Can Dyazide (Triamterene/Hydrochlorothiazide) be taken with Losartan?

From the Guidelines

It is not recommended to take Dyazide (Triamterene/Hydrochlorothiazide) with Losartan without medical supervision due to the potential risk of hyperkalemia and other adverse effects. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1, the combination of a potassium-sparing diuretic (such as triamterene) with an angiotensin II receptor blocker (such as losartan) can increase the risk of hyperkalemia.

Key Considerations

• The triamterene in Dyazide can raise potassium levels, and losartan can also increase potassium levels, potentially leading to dangerous hyperkalemia.
• 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 recommends avoiding the use of potassium-sparing diuretics in patients with significant chronic kidney disease (CKD).
• The 2024 ESC guidelines 1 recommend that when BP is still uncontrolled under maximally tolerated triple-combination therapy, the patient should be considered resistant and referred to an expert centre for appropriate work-up, and the addition of spironolactone should be considered.

Monitoring and Precautions

• If your doctor has prescribed both medications, they will likely monitor your blood pressure, kidney function, and electrolyte levels regularly.
• Never adjust your medication regimen without consulting your healthcare provider, as they can determine the appropriate dosing and monitoring needed for your specific situation.
• It is essential to follow the recommended dosing and monitoring guidelines to minimize the risk of adverse effects and ensure the safe use of these medications.

From the FDA Drug Label

7.1 Agents Increasing Serum Potassium Coadministration of losartan with other drugs that raise serum potassium levels may result in hyperkalemia. Monitor serum potassium in such patients.

1. 4 Dual Blockade of the Renin-Angiotensin System (RAS) Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy

The combination of Losartan and Triamterene/Hydrochlorothiazide (Dyazide) may increase the risk of hyperkalemia due to the potassium-sparing effect of Triamterene.

• Monitor serum potassium levels in patients taking Losartan with Dyazide.
• Closely monitor blood pressure, renal function, and electrolytes in patients on Losartan and Dyazide. 2

From the Research

Combination Therapy with Losartan and Hydrochlorothiazide

• The combination of Losartan and Hydrochlorothiazide (HCTZ) has been shown to be effective in lowering blood pressure in patients with hypertension 3, 4, 5, 6, 7.
• Studies have demonstrated that this combination therapy can be used as an initial therapy in severe hypertension or as an addition to other antihypertensive medicines 3, 7.
• The efficacy of Losartan/HCTZ combination therapy has been demonstrated in various patient populations, including those with comorbidities such as left ventricular hypertrophy, coronary heart disease, and chronic kidney disease 3, 4, 5.

Safety and Tolerability

• The combination of Losartan and HCTZ has been shown to be well tolerated, with a low incidence of adverse events 3, 4, 5.
• The safety profile of Losartan/HCTZ combination therapy is similar to that of losartan alone, with no significant increase in adverse metabolic effects 4.

Dyazide (Triamterene/Hydrochlorothiazide) and Losartan

• While there are no direct studies on the combination of Dyazide (Triamterene/Hydrochlorothiazide) and Losartan, the available evidence suggests that Losartan can be safely used with HCTZ, which is a component of Dyazide 3, 4, 5, 6, 7.
• However, it is essential to note that Triamterene is a potassium-sparing diuretic, and its combination with Losartan, an angiotensin II receptor antagonist, may increase the risk of hyperkalemia 3, 4, 5.

Clinical Considerations

• When using Dyazide (Triamterene/Hydrochlorothiazide) with Losartan, careful monitoring of potassium levels and blood pressure is recommended to minimize the risk of adverse effects 3, 4, 5.
• The combination of Losartan and HCTZ has been shown to be effective in reducing blood pressure and proteinuria in patients with hypertension and chronic kidney disease 4.