Amiloride
Mechanism :
Amiloride is a potassium-conserving drug that possesses weak natriuretic, diuretic and antihypertensive activity. Co-administration with a thiazide or loop diuretic, decreases the urinary excretion of magnesium which occurs when a thiazide or loop diuretic is used alone. Amiloride has potassium-conserving activity in patients receiving kaliuretic-diuretic agents.
Indication :
- Hypokalemia when thiazides or other kaliuretic diuretics are used
- Nephrogenic diabetes insipidus
- Hypertension (off-label)
Contraindications :
Hyperkalemia
Antikaliuretic Therapy or Potassium Supplementation
Nephrogenic diabetes insipidus in infants
Dosing :
Safety and efficacy for use in pediatric patients has not yet been established.0.625 mg/kg PO given once daily; gradually dose can be increased. Maximum dosage: 20 mg/day.
0.3 mg/kg/day in divided doses 3 times daily.
Adverse Effect :
Hyperkalemia, nausea, anorexia, abdominal pain, flatulence, diarrhea, constipation, appetite changes, muscle cramps, dizziness, encephalopathy, cough, dyspnea.
Interaction :
Angiotensin-converting enzyme inhibitor: Risk of hyperkalemia may be increased.
Lithium: Reduce its renal clearance and add a high risk of lithium toxicity.
NSAIDS: Reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
20-50 | Use 50% of dose |
10-20 | Use 50% of dose |
<10 | Avoid |
Dose in Patients undergoing Renal Replacement Therapies
CAPD | Not applicable. Avoid |
HD | Not applicable. Avoid |
HDF/High flux | Not applicable. Avoid |
CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
No dosage adjustments are recommended. Diuretics should be used with caution in patients with liver disease since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.