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Can Triamterene, Atenolol, Metformin, Nexium, Clonazepam And Ramipril Be Taken Together?

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Posted on Tue, 13 Oct 2015
Question: I am a type 2 diabetic. My doctor has prescribed Triamterene plus atenolol and Ramipril. He also wants me to take Metformin. In addition, I take Nexium and Clonazepam. I have a high sensitivity level to medication. Initially, I was told to add the Ramipril to the Triamterene. I had terrible back pain and was very nauseous. I began to read about side effects and it seems that the combination of meds I am being told to take interact with one another. All of the literature says to be careful if you are diabetic when taking any of these meds. I have yet to start the Metformin and have discontinued the Ramipril and Triamterene.
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Answered by Dr. Panagiotis Zografakis (1 hour later)
Brief Answer:
there are some interactions

Detailed Answer:
Hello,

this is a strange combination of antihypertensive drugs. I don't know the reasoning behind this decision, so I can't comment on it but I'll mention some important interactions that I believe you should know.

Triamterene is a potassium sparing diuretic. We usually use such diuretics when there is a need for diuretic (obviously!) and when the potassium levels are on the low side. Sometimes it is used along with other diuretics (which lower the potassium levels) as protection against hypokalemia. Triamterene may worsen glucose control.

Ramipril is an angiotensin converting enzyme inhibitor (ACEi) which means that it also causes hyperkalemia. Using it along with potassium sparing diuretics needs careful monitoring of the potassium levels.

Atenolol is not the most efficient antihypertensive choice and may worsen your glucose control. It may also blunt some of the symptoms of hypoglycemia, which is a potentially dangerous situation in diabetics.

Finally using triamterene with metformin may (not always) affect its excretion, causing an increased rate of side effects from metformin.

Besides the aforementioned interactions, no other serious interaction is documented. Nausea can be caused by many medications including some of the drugs you take. Back pain is an uncommon side effect. Please remember that other causes of your symptoms have to be eliminated first before attributing the symptoms to the drugs.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3809 Questions

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Can Triamterene, Atenolol, Metformin, Nexium, Clonazepam And Ramipril Be Taken Together?

Brief Answer: there are some interactions Detailed Answer: Hello, this is a strange combination of antihypertensive drugs. I don't know the reasoning behind this decision, so I can't comment on it but I'll mention some important interactions that I believe you should know. Triamterene is a potassium sparing diuretic. We usually use such diuretics when there is a need for diuretic (obviously!) and when the potassium levels are on the low side. Sometimes it is used along with other diuretics (which lower the potassium levels) as protection against hypokalemia. Triamterene may worsen glucose control. Ramipril is an angiotensin converting enzyme inhibitor (ACEi) which means that it also causes hyperkalemia. Using it along with potassium sparing diuretics needs careful monitoring of the potassium levels. Atenolol is not the most efficient antihypertensive choice and may worsen your glucose control. It may also blunt some of the symptoms of hypoglycemia, which is a potentially dangerous situation in diabetics. Finally using triamterene with metformin may (not always) affect its excretion, causing an increased rate of side effects from metformin. Besides the aforementioned interactions, no other serious interaction is documented. Nausea can be caused by many medications including some of the drugs you take. Back pain is an uncommon side effect. Please remember that other causes of your symptoms have to be eliminated first before attributing the symptoms to the drugs. I hope you find my comments helpful! You can contact me again, if you'd like any clarification or further information. Kind Regards!