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. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic. 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. combivent
Substantially eliminated by kidneys; assess renal function periodically since geriatric patients are more likely to have decreased renal function. This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using amiloride. You may need to stop taking amiloride at least 3 days before having a glucose tolerance test. Not all side effects for Midamor may be reported. You should always consult a doctor or healthcare professional for medical advice. The risk of hyperkalemia may be increased when potassium-conserving agents, including Midamor, are administered concomitantly with an angiotensin-converting enzyme inhibitor, an angiotensin II receptor antagonist, cyclosporine or tacrolimus.
Known hypersensitivity to amiloride or any ingredient in the formulation. Has been used to control hypertension and correct electrolyte abnormalities associated with primary hyperaldosteronism. According to some clinicians, maximum effective daily dosage may be as high as 40 mg daily. 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. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
Midamor should be administered with food. Store at room temperature away from moisture, heat, or freezing temperatures. What happens if I miss a dose? Are there any interactions with medications? Amiloride alone has mild hypotensive activity.
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. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. 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. Midamor, one 5 mg tablet daily, should be added to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. The dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets of Midamor daily 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. ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension ESH and of the European Society of Cardiology ESC. J Hypertens.
For muscle cramps in zinc deficient people with liver disease: zinc sulfate 220 mg twice daily. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Exclusivity is the sole marketing rights granted by the FDA to a manufacturer upon the approval of a drug and may run simultaneously with a patent. Exclusivity periods can run from 180 days to seven years depending upon the circumstance of the exclusivity grant. 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. 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. Ask your healthcare professional how you should dispose of any medicine you do not use. Increase dosage as necessary up to a maximum of 20 mg once daily. MIDAMOR should be administered with food. Store Midamor at room temperature, between 59 and 86 degrees F 15 and 30 degrees C in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Midamor out of the reach of children and away from pets. Duration of therapy: When given as the sole diuretic, continue the initial dose for at least 5 days, after which the initial dose may be adjusted to an optimal maintenance dose. 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. National high blood pressure education program working group on hypertension control in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. Some experts state that inclusion in combination drug regimens may be considered in patients with resistant hypertension. Duration of therapy: Treatment should be continued for at least 2 weeks to achieve a maximum response. Subsequently, the dose may be adjusted according to patient response. If your symptoms do not improve or if they become worse, check with your doctor. procardia
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Some medical conditions may interact with Midamor. Does not inhibit carbonic anhydrase and has no effect on free water clearance or concentrating mechanisms. If hypokalemia persists after an adequate trial of 10 mg daily may increase dosage to 15 and then 20 mg daily. Crosses the placenta in animals; not known whether crosses placenta in humans. For the long test, correction of hypokalemia and hypertension provides presumptive evidence of primary hyperaldosteronism. 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. The information contained in the Truven Health Micromedex products as delivered by Drugs. Patterson JH, Adams KF Jr, Applefeld MM et al. Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Pharmacotherapy. Exhibits potassium-sparing effect when used with kaliuretic diuretics. Amiloride is a type of diuretic water pill that helps prevent your body from losing too much potassium. Use Midamor with caution in the ELDERLY; they may be more sensitive to its effects. anot.info tolterodine
