amiloride hydrochloride + bumetanide: clinical use

Prescribing considerations

• Assess fluid status, blood pressure, renal and hepatic function, electrolytes, diabetes, gout and urinary outflow symptoms before and during treatment.
• Monitor for both hyperkalaemia and hypokalaemia.
• Use particular caution with hypotension, hepatic impairment, porphyria, diabetes, gout, impaired micturition and concurrent nephrotoxic or ototoxic treatment.

Contraindications and cautions

• Hyperkalaemia, severe electrolyte imbalance, anuria, acute renal insufficiency or severe progressive renal disease.
• Severe liver disease, hepatic coma or precomatose cirrhotic states.
• Addison’s disease.
• Hypersensitivity to either active ingredient or an excipient.
• Concurrent potassium supplements or other potassium-sparing agents.
• Use in children and adolescents under 18 years.

Monitoring

• Fluid balance, oedema, body weight and symptoms of over-diuresis.
• Blood pressure and postural symptoms.
• Serum potassium, sodium and other electrolytes, urea and renal function.
• Glucose control in diabetes and uric acid or gout symptoms where relevant.
• Hearing when clinically indicated, particularly with other ototoxic medicines.

Clinical pharmacology

Bumetanide is a loop diuretic acting mainly in the ascending limb of the loop of Henle. Amiloride inhibits epithelial sodium channels in the distal nephron, reducing potassium secretion and adding mild natriuresis.

Formulation and product differences

• Fixed-combination oral tablet containing lactose monohydrate.
• Cream, oval tablet marked “149”; the score line is not intended for breaking.
• Available in blister packs and bottles; not all pack sizes may be marketed.
• No special storage conditions are specified.

Tablet

Route: Oral

Strengths: 1 mg + 5 mg