Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Tarssanen L, Huikko M, Rossi M "Amiloride-induced hyponatremia.
Used in fixed combination with hydrochlorothiazide for treatment of edema in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked. Go AS, Bauman MA, Coleman King SM et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. Midamor should not be given to patients receiving other potassium-conserving agents, such as spironolactone or triamterene. Sherman LG, Liang CS, Baumgardner S et al. Piretanide, a potent diuretic with potassium-sparing properties, for the treatment of congestive heart failure. Clin Pharmacol Ther.
Antikaliuretic therapy should be instituted only with caution in severely ill patients in whom respiratory or metabolic acidosis may occur, such as patients with cardiopulmonary disease or poorly controlled diabetes. If Midamor is given to these patients, frequent monitoring of acid-base balance is necessary. Teratogenicity studies with amiloride HCl in rabbits and mice given 20 and 25 times the maximum human dose, respectively, revealed no evidence of harm to the fetus, although studies showed that the drug crossed the placenta in modest amounts. Reproduction studies in rats at 20 times the expected maximum daily dose for humans showed no evidence of impaired fertility. At approximately 5 or more times the expected maximum daily dose for humans, some toxicity was seen in adult rats and rabbits and a decrease in rat pup growth and survival occurred.
This medicine may increase the amount of potassium in your blood. Cases of severe hyponatremia have been reported during hydrochlorothiazide-amiloride the active ingredient contained in Midamor therapy. In 3 cases, the patients subsequently did well with hydrochlorothiazide and potassium supplementation, suggesting a significant role for amiloride in the development of their hyponatremia. Midamor should be discontinued at least three days before glucose tolerance testing.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Has been used in combination with hydrochlorothiazide in patients with recurrent calcium nephrolithiasis. Keep out of the reach of children. In diabetic patients, hyperkalemia has been reported with the use of all potassium-conserving diuretics, including Midamor, even in patients without evidence of diabetic nephropathy. Therefore, Midamor should be avoided, if possible, in diabetic patients and, if it is used, serum electrolytes and renal function must be monitored frequently. Hyperkalemia, b nausea, b vomiting, b diarrhea, b abdominal pain, b flatulence, b anorexia, b mild skin rash, b headache. If it is necessary to use Midamor alone see the starting dosage should be one 5 mg tablet daily. This dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets usually are not needed, and there is little controlled experience with such doses. If persistent hypokalemia is documented with 10 mg, the dose can be increased to 15 mg, then 20 mg, with careful monitoring of electrolytes. Treatment of edematous conditions in patients with congestive heart failure who are only partially responsive to or intolerant of other therapeutic measures or who are taking digitalis when other therapies are considered inappropriate.
Exerts potassium-sparing effect by decreasing sodium reabsorption in the distal tubule and reducing both potassium and hydrogen secretion and subsequent excretion. Initially, 5 mg daily; a b 524 increase dosage as necessary to 10 mg daily. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Your doctor may recommend you eat certain foods or take supplements to keep your potassium from getting too low. Follow the diet and medication plan created for you by your doctor or nutrition counselor. Increases urinary excretion of sodium, calcium, and bicarbonate with little, if any, increase in chloride excretion. Treatment of patients with hypokalemia when other measures are considered inappropriate or inadequate. ACE inhibitors, angiotensin II receptor antagonists, calcium-channel blockers, thiazide diuretics are preferred for initial management. According to some clinicians, maximum effective daily dosage may be as high as 40 mg daily. Food decreases the extent of GI absorption to about 30%, but does not affect the rate of absorption. Such measures include the intravenous administration of sodium bicarbonate solution or oral or parenteral glucose with a rapid-acting insulin preparation. If needed, a cation exchange resin such as sodium polystyrene sulfonate may be given orally or by enema. Patients with persistent hyperkalemia may require dialysis. If it is necessary to use MIDAMOR alone see the starting dosage should be one 5 mg tablet daily. This dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets usually are not needed, and there is little controlled experience with such doses. If persistent hypokalemia is documented with 10 mg, the dose can be increased to 15 mg, then 20 mg, with careful monitoring of electrolytes. Drinking alcohol with this medicine can cause side effects. Zinc can attach to tetracyclines in the stomach. This decreases the amount of tetracyclines that can be absorbed. Taking zinc with tetracyclines might decrease the effectiveness of tetracyclines. To avoid this interaction, take tetracyclines 2 hours before or 4-6 hours after taking zinc supplements. Major Do not take this combination. allopurinol
AHFS Drug Information 2017. McEvoy GK, ed. Amiloride hydrochloride. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. Other adverse experiences that have been reported with amiloride are generally those known to be associated with diuresis, or with the underlying disease being treated. Nervous system side effects occur in less than 3% of patients, and include headache, weakness, and fatigue. Encephalopathy may be induced by amiloride-associated metabolic changes in some patients with severe liver disease. In treating patients with congestive heart failure after an initial diuresis has been achieved, potassium loss may also decrease and the need for MIDAMOR should be re-evaluated. Dosage adjustment may be necessary. Maintenance therapy may be on an intermittent basis. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients. Not metabolized in the liver. best brand alfuzosin alfuzosin
Are there any interactions with medications? If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily with careful monitoring of serum electrolytes. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. For treating stomach ulcers: zinc sulfate 200 mg three times daily. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Midamor while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while taking Midamor. Studies in rats have shown that amiloride is excreted in milk in concentrations higher than those found in blood, but it is not known whether Midamor is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Midamor, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. May increase urinary aldosterone and plasma renin concentrations, probably as a compensatory feedback mechanism caused by potassium retention and natriuresis. Midamor is contraindicated in patients who are hypersensitive to this product.
