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Generic Amiloride (5mg + 50)
AMILORIDE HCI
Tablets: 5 mg (Rx) Midamor (Merck)
Indications
Adjunctive treatment with thiazide or loop diuretics in CHF or hypertension to: Help restore normal serum potassium in patients who develop hypokalemia on the kaliuretic diuretic; prevent hypokalemia in patients who would be at particular risk if hypokalemia were to develop (e.g., digitalized patients or patients with significant cardiac arrhythmias).
Unlabeled uses: Amiloride (10 to 20 mg/day) may be useful in reducing lithium-induced polyuria without increasing lithium levels as is seen with thiazide diuretics.
Administration and Dosage
Administer with food.
Concomitant therapy: Add amiloride 5 mg/day to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. Increase dosage to 10 mg/day, if necessary; doses > 10 mg are usually not needed. If persistent hypokalemia is documented with 10 mg, increase the dose to 15 mg, then 20 mg, with careful titration of the dose and careful monitoring of electrolytes.
In patients with CHF, potassium loss may decrease after an initial diuresis; reevaluate the need or dosage for amiloride. Maintenance therapy may be intermittent.
Single drug therapy: The starting dose is 5 mg/day. Increase to 10 mg/day, if necessary; doses > 10 mg are usually not needed. If persistent hypokalemia is documented with 10 mg, increase the dose to 15 mg, then 20 mg, with careful monitoring of electrolytes.
Contraindications
Hypersensitivity to amiloride; serum potassium > 5.5 mEq/L; antikaliuretic therapy or potassium supplementation; renal function impairment patients receiving spironolactone or triamaterene.
Warnings
Hyperkalemia: Amiloride may cause hyperkalemia (serum potassium > 5.5 mEq/L) that, if uncorrected, is potentially fatal. Monitor serum potassium carefully. Symptoms of hyperkalemia include paresthesias, muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, shock, and ECG abnormalities.
Diabetes mellitus: Avoid use of amiloride in diabetic patients. If it is used, monitor serum electrolytes and renal function frequently. Discontinue use > 3 days before glucose tolerance testing.
Metabolic or respiratory acidosis: Cautiously institute amiloride in severely ill patients in whom respiratory or metabolic acidosis may occur, such as patients with cardiopulmonary disease or poorly controlled diabetes. Monitor acid-base balance frequently. Shifts in acid-base balance alter the ratio of extracellular/intracellular potassium; the development of acidosis may be associated with rapid increases in serum potassium.
Renal function impairment: Anuria, acute or chronic renal insufficiency and evidence of diabetic nephropathy are contraindications because potassium retention is accentuated and may result in the rapid development of hyperkalemia. Do not give to patients with evidence of renal impairment (BUN > 30 mg/dL or serum creatinine > 1.5 mg/dL) or diabetes mellitus without continuous monitoring of serum electrolytes, creatinine, and BUN levels.
Hepatic function impairment: In patients with preexisting severe liver disease, hepatic encephalopathy (manifested by tremors, confusion, and coma, and increased jaundice) may occur. Because amiloride is not metabolized by the liver, drug accumulation is not anticipated in patients with hepatic dysfunction, but accumulation can occur if hepatorenal syndrome develops.
Pregnancy. Category B.
Lactation: It is not known whether amiloride is excreted in breast milk.
Children: Safety and efficacy for use in children have not been established.
Precautions
Electrolyte imbalance and BUN increases: Hyponatremia and hypochloremia may occur when amiloride is used with other diuretics. Increases in BUN levels usually accompany vigorous fluid elimination, especially when diuretic therapy is used in seriously ill patients, such as those who have hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant edema.
Drug Interactions
Drugs that may interact include digoxin, potassium preparations, ACE inhibitors, and NSAIDs.
Adverse Reactions
Possible adverse reactions include headache, nausea, anorexia, diarrhea, vomiting.
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