Amiloride/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Moduretic

Oral combination product; potassium-sparing diuretic and thiazide diuretic; amiloride counteracts potassium loss due to HCTZ; useful in patients requiring thiazide diuretics with hypokalemia unresponsive to potassium supplements.

Indicated for the treatment of hypertension, peripheral edema, or edema associated with heart failure in patients who develop hypokalemia when thiazides (or other kaliuretic diuretics) are used alone, or in patients with significant risks for hypokalemia (e.g., digitalized, cardiac arrhythmias).

Hypersensitivity to amiloride, HCTZ or sulfonamides

Concomitant use with potassium-sparing agents (eg, spironolactone, triamterene)

Concomitant administration with any form of potassium supplementation

Acute renal failure or evidence of diabetic nephropathy

Anuria

Hyperkalemia (potassium levels ≥ 5.5 mEq/L)

Amiloride

• Hyperkalemia (10%)

• Impotence (<3%)

• Diarrhea (3-8%)

• Headache (3-8%)

• Nausea (3-8%)

• Vomiting (3-8%)

• Abdominal pain (<3%)

• Muscle cramps (<3%)

• Appetite changes (<3%)

• Constipation (<3%)

• Cough (<3%)

• Dizziness (<3%)

• Dyspnea (<3%)

• Encephalopathy (<3%)

• Fatigue (<3%)

• Weakness (<3%)

• Gas pain (<3%)

Hydrochlorothiazide

• Anorexia

• Epigastric distress

• Hypotension

• Orthostatic hypotension

• Photosensitivity

• Anaphylaxis

• Anemia

• Confusion

• Erythema multiforme

• Stevens-Johnson syndrome

• Exfoliative dermatitis including toxic epidermal necrolysis

• Dizziness

• Hypokalemia and/or hypomagnesemia

• Hyperuricemia

• Headache

Avoid use in patients with diabetes; may require adjustments in insulin or oral hypoglycemic treatment; hyperglycemia may occur during administration

Electrolyte imbalance (hypokalemia, hypophosphatemia, hyperkalemia, hypercalcemia, hypomagnesemia, hyponatremia, or hypochloremic alkalosis) may occur

Triglyceride and cholesterol levels may increase

May experience increase in serum urea nitrogen (BUN), or serum creatinine

Symptoms of lupus erythematosus may exacerbate

Hydrochlorothiazide may cause acute transient myopia and acute angle closure glaucoma within hours or weeks of initiating therapy

Gout symptoms may be precipitated

Hypersensitivity reactions may occur with or without history of allergy or bronchial asthma

Not for administration in patients with acute or chronic renal insufficiency (cumulative drug effects may be observed); diuretics may precipitate azotemia in renal disease

Use caution in patients in whom respiratory or metabolic acidosis may occur

Use caution in patients with hepatic impairment; minor alterations of fluid and electrolyte imbalance may precipitate hepatic coma

The risk of hydrochlorothiazide toxicity may be greater in renal impairment

Antihypertensive effects of this therapy may be enhanced in postsympathectomy patients

Pregnancy Category: B

Lactation: Excretion in breast milk is unknown. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.