In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Increased BUN concentration may occur, most frequently during forced diuresis in debilitated patients with hepatic cirrhosis with ascites and metabolic alkalosis or in those with resistant edema. a b In such patients, monitor BUN concentration carefully when amiloride is used with other diuretics. AMILoride and ethanol may have additive effects in lowering your blood pressure. Long-term maintenance therapy for patients deemed unsuitable for surgery or those with idiopathic hyperaldosteronism. This may not be a complete list of all interactions that may occur. Ask your health care provider if Midamor may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Three-character codes are assigned only in situations when more than one reference listed drug of the same strength has been designated under the same heading. Two or more reference listed drugs are generally selected only when there are at least two potential reference drug products which are not bioequivalent to each other. If a study is submitted that demonstrates bioequivalence to a specific listed drug product, the generic product will be given the same three-character code as the reference listed drug it was compared against. 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. Not metabolized in the liver. Amiloride Midamor is used as a "water pill" to help remove excess water from the body. Another effect of amiloride Midamor is that it can increase the amount of zinc in the body. Taking zinc supplements with amiloride Midamor might cause you to have too much zinc in your body. Dosing considerations for Zinc. 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. Hyponatremia and hypochloremia may occur when Midamor is used with other diuretics and increases in BUN levels have been reported. These increases usually have accompanied vigorous fluid elimination, especially when diuretic therapy was used in seriously ill patients, such as those who had hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant edema. Therefore, when Midamor is given with other diuretics to such patients, careful monitoring of serum electrolytes and BUN levels is important. In patients with pre-existing severe liver disease, hepatic encephalopathy, manifested by tremors, confusion, and coma, and increased jaundice, have been reported in association with diuretics, including amiloride HCl. 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. The adverse reactions for Midamor listed in the following table have been arranged into two groups: 1 incidence greater than one percent; and 2 incidence one percent or less. The incidence for group 1 was determined from clinical studies conducted in the United States 837 patients treated with Midamor. The adverse effects listed in group 2 include reports from the same clinical studies and voluntary reports since marketing. The probability of a causal relationship exists between Midamor and these adverse reactions, some of which have been reported only rarely. Lithium generally should not be given with diuretics because they reduce its renal clearance and add a high risk of lithium toxicity. Read circulars for lithium preparations before use of such concomitant therapy. Initially, 5 mg daily; a b 524 increase dosage as necessary to 10 mg daily. sinemet kit price
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. 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. 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. Warning signs of hyperkalemia include paresthesias, muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, and shock. Midamor usually begins to act within 2 hours after an oral dose. Its effect on electrolyte excretion reaches a peak between 6 and 10 hours and lasts about 24 hours. Peak plasma levels are obtained in 3 to 4 hours and the plasma half-life varies from 6 to 9 hours. Available as amiloride hydrochloride; dosage expressed in terms of the salt. 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? Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus. Davidson C, Burkinshaw L, Morgan DB "The effects of potassium supplements, spironolactone or amiloride on the potassium status of patients with heart failure. 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. Contraindicated in patients with anuria, acute renal insufficiency, or significant impairment of renal excretory function. Initially, 5 mg daily; increase dosage as necessary to 10 mg daily. If hyperkalemia occurs in patients taking Midamor, the drug should be discontinued immediately. 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. AHFS Drug Information 2017. McEvoy GK, ed. Amiloride hydrochloride. 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.
To increase growth and weight gain in children with sickle cell disease who have not reached puberty: 10 mg elemental zinc per day. Midamor Amiloride HCl is available for oral use as tablets containing 5 mg of anhydrous amiloride HCl. Take amiloride with food. For treating attention deficit-hyperactivity disorder ADHD in children: doses of zinc sulfate 55 mg 15 mg elemental zinc to 150 mg 40 mg elemental zinc daily. Amiloride HCl was devoid of mutagenic activity in various strains of Salmonella typhimurium with or without a mammalian liver microsomal activation system Ames test. III to IV when used in addition to standard therapy. Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. For treating age-related macular degeneration AMD: elemental zinc 80 mg plus vitamin C 500 mg, vitamin E 400 IU, and beta-carotene 15 mg daily. Zinc might decrease how much antibiotic the body absorbs. Taking zinc along with some antibiotics might decrease the effectiveness of some antibiotics. To avoid this interaction, take antibiotics at least 2 hours before or 4-6 hours after zinc supplements. Major Do not take this combination. 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. 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. The presence of other medical problems may affect the use of this medicine. Hyperkalemia, b nausea, b vomiting, b diarrhea, b abdominal pain, b flatulence, b anorexia, b mild skin rash, b headache. Moderate Be cautious with this combination. purchase genuine prozac online
