Can triamterene (Triamterene)/Hydrochlorothiazide (HCTZ) cause gout?

From the Guidelines

Yes, triamterene/HCTZ can cause gout, as the HCTZ component raises uric acid levels in the blood, leading to hyperuricemia, which is the primary risk factor for gout. This medication combination, commonly prescribed for high blood pressure and fluid retention, increases the risk of gout attacks. The triamterene component may also contribute to this effect, though to a lesser extent than HCTZ. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, patients taking this medication should be monitored for uric acid levels.

Key Points to Consider

• HCTZ is a thiazide diuretic that reduces the kidney's ability to excrete uric acid, leading to hyperuricemia.
• Patients taking triamterene/HCTZ who experience sudden, severe joint pain, redness, swelling, or warmth in a joint should contact their healthcare provider, as these may be signs of a gout attack.
• People with a history of gout or elevated uric acid levels should inform their doctor before starting this medication, as alternative treatments might be more appropriate.
• Regular monitoring of uric acid levels may be recommended for patients on triamterene/HCTZ, particularly those with risk factors for gout.

Management of Gout

The management of gout includes both pharmacologic and nonpharmacologic approaches, as outlined in the management of acute and recurrent gout guideline from the American College of Physicians 1. Patients with gout should discuss the benefits, harms, costs, and individual preferences with their healthcare provider before initiating urate-lowering therapy.

Recommendations

• Patients with a history of gout or elevated uric acid levels should be cautious when taking triamterene/HCTZ.
• Regular monitoring of uric acid levels is recommended for patients on triamterene/HCTZ, particularly those with risk factors for gout.
• Alternative treatments may be considered for patients with a history of gout or elevated uric acid levels.

From the FDA Drug Label

Triamterene has elevated uric acid, especially in persons predisposed to gouty arthritis Hyperuricemia may occur or frank gout may be precipitated in patients receiving thiazide therapy.

Triamterene/HCTZ and Gout:

• Yes, triamterene/HCTZ can cause gout, as it can elevate uric acid levels, especially in persons predisposed to gouty arthritis.
• Key Points:
  • Triamterene can increase uric acid levels.
  • HCTZ can precipitate frank gout in patients receiving thiazide therapy.
  • Patients with a history of gout should be cautious when taking triamterene/HCTZ 2, 3.

From the Research

Triamterene/HCTZ and Gout

• Triamterene/HCTZ is a combination medication used to treat high blood pressure and edema, with triamterene being a potassium-sparing diuretic and HCTZ (hydrochlorothiazide) being a thiazide diuretic.
• The relationship between triamterene/HCTZ and gout is primarily related to the thiazide diuretic component, HCTZ, as it can increase uric acid levels in the blood, which is a risk factor for gout 4, 5.
• A study published in 2016 found that diuretics, including thiazide diuretics like HCTZ, can raise serum uric acid levels and reduce glomerular filtration rate, increasing the risk of hyperuricemia and gout 4.
• Another study from 1997 found that thiazide diuretic therapy, particularly at doses of 25 mg/day or higher, is associated with a significantly increased risk for initiation of anti-gout therapy, suggesting a link between thiazide diuretics and gout 5.
• While there is no direct evidence on triamterene/HCTZ specifically, the thiazide diuretic component of the medication may contribute to an increased risk of gout due to its effects on uric acid metabolism 4, 5.

Mechanism of Action

• Thiazide diuretics, like HCTZ, can increase uric acid levels by reducing the excretion of uric acid in the kidneys, leading to hyperuricemia, a key risk factor for gout 4, 5.
• The potassium-sparing diuretic component, triamterene, may have a lesser effect on uric acid levels, but its combination with HCTZ may still contribute to an increased risk of gout due to the thiazide diuretic effect 4.

Clinical Implications

• Patients taking triamterene/HCTZ should be monitored for signs and symptoms of gout, particularly if they have a history of hyperuricemia or gout 4, 5.
• Alternative antihypertensive medications that do not increase uric acid levels, such as calcium channel blockers or ACE inhibitors, may be considered for patients at high risk of gout 4.