Sunday, March 17, 2013

Amiloride-hydrochlorothiazide


It is a non-proprietary combination of amiloride and hydrochlorothiazide. Co-amilozide is used in the treatment of hypertension and congestive heart failure with the tendency of the thiazide to cause low potassium levels (hypokalaemia) offset by the potassium-sparing effects of amiloride.
Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.
Amiloride is a potassium sparing-diuretic that also prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.
The combination of hydrochlorothiazide and amiloride is used to treat fluid retention (edema) and high blood pressure (hypertension).
Hydrochlorothiazide and amiloride may also be used for purposes not listed in this medication guide.
You should not use this medication if you have kidney disease, urination problems, diabetes, or high levels of potassium in your blood. Do not use potassium supplements while you are taking hydrochlorothiazide and amiloride.
Before using this medication, tell your doctor if you have heart disease, cirrhosis or other liver disease, glaucoma, a breathing disorder, gout, lupus, an allergy to sulfa drugs or penicillin, or a pancreas disorder. Tell your doctor if you use steroids or other blood pressure medicines.
Drinking alcohol can increase certain side effects of hydrochlorothiazide and amiloride.
Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking hydrochlorothiazide and amiloride.
There are many other drugs that can interact with hydrochlorothiazide and amiloride. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
DOSE
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.
Congestive heart failure   -  Oral
 
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.
Hepatic cirrhosis with ascites and oedema    -  Oral
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.
Should be taken with food.
overdose - Symptoms include dehydration and electrolyte imbalance. Treatment is symptomatic and supportive.
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.
You should not use this medication if you are allergic to hydrochlorothiazide or amiloride, or if you have:
kidney disease or are unable to urinate;
high potassium levels (hyperkalemia); or
if you are taking potassium supplements.
To make sure you can safely take hydrochlorothiazide and amiloride, tell your doctor if you have any of these other conditions:
diabetes;    heart disease;       cirrhosis or other liver disease;      glaucoma;       a breathing disorder;     lupus;      an allergy to sulfa drugs or penicillin;     a pancreas disorder; or  
if you are using another blood pressure medication or a steroid.



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