Used concomitantly with a thiazide diuretic mainly to prevent or treat diuretic-induced hypokalemia. a b See Hypokalemia Induced by Kaliuretic Diuretics under Uses. Hummel SL, Konerman MC. Dietary Sodium Restriction in Heart Failure: A Recommendation Worth its Salt? 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. Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. 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. Distributed into milk in animals. a b c Discontinue nursing or the drug. 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. Metabolic side effects are the most common. Amiloride may cause hyperkalemia in up to 10% of patients, although the risk is decreased to about 1% to 2% when thiazide or loop diuretics are coadministered. Patients with diabetes or who are on other potassium-sparing therapy, ACE inhibitors, or potassium supplementation are predisposed to amiloride-induced hyperkalemia. It is not known whether the drug is dialyzable. Effect on urinary electrolyte excretion persists for about 24 hours. 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. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Appropriate studies have not been performed on the relationship of age to the effects of amiloride in the pediatric population. Your doctor may increase your dose if needed. leflunomide money order now canada
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. Distributed into milk in animals; not known whether distributed into human milk. MIDAMOR, one 5 mg tablet daily, should be added to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. The dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets of MIDAMOR daily 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. Administer orally, preferably with food to decrease GI adverse effects. Midamor should not be given to patients receiving other potassium-conserving agents, such as spironolactone or triamterene. About 50% of an oral dose is absorbed. Maximum 20 mg once daily. When abnormal, the ECG in hyperkalemia is characterized primarily by tall, peaked T waves or elevations from previous tracings. There may also be lowering of the R wave and increased depth of the S wave, widening and even disappearance of the P wave, progressive widening of the QRS complex, prolongation of the PR interval, and ST depression. Also useful in patients with hypokalemia who do not respond to potassium supplements or those who cannot tolerate potassium supplements. Exerts potassium-sparing effect by decreasing sodium reabsorption in the distal tubule and reducing both potassium and hydrogen secretion and subsequent excretion. The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and Drugs. L may occur with all potassium-sparing agents, including amiloride. a b c See Boxed Warning. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension. Safety and efficacy have not been established in patients younger than 18 years. 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. For the short test, increased serum potassium with this drug and a decrease upon discontinuation provide presumptive evidence of primary hyperaldosteronism. zyrtec
Ask your health care provider any questions you may have about how to use Midamor. Treatment of edematous conditions in patients with nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Drugs. 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. 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. While using amiloride, you will need frequent blood tests. Your heart function may need to be checked using an electrocardiograph or ECG sometimes called an EKG. 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. 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. The dose of this drug should remain unchanged if a second diuretic is added. Maximum 20 mg daily recommended by some experts. Midamor is not an aldosterone antagonist and its effects are seen even in the absence of aldosterone. Importance of taking drug with food to help avoid stomach upset.
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Patient advice: Advise patients to avoid potassium supplements and foods containing high levels of potassium, including salt substitutes. Reactions occurring in 3% to 8% of patients treated with Midamor. Those reactions occurring in less than 3% of the patients are unmarked. Tarssanen L, Huikko M, Rossi M "Amiloride-induced hyponatremia. desvenlafaxine stock purchase program
The use of potassium-conserving agents is often unnecessary in patients receiving diuretics for uncomplicated essential hypertension when such patients have a normal diet. Midamor has little additive diuretic or antihypertensive effect when added to a thiazide diuretic. Potassium-sparing effect of amiloride is additive with that of spironolactone. a May be effective in some patients unresponsive to spironolactone; unlike spironolactone, diuretic effect of amiloride is independent of aldosterone concentrations. If hyperkalemia occurs, discontinue amiloride immediately. 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.
Monitor serum electrolyte and BUN concentrations closely in patients with hepatic cirrhosis with ascites and metabolic alkalosis receiving amiloride in combination with other diuretics. 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. Safety and effectiveness in pediatric patients have not been established.
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. Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked and in patients who develop hypokalemia during hydrochlorothiazide monotherapy.