Triamterene 50mg capsules

BACKGROUND: By entering collecting duct principal cells via the epithelial sodium channel (ENaC), lithium is capable of inducing vasopressin insensitivity, resulting in excessive urine production, nephrogenic diabetes insipidus (NDI) and potential for other long-term forms of renal dysfunction. ENaC inhibitors (ENaC-I) such as amiloride have been shown in animal models to minimise this adverse effect, and while ENaC-I are often considered an effective strategy, the literature on ENaC-I for lithium-related polyuria has not yet been synthesised despite the importance of this topic. This review aimed to identify all published evidence for adjunctive use of an ENaC-I for lithium-related polyuria to estimate its effectiveness while also exploring potential moderators of effectiveness. METHOD: The systematic search covered databases MEDLINE, EMBASE and PsycINFO complemented by handsearches, aiming to identify all studies of ENaC-I interventions in lithium-treated patients with pre- and post-ENaC-I polyuria as outcomes. RESULTS: 10 studies totalling 25 participants were eligible for inclusion and were synthesised narratively. Amiloride was the ENaC-I used in 24/25 participants, and triamterene in the other. 8/10 publications were single case reports, 4 of which presented substantial confounding issues. Clear improvements to polyuria were demonstrated in most papers, including the two larger studies. CONCLUSIONS: Although it appears very likely that ENaC inhibitors help ameliorate polyuria in lithium-treated patients, the quantity and quality of evidence is low. Heterogeneity in patient characteristics, intervention characteristics and study designs limit conclusions regarding the contribution of factors likely to influence ENaC-I effectiveness for lithium-induced polyuria. Besides, adverse effects require further exploration.

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Diuretics alleviate fluid retention and electrolyte abnormalities; however, comparative preclinical animal studies remain limited. This systematic review evaluated the effects of loop diuretics (furosemide), thiazide diuretics (hydrochlorothiazide), and potassium-sparing agents (amiloride, triamterene) on renal function, electrolyte balance, and survival in rats. PRISMA 2020 guidelines were followed to search PubMed, Web of Science, and Google Scholar for comparative studies published between 2015 and 2025 investigating diuretic effects on glomerular filtration rate, creatinine clearance, urinary sodium/potassium/chloride excretion, plasma electrolytes, kidney injury biomarkers, and survival in rats. Dual screening and data extraction were performed independently by two reviewers, and risk of bias was assessed using the ARRIVE 2.0 checklist. Twelve studies (440 rats) were included. Thiazides (1.3–2.0-fold) and potassium-sparing agents (1.1–1.4-fold) increased urine volume less than loop diuretics (2.8–3.5-fold). Loop diuretics increased urinary potassium excretion and reduced plasma potassium to clinically dangerous levels (2.3–2.5 mmol/L), increasing the risk of hypokalemia by 2.3–3.2-fold. Thiazides showed moderate efficacy but also posed a significant risk of hypokalemia (1.5–1.9-fold K⁺ loss). Combination therapy with loop and potassium-sparing agents increased diuretic efficacy by 30–94% and reduced electrolyte disturbances by 30–50%. Diuretic resistance (approximately a 25% reduction in efficiency) was associated with aldosterone-mediated epithelial sodium channel overexpression during days 5–7 of chronic therapy. Aldosterone-deficient animals responded more favorably to diuretics. In disease models, furosemide promoted medullary damage in acute ischemia–reperfusion injury but improved survival in chronic renal failure (43–82% reduction in kidney injury biomarkers and 75–100% improvement with combination therapy). Metabolomic analyses indicated that outer medullary osmolyte depletion (betaine 89%, glycerophosphocholine 46–63%) contributed to impaired urine concentration. Prolonged furosemide use also resulted in significant micronutrient depletion (magnesium 16–33%, iron 52%, copper 31%). Effective loop diuretic therapy requires careful electrolyte monitoring. Combination therapy, particularly with loop and potassium-sparing diuretics, appears to be the most effective and safest strategy. Diuretic resistance caused by aldosterone-mediated sodium channel activation may be reduced through intermittent dosing, sodium restriction, or renin–angiotensin–aldosterone system antagonism. Future research should investigate long-term treatment protocols, combination regimens, disease-specific responses, and metabolomic standardization to optimize clinical diuretic therapy.

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INTRODUCTION: Hypertension constitutes the primary health burden of cardiovascular diseases, and the global control of blood pressure (BP) remains insufficient. Single pill combinations (SPCs) are employed as a means to streamline the management of poor BP control due to non-adherence and treatment inertia. The compound reserpine and triamterene tablets constitute a quadruple SPC, comprising reserpine 0.1 mg, dihydralazine 12.5 mg, hydrochlorothiazide 12.5 mg and triamterene 12.5 mg. It is widely employed in primary medical institutions and has favourable efficacy, tolerability and cost-effectiveness. METHODS AND ANALYSIS: The COSPQ-BP trial is a 12-week prospective randomised controlled trial to enrol 1332 patients with primary mild-to-moderate hypertension. Participants who meet the inclusion criteria will be randomly assigned to a 1:1 ratio to an intervention group (compound reserpine and triamterene tablets) or a control group (valsartan/hydrochlorothiazide). The primary outcome will be mean changes from baseline in 24-hour ambulatory systolic BP after intervention for 12 weeks. The secondary outcomes have been predetermined and will primarily encompass the following: (1) changes in other BP measures, as well as changes in blood lipids, blood glucose and uric acid at 12 weeks and (2) evaluation of the impact of starting antihypertensive therapy with compound reserpine and triamterene tablets or valsartan/hydrochlorothiazide on the depressive and anxiety statess of patients. ETHICS AND DISSEMINATION: The study protocol (version number: V5.0, version date: 17 January 2023) has been approved by the ethics committee (Biomedical Ethics Committee of West China Hospital of Sichuan University, approval number: Review (51) in 2023). Written informed consent will be obtained from each participant by researchers. The findings of this study will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trials Registry (ChiCTR2300067920). The COSPQ-BP trial is currently enrolling. The study period will be from 1 January 2024 to 31 December 2025.

