트리암테렌

칼륨 보존성 이뇨제

트리암테렌은 **칼륨 보존성 이뇨제**로, 개의 **울혈성 심부전(CHF)** 보조 치료 시 스피로놀락톤의 대안으로 고려될 수 있습니다. * **임상적 유용성**: 수의학에서의 사용 경험과 약동학적 데이터는 제한적입니다. 소동물에게는 여전히 스피로놀락톤이 선호되는 칼륨 보존성 이뇨제입니다. * **주요 장점**: 루프 이뇨제(푸로세미드 등)나 티아지드계 이뇨제 사용 시 흔히 발생하는 과도한 칼륨 손실을 방지하면서 부종과 체액 과다를 관리하는 데 도움이 됩니다.

작용 기전: Triamterene exerts a direct effect on the **late distal convoluted tubule** and **collecting duct** of the kidneys. * **Mechanism**: It directly blocks **epithelial sodium channels (ENaC)** on the lumenal side of the kidney tubule → inhibits the reabsorption of sodium (Na+) → decreases the electrical gradient across the tubular membrane → reduces the driving force for the secretion and excretion of potassium (K+) and hydrogen (H+) ions. * **Aldosterone Independence**: Unlike spironolactone, triamterene does **not** competitively inhibit aldosterone. Its action is independent of endogenous aldosterone levels. * **Net Effect**: Increases urinary excretion of sodium, calcium, magnesium, and bicarbonate while retaining potassium and chloride. It has little effect on blood pressure when used alone but can slightly reduce Glomerular Filtration Rate (GFR).

동물 종별 용량

Dogs

Adjunctive treatment of recurrent heart failure associated with chronic mitral valve insufficiency · 1-2 mg/kg PO q12h · PO · q12h · Documentation of use is limited; spironolactone is drug of choice.
As a diuretic for adjunctive treatment of CHF · 2-(4) mg/kg/day PO · PO · q24h

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Anuria
Severe or progressive renal disease
Severe hepatic disease
Hypersensitivity to triamterene
Preexisting hyperkalemia or history of triamterene-induced hyperkalemia
Concurrent therapy with another potassium-sparing agent (e.g., spironolactone, amiloride)
Concurrent potassium supplementation

이상반응

Hyperkalemia (most significant risk)
Gastrointestinal upset
Hyponatremia
Headache or dizziness (reported in humans)
Increased sensitivity to sunlight
Hypersensitivity reactions (rare)
Nephrolithiasis (rare)
Blood dyscrasias such as agranulocytosis, thrombocytopenia, or megaloblastosis (rare)

약물 상호작용

ACE Inhibitors (e.g., enalapril, benazepril) · Increased risks for hyperkalemia.
Antidiabetic Agents (insulin, oral hypoglycemics) · Triamterene may increase blood glucose levels.
Antihypertensive Agents · Possible potentiation of hypotensive effects.
Diuretics, Potassium-Sparing (spironolactone, amiloride) · Increased risk of hyperkalemia; concurrent use is contraindicated.
Lithium · Triamterene may reduce lithium clearance, increasing the risk of lithium toxicity.
NSAIDs (especially indomethacin) · May increase the risks of nephrotoxicity when used concurrently.
Potassium Supplements or High Potassium Foods · Increased risk for hyperkalemia.
Quinidine · Laboratory interaction: Triamterene may interfere with the fluorescent assay of quinidine.

모니터링

Serum electrolytes (especially potassium)
BUN and creatinine
Hydration status
Blood pressure, if indicated
Signs of edema
Patient weight, if indicated

과용량

The oral LD50 for triamterene in mice is 380 mg/kg. * **Clinical Signs**: Fluid and electrolyte imbalance (especially hyperkalemia) is the most likely risk. Gastrointestinal effects or hypotension are also possible. * **Management**: Consider gut emptying protocols for very large or unknown quantity ingestions. Acute overdoses should generally be managed by observation, with rigorous fluid, electrolyte (especially serum potassium), and acid-base monitoring. Initiate supportive treatment as required.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.