Hyperkalemia occurs commonly about 10% when amiloride is used without a kaliuretic diuretic. This incidence is greater in patients with renal impairment, diabetes mellitus with or without recognized renal insufficiency and in the elderly. When Midamor is used concomitantly with a thiazide diuretic in patients without these complications, the risk of hyperkalemia is reduced to about 1-2 percent. It is thus essential to monitor serum potassium levels carefully in any patient receiving amiloride, particularly when it is first introduced, at the time of diuretic dosage adjustments, and during any illness that could affect renal function. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. Management of edema associated with heart failure, cirrhosis of the liver, or secondary hyperaldosteronism. It is not known whether the drug is dialyzable. The manufacturers state that amiloride produces little additive hypotensive activity when used concurrently with a thiazide diuretic. Importance of avoiding ingestion of potassium supplements, salt substitutes, or excessive amounts of potassium-rich foods. Lab tests, including electrolyte levels and blood pressure monitoring, may be performed while you use Midamor. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Use appropriate replacement therapy in those who are sodium depleted. a Use water restriction rather than replacement of sodium chloride in edematous patients with dilutional hyponatremia during hot weather, except in rare instances when hyponatremia is life-threatening. The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Anuria, acute or chronic renal insufficiency, and evidence of diabetic nephropathy are contraindications to the use of Midamor. Moderate Be cautious with this combination. See Specific Drugs, Foods, and Laboratory Tests under Interactions. Use with caution in patients with cardiopulmonary disease or uncontrolled diabetes mellitus because of risk of developing metabolic or respiratory acidosis, which may result in rapid increases in serum potassium concentration. a b Monitor acid-base balance frequently in such patients. Distributed into milk in animals. a b c Discontinue nursing or the drug. However, some clinicians state maximum effective dosage may be as high as 40 mg daily. arava brand arava
Renal clearance may be reduced in patients with renal impairment. Zinc might decrease blood sugar in people with type 2 diabetes. Diabetes medications are also used to lower blood sugar. Taking zinc along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed. Monitor serum potassium and other electrolyte concentrations following changes in dosage or with concurrent illness or drug therapy. a b See Hyperkalemia under Cautions and also see Interactions. For the eating disorder anorexia nervosa: 100 mg of zinc gluconate daily. If your symptoms do not improve or if they become worse, check with your doctor. Significantly elevated serum uric acid, cholesterol, and triglyceride levels have been associated with combination hydrochlorothiazide-amiloride therapy. These metabolic abnormalities may not be due to amiloride since they are reported during hydrochlorothiazide monotherapy. If hyperkalemia occurs in patients taking Midamor, the drug should be discontinued immediately. About 50% of an oral dose is absorbed. Clinical studies of Midamor did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. Amiloride should rarely be used alone, because such use may result in increased risk of hyperkalemia. a b Use alone only when persistent hypokalemia has been documented. price pletal tablet
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Other reactions have been reported but occurred under circumstances where a causal relationship could not be established. However, in these rarely reported events, that possibility cannot be excluded. Therefore, these observations are listed to serve as alerting information to physicians. Anon. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Part II. Management of heart failure: approaches to the prevention of heart failure. Am J Cardiol. May be particularly useful for preventing diuretic-induced hypokalemia in patients in whom the clinical consequences of hypokalemia represent an important risk, such as patients receiving cardiac glycosides or those with cardiac arrhythmias. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Millar JA, Fraser R, Mason P, Leckie B, Cumming AM, Robertson JI "Metabolic effects of high dose amiloride and spironolactone: a comparative study in normal subjects. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of amiloride in the elderly. If you miss a dose of Midamor, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once. Do not keep outdated medicine or medicine no longer needed. Products meeting necessary bioequivalence requirements.
