Meds and you

27 September 2013

The combination of hydrochlorothiazide and amiloride

The combination of hydrochlorothiazide and amiloride is a diuretic. Diuretics are drugs that increase the production of urine, thereby removing excess water from the body.

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The combination of hydrochlorothiazide and amiloride is the active ingredient of Moderate, Adco-Retic (Nappi Code: 780618-009/017), Amiloretic (Nappi Code: 702803-006/014/022), Betaretic (Nappi Code: 808695-029), Moduretic (Nappi Code: 744379-008/016) and Sandoz Co-Amilozide (Nappi Code: 702951-005).

General information
The combination of hydrochlorothiazide and amiloride is a diuretic. Diuretics are drugs that increase the production of urine, thereby removing excess water from the body.

In South Africa the combination is registered for the treatment of oedema - an accumulation of excessive amounts of fluid in body tissue resulting in swelling - that results from conditions such as congestive heart failure and kidney or liver disorders. It is also used for the treatment of mild to moderately high blood pressure, and to treat congestive heart failure, a condition where the heart battles to cope with its workload, and mild to moderately high blood pressure.

It is not a cure for high blood pressure, but is effective in keeping it under control. For it to be effective you must take it regularly. High blood pressure declines slowly and it may take a few weeks for this drug to reach its full effect. Keep taking this medicine during this period, even if you are feeling better or fail to notice any improvement.

The first couple of doses of this medication may cause a sudden drop in blood pressure, which may cause dizziness or blackouts when you suddenly get up. It is therefore advised to be resting when starting treatment and to lie down for 2 hours afterwards.

This combination can be used on its own in treating mild cases of high blood pressure, or in combination with other medicines when high blood pressure is more severe.

The diuretic should best be taken in the morning to prevent additional night-time visits to the toilet. It is possible that you may produce a larger volume of urine at the start of treatment with the combination of hydrochlorothiazide and amiloride. Be aware of where your nearest ablution facilities are if you are away from home!

Some diuretics such as hydrochlorothiazide enhance the excretion of potassium from your body, while others, such as amiloride, don’t have this effect (and is therefore called a potassium-sparing diuretic). This combination finds a balance between the two types of diuretics, keeping side-effects to a minimum.

How does this combination work?
A diuretic such as the combination of hydrochlorothiazide and amiloride reduces the overall fluid volume in the body, thereby reducing pressure within blood vessels.

Fast facts

Drug schedule: schedule 3
Available as: this combination is available as tablets.
What does it do? This drug lowers blood pressure and reduces fluid volume in the body.
Overdose risk: low
Dependence risk: low
Is this combination available as a generic? yes
Is this combination available on prescription only? yes

User information

Stopping this medicine: it may be dangerous to discontinue this drug abruptly as symptoms of the condition being treated may recur. Don't discontinue this drug without speaking to your doctor.
Prolonged use: prolonged use may result in an electrolyte disturbance. Kidney function may also need to be evaluated periodically.

Special precautions
Consult your doctor before using this drug if:

 

  • you have kidney or liver disease
  • you have known low blood levels of potassium or high blood levels of calcium, or if you are taking a potassium supplement
  • you have gout
  • you have diabetes
  • you have Addison's disease
  • you have systemic lupus erythematosus
  • you are taking other medication

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant.
Breastfeeding: avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.
Porphyria: this medication is safe for use.
Infants and children: safety and efficacy of this medication has not been established for children. If used in children the dose must be determined by a paediatrician.
The elderly: caution is advised in the elderly as adverse effects may be more likely.
Driving and hazardous work: caution is advised as use of this medication may lead to dizziness and light-headedness. Avoid such activities until you know how this medication affects you.
Alcohol: avoid concomitant use of alcohol with this medication.

Possible side effects

 

Side Effect
Frequency
Consult your doctor
 
Common
Rare
Only if severe
In all cases
muscle cramps or pain
X
 
X
 
palpitations
 
X
 
X
weakness
 
X
 
X
dizziness
 
X
X
 
nausea
X
 
X
 
reduced appetite
 
X
X
 
stomach cramps
 
X
X
 
flatulence
 
X
X
 
headache
 
X
X
 
thirst/dry mouth
X
 
X
 
constipation
 
X
X
 
loss of appetite
 
X
X
 
erectile dysfunction
 
X
X
 
gout
 
X
X
 
increased blood sugar
 
X
X
 
skin rash/itch
 
X
 
X
visual disturbances
 
X
 
X
swelling of mouth/difficulty breathing
 
X
 
X
unusual bleeding and bruising
 
X
 
X

Interactions

Drug interactions

 

ACE inhibitor drugs increased dizziness at start of treatment
alcohol, barbiturates increased dizziness at start of treatment
allopurinol, tetracycline antibiotics increased risk of hydrochlorothiazide toxicity
cholestyramine reduced absorption of this diuretic
corticosteroids reduced diuretic effect/risk of potassium depletion
digoxin increased risk of toxicity in case of potassium depletion
terfenadine, sotalol, pimozide risk of heart rhythm disturbance
lithium risk of lithium toxicity
Non-steroidal anti-inflammatory drugs reduced diuretic effect/ increased risk of kidney damage
oral anti-diabetic drugs blood sugar lowering effect may be reduced
co-trimoxazole, trimethoprim reduced sodium levels in body
vitamin D increased risk of high calcium blood levels

Disease interactions
Consult your doctor before using this drug if you have kidney or liver disease, gout, diabetes, Addison’s disease or if you have systemic lupus erythematosus.

Overdose action
A small overdose is no cause for concern. In case of intentional large overdose seek emergency medical attention.

Recommended dosage
See dosage for each individual agent.

 

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.
 
 

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