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Amiloride and hydrochlorothiazide: Drug information

Amiloride and hydrochlorothiazide: Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Amiloride and hydrochlorothiazide: Patient drug information"

For abbreviations, symbols, and age group definitions 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: Liver 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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

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

Alcohol (Ethyl): May increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Aliskiren: Potassium-Sparing Diuretics may increase hyperkalemic effects of Aliskiren. Risk C: Monitor

Allopurinol: Thiazide and Thiazide-Like Diuretics may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects 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 increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

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

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II Receptor Blockers: Potassium-Sparing Diuretics may increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Potassium-Sparing Diuretics may increase hyperkalemic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects 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 increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Thiazide and Thiazide-Like Diuretics. Management: Separate administration of bile acid sequestrants and oral 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 decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

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

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

Corticosteroids (Systemic): May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor

CycloSPORINE (Systemic): Potassium-Sparing Diuretics may increase hyperkalemic effects of CycloSPORINE (Systemic). Risk X: Avoid

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexketoprofen: May increase adverse/toxic effects of Sulfonamides. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

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

Diazoxide Choline: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the hyperglycemic and hyperuricemic effects may be increased. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Diazoxide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Diazoxide. Risk C: Monitor

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Digitoxin: Potassium-Sparing Diuretics may increase adverse/toxic effects of Digitoxin. Potassium-Sparing Diuretics may decrease therapeutic effects of Digitoxin. Risk C: Monitor

Dofetilide: HydroCHLOROthiazide may increase QTc-prolonging effects of Dofetilide. HydroCHLOROthiazide may increase serum concentration of Dofetilide. Risk X: Avoid

Drospirenone-Containing Products: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Finerenone: Potassium-Sparing Diuretics may increase hyperkalemic effects of Finerenone. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Heparin: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

Heparins (Low Molecular Weight): May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

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

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Thiazide and Thiazide-Like Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Lithium: Thiazide and Thiazide-Like Diuretics may decrease 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 increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects 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

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methenamine: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Methenamine. Risk C: Monitor

Methotrexate: HydroCHLOROthiazide may increase nephrotoxic effects of Methotrexate. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase hypercalcemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase 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

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may decrease antihypertensive effects of Potassium-Sparing Diuretics. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects 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 increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Thiazide and Thiazide-Like Diuretics may increase therapeutic effects of Palopegteriparatide. Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Potassium Salts: May increase hyperkalemic effects 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 increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk X: Avoid

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Promazine: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

QuiNIDine: AMILoride may increase adverse/toxic effects of QuiNIDine. AMILoride may decrease therapeutic effects of QuiNIDine. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

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

Sotagliflozin: HydroCHLOROthiazide may decrease therapeutic effects of Sotagliflozin. Sotagliflozin may decrease serum concentration of HydroCHLOROthiazide. Risk C: Monitor

Tacrolimus (Systemic): Potassium-Sparing Diuretics may increase hyperkalemic effects of Tacrolimus (Systemic). Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Tolvaptan: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

Topiramate: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Topiramate. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Topiramate. Risk C: Monitor

Toremifene: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Toremifene. Risk C: Monitor

Trimethoprim: May increase hyperkalemic effects of Potassium-Sparing Diuretics. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Vitamin D Analogs. Risk C: Monitor

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: Amilorid comp ratiopharm | 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: Amiur h | 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 | Tialorid mite;
  • (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;
  • (SR) Suriname: Amiloride Hcl/Hydrochloorthiazide;
  • (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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