Hydrochlorothiazide and Amiloride

(hye droe klor oh thye' a zide) (a mil' oh ride)

PCaution when used during lactation - Caution when used during pregnancy

LCI - Contraindicated in lactation

Molecule Info

 
Indication & Dosage Oral
Hypertension
Adult: Per tab contains amiloride hydrochloride 2.5 mg and hydrochlorothiazide 25 mg: Initially 1 tab daily, increased up to a max of 2 tabs daily as a single or divided dose. Per tab contains amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg: Initially 1/2 tab daily, increased up to a max of 1 tab daily as a single or divided dose.
Oral
Congestive heart failure
Adult: Per tab contains amiloride hydrochloride 2.5 mg and hydrochlorothiazide 25 mg: Initially 1 tab daily, increased up to a max of 4 tabs daily. Per tab contains amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg: Initially 1/2 tab daily, increased up to a max of 2 tabs daily. Reduce maintenance dose if possible.
Oral
Hepatic cirrhosis with ascites and oedema
Adult: Per tab contains amiloride hydrochloride 2.5 mg and hydrochlorothiazide 25 mg: Initially 2 tabs daily, increased up to a max of 4 tabs daily. Per tab contains amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg: Initially 1 tab daily, increased up to a max of 2 tabs daily. Reduce maintenance dose if possible.
Administration Should be taken with food.
Overdosage Symptoms include dehydration and electrolyte imbalance. Treatment is symptomatic and supportive.
Contraindications Hyperkalaemia; anuria; acute renal failure, severe progressive renal disease; severe hepatic failure, precoma associated with hepatic cirrhosis; Addison's disease; hypercalcaemia; diabetic neuropathy; DM. Child <18 yr. Lactation.
Special Precautions Renal impairment; BUN >10 mmol/L, serum creatinine >130 mmol/L. Monitor serum electrolytes and blood urea levels in seriously ill patients e.g. those with hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant oedema. Pre-existing severe liver disease. May affect parathyroid function. Hyperuricaemia or gout may occur. Cholesterol and triglyceride levels may be increased. Thiazides may impair glucose tolerance. DM may be precipitated or aggravated. May activate or exacerbate SLE. Elderly. Hyponatraemia. Pregnancy.
Adverse Drug Reactions Electrolyte imbalance e.g. hyponatraemia, hypochloraemic alkalosis, hypokalaemia and hypomagnesaemia. Anaphylaxis, back pain, chest pain, fatigue, fever, headache, malaise, neck/shoulder ache, pain in extremities, syncope, weakness; angina, arrhythmias, digitalis toxicity, orthostatic hypotension, necrotising angiitis, palpitation and tachycardia; GI disturbances; agranulocytosis, aplastic anaemia, haemolytic anaemia, leucopenia, neutropenia, purpura and thrombocytopenia; alopecia, diaphoresis, dry mouth, flushing, photosensitivity, pruritis, rash, sialadenitis and urticaria; glycosuria, gout, hyperglycaemia and hyperuricaemia; joint pain, leg ache and muscle cramps; dizziness, encephalopathy, paraesthesia, stupor, tremors, vertigo; decreased libido, depression, insomnia, mental confusion, nervousness, restlessness, sleepiness and somnolence; cough, dyspnoea and respiratory distress; bad taste, increased intraocular pressure, nasal congestion, tinnitus, visual disturbance and xanthopsia; bladder spasm, dysuria, impotence, incontinence, interstitial nephritis, nocturia, polyuria, renal dysfunction.
Drug Interactions Additive effects with other antihypertensives. May increase the responsiveness to tubocurarine. May reduce arterial responsiveness to pressor amines e.g. norepinephrine. Orthostatic hypotension may occur with alcohol, barbiturates and narcotics. Discontinue diuretics 2-3 days before initiation of an ACE inhibitor to reduce the likelihood of 1st dose hypotension. Increased hypokalaemia with corticosteroids or ACTH. Attenuation of diuretic, natriuretic and antihypertensive effects of diuretics with NSAIDs. Increased hyponatraemia with chlorpropamide. Increased hyperkalaemia with ciclosporin, tacrolimus, indometacin and angiotensin II receptor antagonists.
Potentially Fatal: Increases risk of hyperkalaemia with other potassium-sparing diuretics (spironolactone or triamterene). Increases risk of lithium toxicity.

Food Interaction Potassium-rich diets are associated with rapid increases in plasma potassium levels.
Lab Interference May interfere with tests for parathyroid function.
Pregnancy Category (US FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1sttrimester (and there is no evidence of a risk in later trimesters).

