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DIURETICS, POTASSIUM-SPARING, AND HYDROCHLOROTHIAZIDE (Systemic)
Some commonly used brand names are:
In the U.S.—
This medicine is a combination of two diuretics (water pills). It is commonly used to help reduce the amount of water in the body.
This combination is also used to treat high blood pressure (hypertension). High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Diuretics help to reduce the amount of water in the body by acting on the kidneys to increase the flow of urine. This also helps to lower blood pressure.
This combination is also used to treat problems caused by too little potassium in the body.
This medicine is available only with your doctor"s prescription, in the following dosage forms:
Before Using This Medicine
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For potassium-sparing diuretics and hydrochlorothiazide, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to amiloride, spironolactone, triamterene, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, methazolamide, or to hydrochlorothiazide or any of the other thiazide diuretics. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. They should not be taken during pregnancy unless recommended by your doctor.
Breast-feeding—Hydrochlorothiazide and spironolactone pass into breast milk. It is not known whether amiloride or triamterene passes into breast milk. Hydrochlorothiazide may also decrease the flow of breast milk. Therefore, you should avoid use of potassium-sparing diuretic and hydrochlorothiazide combinations during the first month of breast-feeding.
Children—Studies on this combination medicine have been done only in adult patients, and there is no specific information comparing use of potassium-sparing diuretic and hydrochlorothiazide combinations in children with use in other age groups.
Older adults—Dizziness or lightheadedness and signs and symptoms of too much potassium in the body or too little potassium in the body may be more likely to occur in the elderly, who are more sensitive than younger adults to the effects of this medicine.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking potassium-sparing diuretics and hydrochlorothiazide, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of potassium-sparing diuretics and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:
Proper Use of This Medicine
This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
If this medicine upsets your stomach, it may be taken with meals or milk. If stomach upset (nausea, vomiting, stomach pain, or cramps) continues, check with your doctor.
For patients taking this medicine for high blood pressure :
Dosing—The dose of potassium-sparing diuretic and hydrochlorothiazide combinations will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of potassium-sparing diuretic and hydrochlorothiazide combinations. If your dose is different, do not change it unless your doctor tells you to do so.
The number of capsules or tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day depends on the strength of the medicine and the medical problem for which you are taking potassium-sparing diuretic and hydrochlorothiazide combinations .
Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this medicine:
Precautions While Using This Medicine
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.
This medicine may cause a loss or increase of potassium in your body. Your doctor may have special instructions about whether or not you need to eat or drink foods or beverages that have a high potassium content (for example, orange or other citrus fruit juices), taking a potassium supplement, or using salt substitutes . Since too much potassium can be harmful, it is important not to change your diet on your own. Tell your doctor if you are already on a special diet (as for diabetes). Since salt substitutes and low-sodium milk may contain potassium, do not use them unless told to do so by your doctor. Check with your health care professional if you need a list of foods that are high in potassium or if you have any questions.
Check with your doctor if you become sick and have severe or continuing vomiting or diarrhea. These problems may cause you to lose additional water and potassium and lead to low blood pressure.
For diabetic patients :
Potassium-sparing diuretics and hydrochlorothiazide may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
If you have a severe reaction from the sun, check with your doctor.
Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.
For patients taking triamterene and hydrochlorothiazide combination :
For patients taking this medicine for high blood pressure :
Tell the doctor in charge that you are taking this medicine before you have any medical tests. The results of some tests may be affected by this medicine.
Side Effects of This Medicine
In rats, spironolactone has been found to increase the risk of development of tumors. However, the doses given were many times the dose of spironolactone given to humans. It is not known whether spironolactone causes tumors in humans.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Black, tarry stools; blood in urine or stools; cough or hoarseness; fever or chills; joint pain; lower back or side pain; painful or difficult urination; pinpoint red spots on skin; skin rash or hives; stomach pain (severe) with nausea and vomiting; unusual bleeding or bruising; yellow eyes or skin
Signs and symptoms of changes in potassium
Confusion; dryness of mouth; increased thirst; irregular heartbeat; mood or mental changes; muscle cramps or pain; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; unusual tiredness or weakness; weak pulse; weakness or heaviness of legs
Reported for triamterene only (rare)
Bright red tongue; burning, inflamed feeling in tongue; cracked corners of mouth
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
More common (less common with triamterene)
Loss of appetite; nausea and vomiting; stomach cramps and diarrhea; upset stomach
Decreased sexual ability; dizziness or lightheadedness when getting up from a lying or sitting position; headache; increased sensitivity of skin to sunlight
Reported for amiloride only (less common)
Reported for spironolactone only (less common)
Breast tenderness in females; deepening of voice in females; enlargement of breasts in males; increased hair growth in females; irregular menstrual periods; sweating
Spironolactone sometimes causes enlarged breasts in males, especially when they take large doses of it for a long time. Breasts usually decrease in size gradually over several months after this medicine is stopped. If you have any questions about this, check with your doctor.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
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