Hydrochlorothiazide-Triamterene Combination Therapy for Hypertension

Dosing and Administration

The American College of Cardiology recommends starting with hydrochlorothiazide 25 mg combined with triamterene 37.5-50 mg once daily, with a maximum total daily dose of hydrochlorothiazide 50 mg and triamterene 100 mg 1, 2
Initial dose of triamterene is 50-100 mg once or twice daily when used alone, as recommended by the American Heart Association 1, 3, 4

The American College of Cardiology recommends monitoring serum potassium, sodium, and magnesium within 1-2 weeks of initiation, then periodically during long-term therapy 5
Avoid using hydrochlorothiazide-triamterene combination in patients with significant chronic kidney disease (GFR <45 mL/min) due to reduced efficacy and increased hyperkalemia risk, as advised by the American College of Cardiology and the American Heart Association 1, 3, 4, 2
The American Heart Association recommends avoiding concurrent use with other potassium-sparing diuretics, potassium supplements, or aldosterone antagonists 1, 3, 2

The American College of Cardiology recommends using loop diuretics (furosemide, bumetanide, torsemide) over thiazides in symptomatic heart failure 1, 3, 4
In moderate-to-severe CKD (GFR <30 mL/min), the American Heart Association prefers loop diuretics over thiazide-type diuretics 1, 3, 4, 2

The American College of Cardiology advises against using lower doses of hydrochlorothiazide (12.5 mg) expecting equivalent efficacy—25 mg is the minimum effective dose for hypertension 1, 3, 2
The American Heart Association recommends against combining hydrochlorothiazide-triamterene with ACE inhibitors or ARBs without very close potassium monitoring due to severe hyperkalemia risk 5
The American College of Cardiology advises against using hydrochlorothiazide-triamterene combination in patients with GFR <45 mL/min as both efficacy decreases and hyperkalemia risk increases 1, 3, 4, 2