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BACKGROUND: Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite treatment with at least three or more antihypertensive agents. Compelling evidence has shown that such a population has a greater risk of cardiovascular events as well as mortality. Although mineralocorticoid receptor antagonists (MRAs) have been shown to be an effective fourth-line treatment for RH, a significant proportion of RH patients do not achieve their blood pressure target. Compound reserpine and triamterene tablets, a traditional Chinese quadruple single-pill combination, have been proven to have good antihypertensive effects as well as safety, and are promising effective antihypertensive drugs for treating RH. METHODS: A randomized crossover clinical trial will be conducted to compare the efficacy and safety of compound reserpine and triamterene tablets treatment regimen (two tablets of olmesartan/amlodipine (OA) + one tablet of compound reserpine and triamterene tablets) with those of a standard treatment regimen (two tablets of OA + indapamide 2.5 mg + spironolactone 20 mg) in patients with RH. Forty patients will be recruited and randomly assigned in a 1:1 ratio to 2 crossover groups. The two groups will receive different combination therapies for 6 weeks and will then switch to the other combination therapy for 6 weeks, with a 4-week wash-out. The primary outcome will be the reduction in average 24-h systolic blood pressure after 6 weeks of intervention between the two groups. DISCUSSION: This study aimed to evaluate whether the compound reserpine and triamterene tablets treatment regimen (A + C + 0) results in a greater reduction in blood pressure in RH patients than the standard treatment regimen (A + C + D + spironolactone). TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400081878. Registered on March 14, 2024 ( http://www.chictr.org.cn ).

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INTRODUCTION: Liddle syndrome is an autosomal dominant monogenic disease that mainly manifests as early-onset hypertension, hypokalaemia and metabolic alkalosis, as well as hyporeninaemia and hypoaldosteronism. The aetiology of Liddle syndrome is missense or frameshift mutations in the SCNN1A, SCNN1B, or SCNN1G genes, which encode for the epithelial sodium channel subunits. Among these, mutations in the SCNN1A gene are very rare. CASE PRESENTATION: A Liddle syndrome case caused by a SCNN1A mutation was reported from China. A 59-year-old proband had a 21-year history of chronic hypertension. His blood pressure was poorly controlled with various antihypertensive drugs, and hypokalaemia was found 8 years ago with no definite cause. At this visit, the patient presented with excessive renal potassium excretion and decreased renin activity in the postural stimulation test; however, his aldosterone level was normal. Subsequent genetic testing identified a missense mutation in SCNN1A (c.1475G>A), which encodes for a protein with an altered amino acid at position 492 (p.Arg492Gln). The pedigree investigation found that the older brother and son of the proband also have the same mutation. The patient's serum potassium returned to normal, and blood pressure control was significantly improved after being treated with triamterene. CONCLUSION: A middle-aged patient with Liddle syndrome was diagnosed. A new point mutation in the SCNN1A gene was detected in this patient, and the pathogenicity of this mutation was predicted using AlphaFold software, expanding the genetic mutation spectrum of Liddle syndrome. Genetic testing should be improved to exclude monogenic hypertension in patients with hypertension complicated with hypokalaemia.

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Abstract Triamterene (TRI) and xipamide (XIP) mixture is used as a binary medication of antihypertension which is considered as a major cause of premature death worldwide. The purpose of this research is the quantitative and qualitative analysis of this binary mixture by green univariate and multivariate spectrophotometric methods. Univariate methods were zero order absorption spectra method (D 0 ) and Fourier self-deconvolution (FSD), as TRI was directly determined by D 0 at 367.0 nm in the range (2.00–10.00 µg/mL), where XIP show no interference. While XIP was determined by FSD at 261.0 nm in the range (2.00–8.00 µg/mL), where TRI show zero crossing. Multivariate methods were Partial Least Squares, Principal Component Regression, Artificial Neural Networks, and Multivariate Curve Resolution-Alternating Least Squares. A training set of 25 mixtures with different quantities of the tested components was used to construct and evaluate them, 3 latent variables were displayed using an experimental design. A set of 18 synthetic mixtures with concentrations ranging from (3.00–7.00 µg/mL) for TRI and (2.00–6.00 µg/mL) for XIP, were used to construct the calibration models. A collection of seven synthetic mixtures with various quantities was applied to build the validation models. All the proposed approaches quantitative analyses were evaluated using recoveries as a percentage, root mean square error of prediction, and standard error of prediction. Strong multivariate statistical tools were presented by these models, and they were used to analyze the combined dosage form available on the Egyptian market. The proposed techniques were evaluated in accordance with ICH recommendations, where they are capable of overcoming challenges including spectral overlaps and collinearity. When the suggested approaches and the published one were statistically compared, there was no discernible difference between them. The green analytical method index and eco-scale tools were applied for assessment of the established models greenness. The suggested techniques can be used in product testing laboratories for standard pharmaceutical analysis of the substances being studied.

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