Amiloride and hydrochlorothiazide: Drug information

(For additional information see "Amiloride and hydrochlorothiazide: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)

ALERT: US Boxed Warning

Hyperkalemia:

Amiloride and hydrochlorothiazide may cause hyperkalemia (serum potassium levels greater than 5.5 mEq/L). In patients without renal impairment or diabetes mellitus, the risk of hyperkalemia with this combination product is about 1% to 2%. This risk is higher in patients with renal impairment or diabetes mellitus (even without recognized diabetic neuropathy). Because hyperkalemia, if uncorrected, is potentially fatal, it is essential to monitor serum potassium levels carefully in any patient receiving amiloride/hydrochlorothiazide, particularly when it is first introduced, at the time of dosage adjustments, and during any illness that could affect renal function.

Brand Names: Canada

AA-Amilzide;
Novamilor [DSC]

Pharmacologic Category

Antihypertensive;
Diuretic, Combination

Dosing: Adult

Heart failure or hypertension

Heart failure or hypertension: Oral: Initial: 1 tablet (amiloride 5 mg/hydrochlorothiazide 50 mg) daily; usual dose: 1 to 2 tablets daily as a single daily dose or in divided doses.

Dosing: Kidney Impairment: Adult

Use with caution; contraindicated in patients with anuria, acute or chronic renal insufficiency, or evidence of diabetic nephropathy. For additional considerations, also see individual agents.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Older Adult

Lower initial doses should be considered; use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see individual agents.

1% to 10%:

Cardiovascular: Cardiac arrhythmia (>1%)

Central nervous system: Dizziness (3% to 8%), headache (3% to 8%), fatigue (>1%)

Dermatologic: Skin rash (3% to 8%), pruritus (>1%)

Endocrine & metabolic: Hyperkalemia (1% to 2%), increased serum potassium (>1%; >5.5 mEq/L)

Gastrointestinal: Nausea (3% to 8%), abdominal pain (>1%), diarrhea (>1%), gastrointestinal pain (>1%)

Neuromuscular & skeletal: Leg pain (>1%), weakness (3% to 8%)

Respiratory: Dyspnea (>1%)

<1%, postmarketing, and/or case reports: Alopecia, angina pectoris, anorexia, arthralgia, back pain, change in appetite, chest pain, confusion, constipation, dehydration, depression, diaphoresis, digitalis intoxication, drowsiness, dysuria, erythema multiforme, exfoliative dermatitis, flatulence, flushing, gastrointestinal distress, gastrointestinal fullness, gastrointestinal hemorrhage, gout, gynecomastia, hiccups, hyponatremia (symptomatic), impotence, increased thirst, insomnia, malaise, muscle cramps, muscle spasm, nasal congestion, nervousness, nocturia, numbness, orthostatic hypotension, paresthesia, renal failure, renal insufficiency, Stevens-Johnson syndrome, stupor, syncope, tachycardia, toxic epidermal necrolysis, unpleasant taste, urinary incontinence, vertigo, visual disturbance, vomiting

Contraindications

Hypersensitivity to amiloride, hydrochlorothiazide, any component of the formulation, or sulfonamide-derived drugs; presence of elevated serum potassium levels (>5.5 mEq/L); if patient is receiving other potassium-sparing agents (eg, spironolactone, triamterene), potassium-containing salt substitutes, potassium-rich diet, or potassium supplements (except in cases of severe and/or refractory hypokalemia); anuria; acute or chronic renal insufficiency; evidence of diabetic nephropathy. Patients with evidence of renal impairment (serum creatinine >1.5 mg/dL, BUN >30 mg/dL) or diabetes mellitus should not receive this medicine without close, frequent monitoring of serum electrolytes and renal function.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Electrolyte disturbances: Hypochloremic alkalosis, hypomagnesemia, and hyponatremia can occur.

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated by hydrochlorothiazide. This risk may be increased with doses ≥25 mg (Gurwitz 1997).

• Hyperkalemia: [US Boxed Warning]: Hyperkalemia can occur; patients at risk include those with renal impairment, diabetes, the elderly, and the severely ill. Serum potassium levels must be monitored at frequent intervals especially when dosages are changed or with any illness that may cause renal dysfunction. Discontinue if hyperkalemia develops. Patients who are severely ill (eg, cardiopulmonary disease, uncontrolled diabetes) may develop respiratory or metabolic acidosis which may be associated with rapid elevations in serum potassium concentrations; use caution in these patients.