Hypochloremia usually does not require specific treatment except in patients with severe hepatic or renal disease. Administer orally, preferably with food to decrease GI adverse effects. Gastrointestinal complaints of diarrhea, nausea, constipation, anorexia, and general abdominal pain occur less than 5% of patients. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Your doctor may increase your dose if needed. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC 7. Bethesda, MD: National Institutes of Health; 2004 Aug. NIH publication No. 04-5230. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Hummel SL, Konerman MC. Dietary Sodium Restriction in Heart Failure: A Recommendation Worth its Salt? Minor adverse reactions were reported relatively frequently about 20% but the relationship of many of the reports to amiloride HCl is uncertain and the overall frequency was similar in hydrochlorothiazide treated groups. purchase cheap estreva shop australia
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. Monitor serum electrolyte, creatinine, and BUN periodically; some clinicians recommend weekly determinations during initiation of therapy. Wilson JR, Reichek N, Dunkman WB et al. Effect of diuresis on the performance of the failing left ventricle in man. Am J Med. In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, when Midamor and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained. Since indomethacin and potassium-sparing diuretics, including Midamor, may each be associated with increased serum potassium levels, the potential effects on potassium kinetics and renal function should be considered when these agents are administered concurrently. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. fmec.info nimodipine
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Studies suggest that this medication may alter milk production or composition. If an alternative to this medication is not prescribed, you should monitor the infant for side effects and adequate milk intake. Maximum 20 mg once daily. Diuretic activity usually occurs within 2 hours. MIDAMOR should be administered with food. Do not stop taking any medications without consulting your healthcare provider. Reevaluate need for amiloride therapy following initial diuresis with a kaliuretic diuretic, since potassium loss may decrease. a Subsequent dosage adjustment may be necessary, or amiloride may be used intermittently. American Heart Association Task Force on practice guidelines. Circulation. Safety and effectiveness in pediatric patients have not been established. Importance of taking drug with food to help avoid stomach upset. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Minor Be cautious with this combination. III to IV when used in addition to standard therapy.
Also useful in patients with hypokalemia who do not respond to potassium supplements or those who cannot tolerate potassium supplements. Initially, 5 mg daily; increase dosage as necessary to 10 mg daily. Amiloride is a type of diuretic water pill that helps prevent your body from losing too much potassium. Administer orally with food. Hyperkalemia has been associated with cardiac irregularities. a b ECG changes associated with hyperkalemia are mainly characterized by tall, peaked T waves or elevations since previous tracings. buy daflon store
Battle DC, von Riotte AB, Gaviria M et al. Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. N Engl J Med. Prophylaxis of hypokalemia in patients taking digitalis when other measures are considered inadequate or inappropriate. Does not competitively inhibit aldosterone; activity is independent of aldosterone concentrations. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; dry mouth; excessive thirst; slowed heart rate; unusual muscle weakness; unusual tiredness; vomiting. ST segment also may occur. a b ECG changes do not usually occur in patients who develop mild hyperkalemia during amiloride therapy. Exhibits weak natriuretic, diuretic, and hypotensive effects. Distributed into milk in animals; not known whether distributed into human milk. In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. Increase dosage as necessary up to a maximum of 20 mg once daily. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. To increase growth and weight gain in children with sickle cell disease who have not reached puberty: 10 mg elemental zinc per day. Dosages exceeding 10 mg daily usually are not necessary, and there is little controlled clinical experience with dosages exceeding 10 mg daily. insulin
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Patient advice: Advise patients to avoid potassium supplements and foods containing high levels of potassium, including salt substitutes. No data are available in regard to overdosage in humans. Use Midamor with caution in the ELDERLY; they may be more sensitive to its effects. Crosses the placenta in animals; not known whether crosses placenta in humans. price of vivitrol pills
Midamor should be administered with food. Appropriate studies have not been performed on the relationship of age to the effects of amiloride in the pediatric population. According to some clinicians, amiloride hydrochloride dosage should be reduced to the lowest effective level in any disease state, following initial diuresis with a kaliuretic diuretic. Take amiloride with food.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC VI. Bethesda, MD: National Institutes of Health. NIH publication No. 98-4080. Store at room temperature away from moisture, heat, or freezing temperatures. What happens if I miss a dose?
Co. Midamor amiloride hydrochloride tablets prescribing information. West Point, PA; 1992 Apr. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. BUN levels. Potassium retention associated with the use of an antikaliuretic agent is accentuated in the presence of renal impairment and may result in the rapid development of hyperkalemia. Not all side effects for Midamor may be reported. You should always consult a doctor or healthcare professional for medical advice. When amiloride HCl is administered concomitantly with an angiotensin-converting enzyme inhibitor, an angiotensin II receptor antagonist, cyclosporine or tacrolimus, the risk of hyperkalemia may be increased. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium.