How does this medication work? What will it do for me?
This is a combination product containing 2 medications (amiloride and hydrochlorothiazide) that belong to the class of medications called diuretics. This combination medication is used to decrease edema (fluid retention) that occurs with congestive heart failure and certain liver disorders. It is also used to lower high blood pressure.
This medication works by causing the body to lose excess water and salt. One of the diuretics, amiloride, called a potassium-sparing diuretic, does not cause potassium to be lost from the body, while the other, hydrochlorothiazide, does cause potassium to be lost from the body. When used together, the loss of potassium from the body is minimized.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Apo-Amilzide is no longer being manufactured for sale in Canada. For brands that may still be available, search under amiloride - hydrochlorothiazide. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.
How should I use this medication?
The dose for each individual component (i.e., amiloride and hydrochlorothiazide) should be established before the combination medication is started.
The usual dose of amiloride - hydrochlorothiazide for high blood pressure or edema caused by heart disease is one or two tablets daily in one dose or in divided doses.
The usual dose of amiloride - hydrochlorothiazide for edema caused by liver disease is one tablet taken once daily.
If one dose is taken, it should be taken early in the day to avoid the need to visit the washroom during sleeping hours. This medication may be taken with or without food. Do not take more than four tablets daily.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not use amiloride - hydrochlorothiazide if you:
- are allergic to hydrochlorothiazide or amiloride or any ingredients of the medication
- are allergic to sulfa drugs (e.g., sulfamethoxazole)
- have increased blood potassium levels (hyperkalemia)
- are taking potassium supplements or other potassium-sparing diuretics (e.g., triamterene or spironolactone)
- are unable to urinate
- have acute kidney failure
- have severe or progressive kidney disease
- have diabetic kidney disease
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- changed sense of taste
- decreased interest in sexual activity
- dizziness or lightheadedness when getting up from a lying or sitting position
- dry mouth
- loss of appetite
- nasal congestion
- stomach cramps
- trouble sleeping
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- difficulty breathing
- increased frequency of infections
- increased skin sensitivity to the sun (e.g., severe sunburn, rash)
- irregular heart rhythm
- joint pain
- non-melanoma skin cancer (e.g., slowly changing discoloured patch on the skin; red, pink lumps on the skin; flat, scaly patches)
- signs of breathing problems (e.g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing)
- signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of kidney problems (e.g., decreased urine production, swelling, fatigue, abdominal pain)
- signs of liver problems (e.g., yellow skin or eyes, dark urine, loss of appetite, abdominal pain, fever, and fatigue)
- signs of changes in potassium:
- dryness of mouth
- increased thirst
- irregular heartbeat
- mood or mental changes
- muscle cramps or pain
- numbness or tingling in the hands, feet, or lips
- shortness of breath or difficulty breathing
- unusual tiredness or weakness
- weak pulse
- weakness or heaviness of the legs
- symptoms of glaucoma (e.g., blurred vision, seeing halos of bright colours around lights, red eyes, increased pressure in your eyes, eye pain or discomfort)
- symptoms of lupus (e.g., fever, general feeling of being unwell, joint pain, confusion, muscle aches, skin rash)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- chest pain
- signs of an allergic reaction (hives; difficulty breathing; swelling of the face, tongue, or throat)
- signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, vomiting blood or material that looks like coffee grounds)
- signs of blood vessel inflammation (e.g., fever, stomach pain, tingling hands or feet, swelling of the hands, feet, ankles)
- signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
- signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
January 31, 2019
Health Canada has issued new restrictions concerning the use of hydrochlorothiazide. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Allergy: Some people who are allergic to sulfa antibiotics or certain diabetes medications also experience allergic reactions to hydrochlorothiazide. Before you take amiloride – hydrochlorothiazide, inform your doctor about any previous adverse reactions you have had to medications, especially antibiotics. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.
Diabetes: Amiloride can affect kidney function, resulting in very high levels of potassium in the blood. Hydrochlorothiazide can cause a loss of blood sugar control. If you have diabetes, your doctor should closely monitor your condition while you are taking this medication, as it may affect blood sugar control. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Fluid and electrolyte balance: If you are taking amiloride – hydrochlorothiazide to treat symptoms of liver disease, it may cause the levels of electrolytes such as potassium, sodium, magnesium, chloride, and calcium in the blood to change while taking this medication. Symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, should be reported to your doctor as soon as possible. Your doctor will do blood tests regularly to monitor the levels of these electrolytes in your blood while you are taking this medication.
Gout and kidney stones: Hydrochlorothiazide may increase the level of uric acid in the body, resulting in symptoms of gout or kidney stone formation. If you develop painful, warm, and swollen joints or difficulty with urination, contact your doctor as soon as possible.
If you have a history of gout or kidney stones, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
High blood potassium: High blood potassium has been observed in some people who take amiloride either alone or with other diuretics (water pills). This happens mostly in seniors, in people with diabetes, and in people with liver or kidney disease. Warning signs or symptoms of high potassium include:
- irregular heartbeat
- numbness or tingling in hands, feet, or lips
- shortness of breath or difficulty breathing
- unusual tiredness or weakness
- weakness or heaviness of the legs
If you experience any of these symptoms, contact your doctor as soon as possible.
Sensitivity to sunlight: This medication may increase your skin's sensitivity to sunlight, increasing the risk of sunburn. Avoid exposure to sunlight for long periods of time, particularly between the hours of 10 am and 2 pm, while you are taking this medication and for 7 days after completing treatment. Wear a broad-spectrum sunscreen and lip balm with an SPF of 30 or greater. If you notice any unusual skin rash or peeling, contact your doctor immediately.
Skin cancer: Recent reviews have connected long-term use of hydrochlorthiazide with an increased risk of developing non-melanoma skin cancer. Talk to your doctor about any concerns you may have.
Systemic Lupus Erythematosus: People with Systemic Lupus Erythematosus (SLE or Lupus) may find that taking amiloride – hydrochlorothiazide causes the symptoms of SLE to flare up. If you have a history of SLE, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Vision changes: Hydrochlorothiazide occasionally causes vision changes including increased eye pressure (glaucoma) and myopia (nearsightedness). If you experience any eye symptoms, such as pain or change in vision, contact your doctor as soon as possible.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known whether amiloride passes into breast milk, but hydrochlorothiazide does. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children. This medication is not recommended for children.
What other drugs could interact with this medication?
There may be an interaction between amiloride - hydrochlorothiazide and any of the following:
- alpha agonists (e.g., clonidine, methyldopa)
- alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
- ammonium chloride
- amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
- angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
- angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
- antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
- antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
- barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
- beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
- beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- calcium supplements (e.g., calcium citrate, calcium carbonate)
- inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
- oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
- diabetes medications (e.g., chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
- other diuretics (water pills; e.g., furosemide, indapamide, spironolactone, triamterene)
- low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
- monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
- multivitamins with/without minerals
- narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
- nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
- phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
- potassium supplements (potassium citrate, potassium chloride, salt substitutes containing potassium)
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- sodium phosphates
- tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
- vitamin D (e.g., alfacalcidiol, calcitriol, cholecalciferol)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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