• Hypersensitivity reactions: Hypersensitivity reactions may occur with hydrochlorothiazide. Risk is increased in patients with a history of allergy or bronchial asthma.

• Ocular effects: Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma, typically occurring within hours to weeks following initiation; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain. Additional treatments may be needed if uncontrolled intraocular pressure persists. Risk factors may include a history of sulfonamide or penicillin allergy.

• Photosensitivity: Photosensitization may occur with hydrochlorothiazide.

• Skin cancer, nonmelanoma: Prolonged use (≥3 years) may increase the risk for squamous cell carcinoma up to 4 times and increase the risk for basal cell carcinoma up to 1.25 times compared to patients not treated with hydrochlorothiazide (Pedersen 2018; Pottegård 2017).

• Sulfa allergy: Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe. Discontinue if signs of hypersensitivity are noted.

Disease-related concerns:

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Diabetes: Use with extreme caution in patients with diabetes mellitus; may see a change in glucose control. Monitor closely; discontinue amiloride 3 days prior to glucose tolerance testing.

• Hepatic impairment: Use hydrochlorothiazide with caution in patients with severe hepatic dysfunction. In progressive or severe liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercholesterolemia: Use hydrochlorothiazide with caution in patients with moderate or high cholesterol concentrations.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.

• Renal impairment: Avoid use of hydrochlorothiazide in severe renal disease (ineffective). Cumulative effects may develop, including azotemia, in patients with impaired renal function.

• Systemic lupus erythematosus (SLE): Hydrochlorothiazide can cause SLE exacerbation or activation.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: Amiloride 5 mg and hydrochlorothiazide 50 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (aMILoride-hydroCHLOROthiazide Oral)

5-50 mg (per each): $1.16

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: Amiloride 5 mg and hydrochlorothiazide 50 mg

Administration: Adult

Oral: Administer with food.

Use: Labeled Indications

Heart failure, hypertension: For the treatment of patients with congestive heart failure or hypertension who develop hypokalemia when thiazides or other kaliuretic diuretics are used alone, or in whom maintenance of normal potassium levels is considered to be clinically important (eg, digitalized patients, patients with significant cardiac arrhythmias).

Medication Safety Issues

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics (amiloride and hydrochlorothiazide) are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Ajmaline: Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor therapy

Alcohol (Ethyl): May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Allopurinol: Thiazide and Thiazide-Like Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Ammonium Chloride: Potassium-Sparing Diuretics may enhance the adverse/toxic effect of Ammonium Chloride. Specifically the risk of systemic acidosis. Risk C: Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Anticholinergic Agents: May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider therapy modification

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. Management: Consider separating administraton of bile acid sequestrants and thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider therapy modification

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Calcium Salts. Risk C: Monitor therapy

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor therapy

CycloSPORINE (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of CycloSPORINE (Systemic). Risk X: Avoid combination

Desmopressin: Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Dexketoprofen: May enhance the adverse/toxic effect of Sulfonamides. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy

Diazoxide: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Dofetilide: HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. Risk X: Avoid combination

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Finerenone: Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Heparin: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Monitor serum potassium concentrations closely. The spironolactone Canadian product monograph lists its combination with heparin or low molecular weight heparins as contraindicated. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Ipragliflozin: May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor therapy

Ivabradine: Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Levosulpiride: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. Risk X: Avoid combination

Licorice: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Lithium: Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Mecamylamine: Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider therapy modification

Methenamine: Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Methenamine. Risk C: Monitor therapy

Methotrexate: HydroCHLOROthiazide may enhance the nephrotoxic effect of Methotrexate. Risk C: Monitor therapy

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Opioid Agonists: May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Diuretics may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification

Potassium-Sparing Diuretics: May enhance the hyperkalemic effect of other Potassium-Sparing Diuretics. Risk X: Avoid combination

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Promazine: Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

QuiNIDine: AMILoride may enhance the adverse/toxic effect of QuiNIDine. AMILoride may diminish the therapeutic effect of QuiNIDine. Risk C: Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Tacrolimus (Systemic): Potassium-Sparing Diuretics may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Topiramate: Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Risk C: Monitor therapy

Toremifene: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. Risk C: Monitor therapy

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. Risk C: Monitor therapy

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. See individual agents.

