Hydrochlorothiazide/Amiloride

Hydrochlorothiazide A Spironolactone Aldactazide) [Antihypertensive/Thiazide K Sparing Diuretic] Uses Edema, HTN Action Thiazide K -sparing diuretic Dose 25-200 mg each component/d, doses Caution [D, +] Contra Sulfonamide aUa-gy Disp Tabs (HCTZ/spironolactone) 25 mg/25 mg, 50 mg/50 mg SE Photosens, X BP, t or -1-K% -1- Na% hypoglycemia, hyperlipidemia, hyperuricemia Additional Interactions t Risk of hypokalemia W/ ACEIs, K-sparing diuretics, K supls, salt substitutes -1- effects OF digoxin EMS See Hydrochlorothiazide Amiloride OD See Hydrochlorothiazide Amiloride... 

Hydrochlorothiazide (HydroDIURIL, Esidrix, others) Hydrochlorothiazide Amiloride (Moduredc)... 

A 69-year-old woman took terbinafine 250 mg/day for 112 days for subungual hyperkeratosis and developed hair loss after 3 months. She was also taking hydrochlorothiazide, amiloride hydrochloride, and amlodi-pine besilate, all in the same dosage for more than 5 years. Clinical and laboratory investigations showed no other obvious causes, and hair loss completely reversed on withdrawal of terbinafine. 

Monistat, Zole miconazole glyburide progestins sulfadiazine hydrochlorothiazide amiloride Dormicum, Versed tolmetin... 

Sulindac does not appear to reduce either the hypotensive or diuretic effects of hydrochlorothiazide, and may even slightly enhance the antihypertensive effects. Another study found that sulindac did not alter the antihypertensive eflicacy of hydrochlorothiazide/amiloride given with beta blockers. Similarly, sulindac 200 mg twice daily for one month did not alter the antihypertensive effect of the combinations of hydrochlorothiazide 25 mg daily with fosinopril 10 to 40 mg daily, or lisinopril 10 to 40 mg daily. ... 

In nephrogenic diabetes insipidus the kidney s ability to respond to AVP is impaired by different causes, such as drugs (e.g. lithium), chronic disorders (e.g. sickle cell disease, kidney failure) or inherited genetic disorders (X-linked or autosomal NDI). This type of diabetes insipidus can not be treated by exogenous administration of AVP or AVP analogues. Instead, diuretics (hydrochlorothiazide combined or not with amiloride) and NSAI (indomethacin) are administrated to ameliorate polyuria. 

Amiloride (Midamor) is used in the treatment of CHF and hypertension and is often used with a thiazide diuretic. Spironolactone and triamterene are also used in tiie treatment of hypertension and edema caused by CHF, cirrhosis, and the nephrotic syndrome Amiloride, spironolactone, and triamterene are also available with hydrochlorothiazide, a thiazide diuretic that enhances tiie antihypertensive and diuretic effects of the drug combination while still conserving potassium. 

Diuretics Thiazides Loop diuretics K+-sparing diuretics Hydrochlorothiazide Furosemide Amiloride 44 4 4... 

Hydrochlorothiazide has its proposed site of action at the distal convoluted tubule or, more specifically, at the early portion of the distal tubule. Hydrochlorothiazide inhibits the reabsorption of Na and Cl. It also promotes the reabsorption of Ca back into the blood, but inhibits the re absorption of Mg from the renal tubular fluid. The K-sparing diuretic agents (spironolactone, triamterene, and amiloride) have their site of action in the nephron at the late distal tubule and the collecting duct. These diuretic agents only cause a mild natriuretic effect... 

Modu retie Diuretic Tab Amiloride 5 mg, hydrochlorothiazide 50 mg Initially 1-2 tab qd headache, hyperuricemia. 

