amiloride hydrochloride dihydrate + furosemide: clinical use

Prescribing considerations

• Confirm that prompt diuresis is required and potassium conservation is clinically important.
• Assess volume status, blood pressure, renal and hepatic function, urinary outflow, diabetes and gout before treatment.
• Review prescribed, non-prescription and complementary products for potassium, renal, ototoxic and hypotensive interactions.
• The selected product is not established for people under 18 years.

Contraindications and cautions

• Hypersensitivity to either active substance, listed excipients, sulfonamides or sulfonamide derivatives
• Hypovolaemia or dehydration
• Severe renal impairment specified by the product licence, anuria or relevant forms of renal failure
• Hyperkalaemia, severe hypokalaemia or severe hyponatraemia
• Concurrent potassium supplements or another potassium-sparing diuretic
• Addison's disease
• Precomatose states associated with cirrhosis
• Breastfeeding

Monitoring

• Check blood pressure, serum electrolytes and renal function before treatment and during therapy.
• Monitor potassium particularly closely in renal impairment or with medicines that can increase potassium.
• Increase monitoring after clinically important fluid loss, including vomiting or diarrhoea.
• Assess for urinary retention in people with impaired urinary outflow.

Clinical pharmacology

Furosemide inhibits electrolyte reabsorption in the thick ascending loop of Henle. Amiloride acts mainly in the distal renal tubule, increasing sodium excretion while reducing potassium excretion.

Formulation and product differences

• The selected formulation contains lactose and sunset yellow, which may cause allergic reactions.
• Its sodium content is regarded as essentially sodium-free.

Tablet

Route: Oral

Strengths: 2.5 mg + 20 mg, 5 mg + 40 mg