chantadee, Sontaya Limmatvapirat, Toshio Oguchi, Ikuo Kanamoto
Triamterene (TRT) is a potassium-retaining diuretic that inhibits Na+-K+ exchange in the distal renal tubules, thus causing the elimination of Na+. TRT could be used along with loop diuretics or thiazide diuretics to prevent hypokalemia [13]. TRT is a weakly basic molecule with a pteridine skeleton and 3 amino groups [14]. TRT is linked with issues such as poor water solubility, and low bioavailability [14]. However, these issues are often resolved by incorporating TRT in cyclodextrin, forming a salt with sulfate or hydrochloride, preparing a solid dispersion (SD), or the preparation of cocrystals [15,16]. An example of an amorphous SD is a “dry” spray of acetaminophen. Amorphous SD is composed of drugs that are molecularly dispersed in a pharmacologically inert carrier. Compared with poorly soluble crystals, Amorphous SD has higher drug dissolution rate due to increased free energy. Amorphous SDs are made up of a drug that is molecularly dispersed in a pharmacologically inert carrier. Compared to the poorly soluble crystalline materials, Amorphous SDs exhibit higher drug dissolution rate due to increased free energy [17,18]. Since TRT is weakly basic, inducing it to form a salt with an acidic substance could presumably improve its solubility. To enhance the solubility of TRT, the current study used AA and AA2G as biocompatible water-soluble additives to prepare SDs of AA/TRT and AA2G/TRT. This study then assessed their physicochemical properties and dissolution profile.
How low can you go? Severe hyponatremia with a sodium of 94 mg/dL corrected with proactive strategy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Manan Shah, Viralkumar Amrutiya, Nikesh Patel, Sophia Kwon, Jeffrey Fein, Abraham Lo
An 83-year-old male with a history of Diabetes Mellitus Type 2, benign prostatic hyperplasia, and hypertension presented with nausea, vomiting, and multiple falls for several days. Patient reported drinking many glasses of water the day prior to admission and was also recently started on triamterene/hydrochlorothiazide for hypertension. Physical examination was benign. Laboratory data revealed serum sodium of 94 mg/dL; therefore, fluid restriction, concomitant 3% hypertonic saline and DDAVP were initiated in the intensive care unit as per Figure 1. Hypertonic saline was administered as 50 ccs/hr boluses with 2 mg of DDAVP every 6 hours for the first 96 hours until sodium was 113 mEq/L. Despite a hospital course complicated by retroperitoneal hemorrhage requiring transfusion and hypovolemic shock with a resultant acute tubular necrosis, the patient’s sodium slowly corrected to 136 mEq/L. The patient was eventually discharged without long-term neurologic or renal complications.