These K+-sparing diuretics have low efficacy when used alone, since only a small amount of total Na+ reabsorption occurs at more distal sites of the nephron. These compounds are used primarily in combination with other diuretics, such as the thiazides and loop diuretics, to prevent or correct hypokalemia. The availability of feed-dose mixtures of thiazides with nonsteroidal K+-sparing compounds has proved a rational form of drug therapy. Both triamterene and amiloride are available alone or in combination with hydrochlorothiazide. 

OFFICIAL NAMES Acetazolamide, amiloride, bendroflume-thiazide, benzthiazide, bumetanide, chlorothiazide, chlorthalidone, dichlorphenamide, dorzolamide, ethacrynic acid, flume-thiazide, furosemide, glycerin, isosorbide, hydrochlorothiazide (HCT), hydroflumethiazide, mannitol, methydothiazide, metola-zone, polythiazide, quinethazone, spironolactone, torsemide, triamterene, trichlormethiazide STREET NAMES Water pills DRUG CLASSIFICATIONS Notscheduled... 

Figure 6.3 Plot of the fraction of dose absorbed (in %) of various drugs as a function of the permeability estimates in the Caco-2 system. Key 1 D-glucose 2 verapamil 3 piroxicam 4 phenylalanine 5 cyclosporin 6 enalapril 7 cephalexim 8 losartan 9 lisinopril 10 amoxicillin 11 methyldopa 12 naproxen 13 an-tipyrine 14 desipramine 15 propanolol 16 amiloride 17 metoprolol 18 terbu-taline 19 mannitol 20 cimetidine 21 ranitidine 22 enalaprilate 23 atenolol 24 hydrochlorothiazide.

Aloe 2. Dandelion 3. Elder 4. Liquorice 5. Nettle 6. Rhubarb 1. Bendroflumethiazide 2. Bumetanide 3. Chlortalidone 4. Hydrochlorothiazide 5. Indapamide 6. Furosemide 7. Torasemide Low body potassium, which may give rise to lethargy and muscle weakness t potassium loss from the gut (aloe, liquorice) Possess diuretic properties (dandelion, elder, nettle, rhubarb) Avoid concomitant use. Provide potassium supplements orally. Use a potassium-sparing diuretic such as spironolactone or amiloride... 

Diuretics amiloride, bendrofluazide, benzthiazide, chlorothiazide, clopamide, cyclopenihiazide, cyclolhiazide, ethacrynic acid, frusemide, hydrochlorothiazide, polythiazide, quineth-azone, spironolactone, triamterene... 

Amiloride exerts an inhibitory action on sodium channels under the influence of aldosterone in the distal tubule. Its action is therefore complementary to that of the thiazides and, used with them, it augments sodium loss and but limits potassium loss. One such combination, co-amilozide, (Moduretic) (amiloride 2.5-5 mg plus hydrochlorothiazide 25-50 mg), is used for hypertension or oedema. The maximum effect of amiloride occurs about 6 h after an oral dose with a duration of action >24h 21 h). The oral dose is 5-20 mg daily. 

Patients with congenital nephrogenic diabetes insipidus are often treated with a combination of a thiazide and a potassium-sparing diuretic, without consensus on the preferred potassium-sparing diuretic. A Japanese adult was systematically studied to determine the renal effects of hydrochlorothiazide plus amiloride and hydrochlorothiazide plus triamterene (1). The combination with amiloride was superior to that with triamterene in preventing excessive urinary potassium loss, hjrpokalemia, and metabolic alkalosis. These results suggest that amiloride is the preferred add-on therapy to hydrochlorothiazide in nephrogenic diabetes insipidus. 

Co-administration of potassium-sparing diuretics with ACE inhibitors can cause severe hyperkalemia (SED-14, 674). In a retrospective study, five patients developed extreme hyperkalemia (9.4-11 mmol/1) within 8-18 days of starting combination therapy with co-amilozide (amiloride -I- hydrochlorothiazide) and an ACE inhibitor (5). 

Konoshita T, Kuroda M, Kawane T, Koni I, Miyamori I, Tofuku Y, Mabuchi H, Takeda R. Treatment of congenital nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride in an adult patient. Horm Res... 

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