Breastfeeding Considerations

Thiazide diuretics are excreted in breast milk; it is not known if amiloride is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.

Dietary Considerations

Take with food.

Monitoring Parameters

I & O, daily weights, BP, serum electrolytes, renal function; signs/symptoms of hyperkalemia; dizziness, lightheadedness; skin to assess for photosensitivity, skin cancer.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Lorinid | Moduretic;
(AR) Argentina: Amiloclor | Co-amilozide vannier | Diur pot | Hidrenox a | Hidroclorotiazida+amilorida northia | Moduretic | Ren-ur;
(AT) Austria: Amiloretik | Amilorid comp | Amilostad hydrochlorthiazide | Loradur | Moduretic;
(AU) Australia: Amizide | Moduretic;
(BD) Bangladesh: Amizide | Kaltide | Moduret | Moduretic | Naturetic;
(BE) Belgium: Amichlor | Belidral | Co-amiloride | Moduretic;
(BR) Brazil: Amilorid | Amiretic | Ancloric | Cloridrato de amilorida + hct | Cloridrato de amilorida + hidroclorotiazida | Diurezin-a | Moduretic;
(CH) Switzerland: Agorex | Amilo-basan | Amilorid comp upsa | Amilorid/hctz helvepharm | Co-amilorid | Comilorid | Ecodurex | Escoretic | Grodurex | Moduretic | Rhefluin;
(CN) China: An li ya | Compound amiloride hydrochloride | Fu fang yan suan a mi luo li pian | Meng da qing | Moduretic | Wu du li;
(CO) Colombia: Amilorida + hidroclorotiazida winthrop | Diclotride-A | Moduretic;
(CZ) Czech Republic: Amilorid/hct al | Apo amilzide | Aquaretic | Loradur | Loradur mite | Moduretic | Rhefluin;
(DE) Germany: Amiduret | Amilocomp beta | Amiloretik | Amilorid comp | Amilorid/hct | Amilothiazid | Amilozid | Aquaretic | Dignoretik | Diursan | Durarese | Hydrocomp-tablinen | Modu-puren | Moduretic | Moduretik | Rhefluin;
(DO) Dominican Republic: Diuzine | Moduretic;
(EC) Ecuador: Moduretic;
(EE) Estonia: Moduretic | Sparkal;
(EG) Egypt: Hydikal | Moduretic | Saluretic | Yostiretic;
(ES) Spain: Ameride | Diuzine;
(ET) Ethiopia: Co amilozide;
(FI) Finland: Amilorid Merck NM | Amitrid | Diuramin | Diurex | Diurex mite | Miloride | Moduretic | Normorix | Sparkal;
(FR) France: Amiloride hydrochlorotiazide rpg | Amiloride Hydrochlorotiazide Teva | Moduretic;
(GB) United Kingdom: Amil co | Amilmaxco | Amizide | Co amilozide | Co amilozide almus | Co amilozide arrow | Co amilozide berk | Co amilozide cox | Co amilozide kent | Delvas | Hypertane | Moduret | Moduretic | Normetic | Synuretic | Vasetic | Zida co;
(GR) Greece: Moduretic | Tiaden;
(GT) Guatemala: Tiazil;
(HK) Hong Kong: Amilco | Amiloretic | Amithiazide | Apo amilzide | Bilduretic | Moduretic | Poli Uretic | Sefaretic;
(HR) Croatia: Moduretic;
(HU) Hungary: Amilorid comp | Amilozid teva | Amilozid-b;
(ID) Indonesia: Amitrid | Lorinid | Moduretic | Scandiuret;
(IE) Ireland: Amilco | Moduret;
(IL) Israel: Kaluril;
(IN) India: Biduret | Biduret-l;
(IT) Italy: Moduretic;
(JO) Jordan: Amuretic | Medoacten | Moduretic | Uniretic;
(KE) Kenya: Adco-retic | Corzide a | Moduretic | Sefaretic;
(KW) Kuwait: Moduretic;
(LB) Lebanon: Moduretic;
(LT) Lithuania: Amilozid | Amilozid-b | Moduretic | Tialorid;
(LU) Luxembourg: Amichlor | Amiloretik | Moduretic;
(LV) Latvia: Amilorid comp | Moduretic | Sparkal | Tialorid;
(MA) Morocco: Moduretic;
