Glezer G A, Merzon A K, Lipko D S, Donskova T V, Levinzon A M, Shelest Iu P
Klin Med (Mosk). 1990 Sep;68(9):61-4.
Hydrochlorothiazide (HCT), 25 or 50 mg a day, alone and in combination with triamterene (T), 50 and 100 mg, respectively, or amiloride (A), 2.5 and 5 mg, respectively, was examined for effects on daily urinary potassium and sodium excretion. Daily sodium excretion was increased 1.5-2-fold with a double dose of the combined drugs as compared with their single dose. T and A produced additive effects on the natriuretic action of HCT. Lower doses of HCT and T failed to prevent urinary potassium loss, but their potassium-sparing effect was shown with their double dose. This effect was largely displayed by A given in a single or double dose. Lower serum potassium levels were seen with all the drugs, but this was less marked with HCT combined with T or A than with HCT monotherapy. Their double dose reduced serum potassium levels to an insignificantly greater extent. In some cases, the elderly patients developed hyperkalemia during the combined therapy. Thus, with the routine dose ratios, A showed a slightly higher potassium-sparing effect than did T. Some patients taking HCT in combination with T showed reddish-brown crystals and casts in the urinary sediment, which may indicate its tubular interstitial damaging action. Consequently, use of the combined drugs is more preferable than HCT monotherapy, and HCT in combination with A is likely to be more preferable than that with T.
研究了氢氯噻嗪（HCT），每日25毫克或50毫克，单独使用以及分别与氨苯蝶啶（T）50毫克和100毫克或阿米洛利（A）2.5毫克和5毫克联合使用时，对每日尿钾和钠排泄的影响。与单剂量相比，联合用药双倍剂量时每日钠排泄量增加了1.5至2倍。T和A对HCT的利尿作用产生相加效应。较低剂量的HCT和T未能防止尿钾流失，但双倍剂量时显示出保钾作用。单剂量或双剂量的A在很大程度上表现出这种作用。所有药物均使血清钾水平降低，但HCT与T或A联合使用时比HCT单药治疗时这种情况不太明显。它们的双倍剂量使血清钾水平降低的程度稍大，但无显著差异。在某些情况下，老年患者在联合治疗期间出现高钾血症。因此，按常规剂量比例，A的保钾作用略高于T。一些服用HCT与T联合用药的患者尿沉渣中出现红棕色晶体和管型，这可能表明其对肾小管间质的损害作用。因此，联合用药比HCT单药治疗更可取，且HCT与A联合使用可能比与T联合使用更可取。
