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Triamterene inhibits the epithelial sodium channels on principal cells in the late distal convoluted tubule and collecting tubulewhich are responsible for 1-2of total sodium reabsorptionAs sodium reabsorption is inhibitedthis increases the osmolarity in the nephron lumen and decreases the osmolarity of the interstitiumSince sodium concentration is the main driving force for water reabsorptiontriamterene can achieve a modest amount of diuresis by decreasing the osmotic gradient necessary for water reabsorption from lumen to interstitiumTriamterene also has a potassium-sparing effectNormallythe process of potassium excretion is driven by the electrochemical gradient produced by sodium reabsorptionAs sodium is reabsorbedit leaves a negative potential in the lumenwhile producing a positive potential in the principal cellThis potential promotes potassium excretion through apical potassium channelsBy inhibiting sodium reabsorptiontriamterene also inhibits potassium excretion.

OtherElevated liver enzymes have been reported in patients receiving MAXZIDE.

Well controlled studies have demonstrated that doses of hydrochlorothiazide as low as 25 mg given once daily are effective in treating hypertensionbut the dose-response has not been clearly established.

MAXZIDEtriamterene and hydrochlorothiazideis indicated for the treatment of hypertension or edema in patients who develop hypokalemia on hydrochlorothiazide aloneMAXZIDE is also indicated for those patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be riskede.gpatients on concomitant digitalis preparationsor with a history of cardiac arrhythmiasetc

Calcium excretion is decreased by thiazidesPathological changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been observed in a few patients on prolonged thiazide therapyThe common complications of hyperparathyroidism such as renal lithiasisbone resorptionand peptic ulceration have not been seenThiazides should be discontinued before carrying out tests for parathyroid function.

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