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Pronunciation:

(a MIL oh ride & hye droe klor oh THYE a zide)

U.S. Brand Names:

Moduretic® [DSC]

Synonyms:

Hydrochlorothiazide and Amiloride

Generic Available:

Yes

Canadian Brand Names:

Apo-Amilzide®; Moduret®; Moduretic®; Novamilor; Nu-Amilzide

Use:

Potassium-sparing diuretic; antihypertensive

Pregnancy Risk Factor:

Pregnancy Implications:

Refer to Hydrochlorothiazide monograph.

Lactation:

Excretion in breast milk unknown/contraindicated

Warnings/Precautions:

Amiloride: May cause hyperkalemia (patients with renal impairment, diabetes and the elderly are at greatest risk). Should be stopped at least 3 days before glucose tolerance testing. Use caution in severely ill patients in whom respiratory or metabolic acidosis may occur.

Hydrochlorothiazide: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Adverse Reactions:

See individual agents.

Drug Interactions:

See individual agents.

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Adults: Oral: Start with 1 tablet/day, then may be increased to 2 tablets/day if needed; usually given in a single dose

Dietary Considerations:

May be taken with food.

Patient Education:

See individual agents. Breast-feeding precaution: Do not breast-feed.

Nursing Implications:

Monitor blood pressure, serum electrolytes, renal function

Cardiovascular Considerations:

Amiloride may cause hyperkalemia, the ECG manifestations of which include peaked T waves, QRS prolongation, and cardiac conduction abnormalities. Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. The combination of amiloride and hydrochlorothiazide may act together to lower blood pressure and limit diuretic-induced changes in plasma potassium. The benefits of thiazide diuretics in the treatment of hypertension is established and compares well with other first-line therapeutic agents. agents.

Diuretics are standard therapy for the management of edema in patients with heart failure.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause drowsiness; rarely may cause insomnia and depression

Mental Health: Effects on Psychiatric Treatment:

May cause impotence and orthostatic hypotension which may be exacerbated by psychotropics; effective agent for the treatment of lithium induced diabetes insipidus

Dosage Forms:

Tablet: Amiloride hydrochloride 5 mg and hydrochlorothiazide 50 mg

International Brand Names:

Apo-Amilzide® (CA); Moduret® (CA); Moduretic® (CA); Novamilor (CA); Nu-Amilzide (CA)

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

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