(MX) Mexico: Moduretic;
(MY) Malaysia: Amilozide | Amizide | Apo amilzide | Moduretic | Moduride | Scanduretic;
(NG) Nigeria: Ashfort amiloride/hydrochlorothiazide | Malretic | Rotaretic | Samduretic | Vamaretic | Zoretic;
(NL) Netherlands: Amiloride comp. | Amiloride Hcl/Hydrochloorthiazide | Amiloride HCl/hydrochloorthiazide Accord | Amiloride hcl/hydrochloorthiazide auro | Amiloride Hcl/Hydrochloorthiazide Merck | Amiloride hcl/hydrochloorthiazide sandoz | Amiloride/Hydrochloorthiazide A | Amiloride/Hydrochloorthiazide Katwijk | Moduretic | Moduretik;
(NO) Norway: Co amilozide | Comilorid mep mite | Moduretic | Normorix;
(NZ) New Zealand: Amizide | Moduretic;
(PE) Peru: Moduretic;
(PK) Pakistan: Conserve | Moduretic;
(PL) Poland: Moduretic | Tialorid | Tialorid mite;
(PR) Puerto Rico: Amiloride hcl/hctz | Amiloride hydrochloride and Hydrochlorothiazi | Moduretic;
(PT) Portugal: Amilorida + hidroclorotiazida generis | Amiloride + hidroclorotiazida | Amiloride 5 + hidroclorotiazid 50 ratiopharm | Amiloride composto | Chibretico | Diurene | Moduretic;
(PY) Paraguay: Clorfal d | Hidramil | Hidro plus | Hidroclorotiazida + amilorida heisecke | Hidroclorotiazida amilorida dima | Moduretic;
(QA) Qatar: Moduretic;
(RU) Russian Federation: Moduretic;
(SA) Saudi Arabia: Amuretic | Apo amilzide | Co amilozide | Moduretic;
(SE) Sweden: Amiloferm | Normorix | Sparkal;
(SG) Singapore: Apo amilzide | Scanduretic;
(SI) Slovenia: Moduretic;
(SK) Slovakia: Amilorid/hct al | Moduretic | Rhefluin;
(TH) Thailand: Amilozide | Bilduretic | Buretic | Freten | Gaduretic | Hiretic | Hydrozide plus | Hyperretic | Loretic | Meditic | Miduret | Milorex | Minitic | Miretic | Modulan | Moduretic | Moduzide | Moure-m | Mourinate | Poli Uretic | Renase | Sefaretic | Starduretic | Thiamil | Thiauril | Upduret | Uretic;
(TN) Tunisia: Amuretic | Moduretic;
(TR) Turkey: Moduretic;
(TW) Taiwan: Amilco | Amiton | Amitrid | Amizide | Anza | Edenil | Moduretic | Scanduretic | Tiaden;
(UA) Ukraine: Amilozid-b | Moduretic;
(UY) Uruguay: Amiloside 550 | Moduretic | Tiaride;
(VE) Venezuela, Bolivarian Republic of: Moduretic;
(ZA) South Africa: Adco-retic | Amiloretic | Betaretic | Dezretic | Hexaretic | Merck-amilozide | Moduretic | Rolab-co-amilozide;
(ZM) Zambia: Amiloretic | Amiloretic H.S. | Betaretic | Co amilozide;
(ZW) Zimbabwe: Urazide

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American Diabetes Association (ADA). Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(suppl 1):S1-S232. https://care.diabetesjournals.org/content/44/Supplement_1. Accessed January 12, 2021.
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Weber MA, Schiffrin EL, White WB, et al. Clinical Practice Guidelines for the Management of Hypertension in the Community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hyperten (Greenwich). 2014;16(1):14-26. [PubMed 24341872]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [published correction appears in Hypertension. 2018;71(6):e140-e144]. Hypertension. 2018;71(6):e13‐e115. doi:10.1161/HYP.0000000000000065 [PubMed 29133356]
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Topic 8604 Version 239.0

خرید پکیج

Amiloride and hydrochlorothiazide: Drug information