Cases of severe hyponatremia have been reported during hydrochlorothiazide-amiloride the active ingredient contained in Midamor therapy. In 3 cases, the patients subsequently did well with hydrochlorothiazide and potassium supplementation, suggesting a significant role for amiloride in the development of their hyponatremia. Treatment of patients with hypokalemia when other measures are considered inappropriate or inadequate. Co. Midamor amiloride hydrochloride tablets prescribing information. West Point, PA; 1992 Apr.
The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. Some MEDICINES MAY INTERACT with Midamor. Administer orally, preferably with food to decrease GI adverse effects. Has been used to correct the metabolic alkalosis produced by thiazides and other kaliuretic diuretics.
Maximum 20 mg once daily. Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? For the long test, correction of hypokalemia and hypertension provides presumptive evidence of primary hyperaldosteronism. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; dry mouth; excessive thirst; slowed heart rate; unusual muscle weakness; unusual tiredness; vomiting. Significantly elevated serum uric acid, cholesterol, and triglyceride levels have been associated with combination hydrochlorothiazide-amiloride therapy. These metabolic abnormalities may not be due to amiloride since they are reported during hydrochlorothiazide monotherapy.
Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. For the short test, increased serum potassium with this drug and a decrease upon discontinuation provide presumptive evidence of primary hyperaldosteronism. When amiloride HCl is administered concomitantly with an angiotensin-converting enzyme inhibitor, an angiotensin II receptor antagonist, cyclosporine or tacrolimus, the risk of hyperkalemia may be increased. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium.
In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. Diuretic activity usually occurs within 2 hours. Monitor serum electrolyte and BUN concentrations closely in patients with hepatic cirrhosis with ascites and metabolic alkalosis receiving amiloride in combination with other diuretics. May be particularly useful for preventing diuretic-induced hypokalemia in patients in whom the clinical consequences of hypokalemia represent an important risk, such as patients receiving cardiac glycosides or those with cardiac arrhythmias. Hyperkalemia occurs commonly about 10% when amiloride is used without a kaliuretic diuretic. This incidence is greater in patients with renal impairment, diabetes mellitus with or without recognized renal insufficiency and in the elderly. When Midamor is used concomitantly with a thiazide diuretic in patients without these complications, the risk of hyperkalemia is reduced to about 1-2 percent. It is thus essential to monitor serum potassium levels carefully in any patient receiving amiloride, particularly when it is first introduced, at the time of diuretic dosage adjustments, and during any illness that could affect renal function. Monitor serum potassium and other electrolyte concentrations following changes in dosage or with concurrent illness or drug therapy. a b See Hyperkalemia under Cautions and also see Interactions. Inc. Midamor amiloride HCl tablets prescribing information. Whitehouse Station, NJ; 2002 Nov.
Consult WARNINGS section for additional precautions. Disclaimer: Every effort has been made to ensure that the information provided by Multum, Truven Health Analytics, Inc. Millar JA, Fraser R, Mason P, Leckie B, Cumming AM, Robertson JI "Metabolic effects of high dose amiloride and spironolactone: a comparative study in normal subjects. Hypochloremia usually does not require specific treatment except in patients with severe hepatic or renal disease. Battle DC, von Riotte AB, Gaviria M et al. Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. N Engl J Med. Antikaliuretic therapy should be instituted only with caution in severely ill patients in whom respiratory or metabolic acidosis may occur, such as patients with cardiopulmonary disease or poorly controlled diabetes. If Midamor is given to these patients, frequent monitoring of acid-base balance is necessary. III to IV when used in addition to standard therapy. Midamor usually begins to act within 2 hours after an oral dose. Its effect on electrolyte excretion reaches a peak between 6 and 10 hours and lasts about 24 hours. Peak plasma levels are obtained in 3 to 4 hours and the plasma half-life varies from 6 to 9 hours. To increase growth and weight gain in children with sickle cell disease who have not reached puberty: 10 mg elemental zinc per day. Some of the side effects that can occur with amiloride may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If hypokalemia persists after an adequate trial of 10 mg daily may increase dosage to 15 and then 20 mg daily. Long-term maintenance therapy for patients deemed unsuitable for surgery or those with idiopathic hyperaldosteronism. For hypogeusia sense of taste is abnormal: 25-100 mg zinc. Patients with persistent hyperkalemia may require dialysis.
Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension. Anon. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Part II. Management of heart failure: approaches to the prevention of heart failure. Am J Cardiol. Potassium-sparing effect of amiloride generally persists during prolonged therapy with the drug, but may diminish with time in some patients. Hummel SL, Konerman MC. Dietary Sodium Restriction in Heart Failure: A Recommendation Worth its Salt? Midamor is a potassium-conserving antikaliuretic drug that possesses weak compared with thiazide diuretics natriuretic, diuretic, and antihypertensive activity. These effects have been partially additive to the effects of thiazide diuretics in some clinical studies. When administered with a thiazide or loop diuretic, Midamor has been shown to decrease the enhanced urinary excretion of magnesium which occurs when a thiazide or loop diuretic is used alone. Midamor has potassium-conserving activity in patients receiving kaliuretic-diuretic agents.
Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Penicillamine is used for Wilson's disease and rheumatoid arthritis. Zinc might decrease how much penicillamine your body absorbs and decrease the effectiveness of penicillamine. Take zinc and penicillamine at least 2 hours apart. Use Midamor as directed by your doctor. Check the label on the medicine for exact dosing instructions. Treatment of edematous conditions in patients with nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Teratogenicity studies with amiloride HCl in rabbits and mice given 20 and 25 times the maximum human dose, respectively, revealed no evidence of harm to the fetus, although studies showed that the drug crossed the placenta in modest amounts. Reproduction studies in rats at 20 times the expected maximum daily dose for humans showed no evidence of impaired fertility. At approximately 5 or more times the expected maximum daily dose for humans, some toxicity was seen in adult rats and rabbits and a decrease in rat pup growth and survival occurred. Drinking alcohol with this medicine can cause side effects.
Exhibits potassium-sparing effect when used with kaliuretic diuretics. Are there any interactions with medications? How should I take Midamor amiloride? Cisplatin -AQ is used to treat cancer. Taking zinc along with EDTA and cisplatin Platinol-AQ might inactivate cisplatin Platinol-AQ therapy. It is not known for sure, though, if the amount of interference caused by zinc is significant. Midamor should not be given to patients receiving other potassium-conserving agents, such as spironolactone or triamterene. For muscle cramps in zinc deficient people with liver disease: zinc sulfate 220 mg twice daily. Substantially eliminated by kidneys; assess renal function periodically since geriatric patients are more likely to have decreased renal function. Food decreases the extent of GI absorption to about 30%, but does not affect the rate of absorption. Nervous system side effects occur in less than 3% of patients, and include headache, weakness, and fatigue. Encephalopathy may be induced by amiloride-associated metabolic changes in some patients with severe liver disease. Your doctor may increase your dose if needed. This may not be a complete list of all interactions that may occur. Ask your health care provider if Midamor may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Midamor should be administered with food. If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily. Known hypersensitivity to amiloride or any ingredient in the formulation. The information contained in the Truven Health Micromedex products as delivered by Drugs. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy.
L may occur with all potassium-sparing agents, including amiloride. a b c See Boxed Warning. For treating stomach ulcers: zinc sulfate 200 mg three times daily. The presence of other medical problems may affect the use of this medicine. Potassium-sparing effect of amiloride is additive with that of spironolactone. a May be effective in some patients unresponsive to spironolactone; unlike spironolactone, diuretic effect of amiloride is independent of aldosterone concentrations. In diabetic patients, hyperkalemia has been reported with the use of all potassium-conserving diuretics, including Midamor, even in patients without evidence of diabetic nephropathy. Therefore, Midamor should be avoided, if possible, in diabetic patients and, if it is used, serum electrolytes and renal function must be monitored frequently. Use appropriate replacement therapy in those who are sodium depleted. a Use water restriction rather than replacement of sodium chloride in edematous patients with dilutional hyponatremia during hot weather, except in rare instances when hyponatremia is life-threatening. Anuria, acute or chronic renal insufficiency, and evidence of diabetic nephropathy are contraindications to the use of Midamor. While using amiloride, you will need frequent blood tests. Your heart function may need to be checked using an electrocardiograph or ECG sometimes called an EKG.
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Ask your healthcare professional how you should dispose of any medicine you do not use. About 50% of an oral dose is absorbed. Safety and efficacy have not been established in patients younger than 18 years.
If your symptoms do not improve or if they become worse, check with your doctor. Does not appear to be diabetogenic or to alter carbohydrate metabolism in humans. Take Midamor by mouth with food. MIDAMOR, one 5 mg tablet daily, should be added to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. The dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets of MIDAMOR daily usually are not needed, and there is little controlled experience with such doses. If persistent hypokalemia is documented with 10 mg, the dose can be increased to 15 mg, then 20 mg, with careful monitoring of electrolytes.
If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily with careful monitoring of serum electrolytes. Minor adverse reactions were reported relatively frequently about 20% but the relationship of many of the reports to amiloride HCl is uncertain and the overall frequency was similar in hydrochlorothiazide treated groups. Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked and in patients who develop hypokalemia during hydrochlorothiazide monotherapy.
When abnormal, the ECG in hyperkalemia is characterized primarily by tall, peaked T waves or elevations from previous tracings. There may also be lowering of the R wave and increased depth of the S wave, widening and even disappearance of the P wave, progressive widening of the QRS complex, prolongation of the PR interval, and ST depression. For sickle cell disease: zinc sulfate 220 mg three times daily. For treating age-related macular degeneration AMD: elemental zinc 80 mg plus vitamin C 500 mg, vitamin E 400 IU, and beta-carotene 15 mg daily.