AmilorideAmiloride hydrochloride

About Amiloride

Amiloride reduces sodium reabsorption in the last parts of the kidney’s tubules, so the body keeps potassium; it is a weak diuretic compared with thiazides. The label approves it as an add-on to thiazides or other diuretics that make the body lose potassium, in congestive heart failure or high blood pressure, to restore normal potassium in people who develop low potassium on those diuretics, or to prevent it in people for whom low potassium would be especially risky; it should rarely be used alone. The dose is one 5 mg tablet a day with food, added to the usual diuretic or blood pressure treatment, and it can be raised to 10 mg a day; if low potassium persists at 10 mg, it can go to 15 and then 20 mg with careful checks of electrolytes, though more than two tablets a day are usually not needed. It starts working within about 2 hours, and its effect lasts about 24 hours. Safety and effectiveness in children have not been established.

High potassium is the main danger: like other potassium-conserving drugs, amiloride can raise potassium above 5.5 mEq per liter, which can be fatal if not corrected. The risk is higher when amiloride is taken without a potassium-losing diuretic, and in people with kidney impairment, diabetes or older age, so potassium is checked carefully, especially at the start, after dose changes and during any illness that affects the kidneys, and amiloride is stopped at once if potassium rises too high. It must not be taken when potassium is already high; with other potassium-conserving drugs; with potassium supplements, potassium salt substitutes or a potassium-rich diet, except in severe or hard-to-treat low potassium; or with absent urine output, acute or chronic kidney insufficiency, or diabetic kidney disease. Nausea, loss of appetite, stomach pain, gas and mild rash are probably caused by it, and minor side effects are reported fairly often.

In diabetes it is avoided if possible, and it is stopped at least 3 days before a glucose tolerance test; acidosis can also bring rapid rises in potassium. The combination with hydrochlorothiazide, a 5 mg/50 mg tablet, is for high blood pressure or heart failure in people who develop low potassium on a thiazide alone or in whom normal potassium is clinically important, such as people taking digitalis or with significant heart rhythm problems; it is not for starting treatment unless low potassium cannot be risked. It is taken as one tablet a day with food, rising to two if needed. Its label opens with the same potassium warning, and the hydrochlorothiazide adds an allergy contraindication for sulfonamide-derived drugs, possible gout and lupus flares, and advice to protect the skin from the sun and have regular skin cancer screening.

Taking Amiloride

How to take it

Once a day with food, at about the same time each day; MedlinePlus says the combination is usually taken in the morning. Do not stop taking it without talking to the prescriber, even if you feel well, and keep appointments for potassium checks.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

In the original container, tightly closed, at room temperature away from heat and moisture (not in the bathroom), out of reach of children; do not freeze it. Use a take-back program rather than flushing.

Interactions to know about

ACE inhibitors, ARBs, cyclosporine and tacrolimus raise the risk of high potassium, and potassium supplements, potassium salt substitutes and other potassium-sparing diuretics are avoided. Ibuprofen, naproxen and other NSAIDs can weaken its effect, and indomethacin can also raise potassium; lithium is generally not given with diuretics.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Amiloride differs from pharmacy to pharmacy

Generic amiloride comes from only a few makers, so it is not on every flat-price generic list, and a pharmacy that fills it rarely may need to order it in and may price it as a slow-moving item.

Amiloride alone and the combination with hydrochlorothiazide are separate products, so a pharmacy fills the one written. Amiloride with a separate hydrochlorothiazide tablet is two fills, each with its own dispensing fee, while the combination is one.

Ways to pay less for Amiloride without insurance

• Ask for the generic, and compare more than one pharmacy.
• Once your dose and potassium are stable, ask for a ninety-day supply.
• If you take amiloride with a separate hydrochlorothiazide tablet, ask the prescriber whether the combination tablet would suit you, so there is one fill instead of two.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Amiloride

1. 1.When will my potassium and kidney function be checked?
2. 2.Which salt substitutes, potassium supplements and potassium-rich foods should I avoid or limit?
3. 3.Is it safe with my ACE inhibitor, ARB, lithium or anti-inflammatory painkiller?
4. 4.I have diabetes; is amiloride safe for me, and should I stop it before a glucose test?

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