amiloride hydrochloride anhydrous + furosemide: clinical use

Prescribing considerations

• Correct hypotension, hypovolaemia, dehydration and significant electrolyte or acid–base disturbances before treatment.
• Ensure urinary output; monitor closely where prostatic enlargement or another urinary outflow obstruction is possible.
• Use particular caution in older or seriously ill patients and in diabetes, gout, cirrhosis with renal impairment, hypoproteinaemia or systemic lupus erythematosus.
• Review interacting medicines and the risk of hyperkalaemia, renal impairment, hypotension and ototoxicity.

Contraindications and cautions

• Hypersensitivity to either active ingredient, sulfonamides, sulfonamide derivatives or product excipients
• Hypovolaemia or dehydration
• Creatinine clearance below 30 mL/min/1.73 m², anuria or specified severe renal-failure states
• Hyperkalaemia, severe hypokalaemia or severe hyponatraemia
• Concurrent potassium supplements or potassium-sparing diuretics
• Addison's disease, cirrhotic precoma, breastfeeding, and age under 18 years

Monitoring

• Assess blood pressure, volume status, sodium, potassium, creatinine and glucose.
• Increase potassium surveillance with renal impairment or medicines that raise potassium.
• Monitor for worsening renal function, symptomatic hypotension, dehydration, gout and glucose intolerance.
• If used during pregnancy for compelling reasons, monitor fetal growth.

Clinical pharmacology

Furosemide is a high-ceiling loop diuretic that increases urinary sodium, chloride and water loss. Amiloride acts mainly in the distal renal tubule, promoting sodium excretion while reducing potassium excretion; renal elimination is important for both components.

Formulation and product differences

• The selected product is a pale-orange film-coated tablet.
• It contains sunset yellow aluminium lake, which may cause allergic reactions, and quinoline yellow in the coating.
• Excipients and tablet appearance can differ between manufacturers; check the product-specific leaflet.