 

Storage Oral: Store in a dry place below 30°C.
Mechanism of Action Amiloride is an antikaliuretic with weak natriuretic, diuretic and antihypertensive effects. Some clinical studies found these effects to be partially additive to the effects of thiazide diuretics. Amiloride exerts its potassium-sparing effect by inhibiting Na reabsorption at the distal renal tubules; this decreases the net -ve potential of the tubular lumen and reduces both K and hydrogen secretion and their subsequent excretion. Hydrochlorothiazide is a diuretic and antihypertensive. It reduces electrolyte reabsorption from the renal tubules. Hydrochlorothiazide increases excretion of Na and chloride in approx equiv amounts. Natriuresis may be accompanied by some loss of K and bicarbonate. It exerts its hypotensive effect partly by reducing peripheral resistance.
Absorption: Amiloride: Bioavailability: about 50%. Hydrochlorothiazide: Fairly absorbed from the GI tract; bioavailability: About 65-70%.
Distribution: Hydrochlorothiazide: Crosses the placental barrier; excreted in breast milk.
Excretion: Amiloride: Plasma half-life: 6-9 hr; terminal half-life: about 20 hr or more. Excreted unchanged by the kidneys. Hydrochlorothiazide: Plasma half-life: About 3-4 hr. Excreted unchanged in the urine.
mph Class Diuretics
ATC Classification C03DB01 - amiloride ; Belongs to the class of other potassium-sparing agents. Used as diuretics. 
C03AA03 - hydrochlorothiazide ; Belongs to the class of low-ceiling thiazide diuretics. Used to promote excretion of urine.

Brand/Product Info


Total Products : 3   
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
AMIZIDE Sanofi Hydrochlorothiazide 50mg+ Amiloride hydrochloride 5mg Tablet 200's: 144.01 MRP
DEZIDE Eskayef Bangladesh Ltd Hydrochlorothiazide 25mg + Triamterene 50mg Tablet 100's: 75.00 MRP
G-THIAZIDE T Gonoshasthaya Pharmaceuticals Ltd Hydrochlorothiazide 25mg+ Triamterene 50mg Tablet 100's: 52.00 MRP

Gen. MedInfo

Why is this medication prescribed?

The combination of amiloride and hydrochlorothiazide, a 'water pill,' is used to treat high blood pressure and fluid retention caused by various conditions, including heart disease. It causes the kidneys to eliminate unneeded water and salt from the body into the urine.

This medicine is sometimes prescribed for other uses; ask your doctor for more information.

How should this medicine be used?

The combination of amiloride and hydrochlorothiazide comes as a tablet to take by mouth. It usually is taken once a day in the morning with food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amiloride and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

This medication controls high blood pressure but does not cure it. Continue to take amiloride and hydrochlorothiazide even if you feel well. Do not stop taking amiloride and hydrochlorothiazide without talking to your doctor.

What special precautions should I follow?

Before taking amiloride and hydrochlorothiazide,

  • tell your doctor if you are allergic to amiloride, hydrochlorothiazide, sulfa drugs, or any other drugs.
  • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially captopril; digoxin; enalapril; indomethacin; lisinopril; lithium; medications for arthritis, diabetes, or high blood pressure; potassium supplements; and vitamins. Do not take this medicine if you are taking spironolactone or triamterene.
  • tell your doctor if you have or have ever had diabetes, gout, or kidney or liver disease.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amiloride and hydrochlorothiazide, call your doctor immediately.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amiloride and hydrochlorothiazide.
  • you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
  • remember that alcohol can add to the drowsiness caused by this drug.

What special dietary instructions should I follow?

Follow your doctor's directions for a low-salt or low-sodium diet and daily exercise program. Avoid potassium-containing salt substitutes. Limit your intake of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice). Ask your doctor for advice on how much of these foods you may have.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Amiloride and hydrochlorothiazide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • upset stomach

  • vomiting

  • diarrhea

  • loss of appetite

  • stomach pain

  • gas

  • frequent urination

  • dizziness

  • headache

If you experience any of the following symptoms, call your doctor immediately:

  • muscle weakness or cramps

  • fatigue

  • slow or irregular heartbeat

  • sore throat

  • unusual bleeding or bruising

  • yellowing of the skin or eyes

  • skin rash

  • difficulty breathing or swallowing

Before Calling Emergency

Determine the following information:

  • Patient's age, weight and condition
  • Name of the product/medicine (ingredients and strengths, if possible)
  • Time it was swallowed/taken
  • Amount swallowed/taken

 What to Expect at the Emergency Room

 The Health Care Provider/ Emergency Doctor will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Antidote, gastric lavage, activated charcoal or other drugs/procedures as required
  • Blood tests to determine body chemical levels and blood acid/base balance
  • EKG/ECG test
  • Medicines to correct fluid and electrolyte imbalances

Do not let anyone else take your medicine.  

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals or other dietary supplements.  You should bring this list with you each time you visit a doctor or if you are admitted into a hospital.  It is also important information to carry with you in case of emergencies.