Perindopril major ace inhibitors can increase the risk of hyperkalemia developing in patients receiving triamterene, especially in the presence of renal impairment.

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Any chloride deficit during thiazide therapy is generally mild and usually does not require any specific treatment except under extraordinary circumstancesas in liver disease or renal diseaseDilutional hyponatremia may occur in edematous patients in hot weatherappropriate therapy is water restrictionrather than administration of saltexcept in rare instances when the hyponatremia is life threateningIn actual salt depletionappropriate replacement is the therapy of choice.

Studies of the mutagenic potential of MAXZIDEthe triamterene/hydrochlorothiazide combinationhave not been performed.

There was an increased incidence of hepatocellular neoplasiaprimarily adenomasin male and female mice at the highest dosage levelThese doses represent 7.5 times and 10 times the MRHD of 300 mg/kgor 6 mg/kg/day based on a 50 kg patientfor male and female micerespectively when based on body-weight and 0.7 times and 0.9 times the MRHD when based on body-surface areaAlthough hepatocellular neoplasiaexclusively adenomasin the rat study was limited to triamterene-exposed malesincidence was not dose dependent and there was no statistically significant difference from control incidence at any dose level.

This is not a complete list of possible side effectsIf you notice other effects not listed abovecontact your doctor or pharmacist.

MAXZIDEtriamterene and hydrochlorothiazidemay produce an elevated blood urea nitrogen levelBUNcreatinine level or bothThis is probably not the result of renal toxicity but is secondary to a reversible reduction of the glomerular filtration rate or a depletion of the intravascular fluid volumeElevations in BUN and creatinine levels may be more frequent in patients receiving divided dose diuretic therapyPeriodic BUN and creatinine determinations should be made especially in elderly patientspatients with suspected or confirmed hepatic disease or renal insufficienciesIf azotemia increasesMAXZIDEtriamterene and hydrochlorothiazideshould be discontinued.

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