From the FDA Drug Label
WARNINGS Hyperkalemia Like other potassium-conserving agents, amiloride may cause hyperkalemia (serum potassium levels greater than 5. 5 mEq per liter) which, if uncorrected, is potentially fatal.
Diabetes Mellitus In diabetic patients, hyperkalemia has been reported with the use of all potassium-conserving diuretics, including amiloride HCl, even in patients without evidence of diabetic nephropathy.
The diuretic that does not induce gout is not directly mentioned in the provided drug label. However, amiloride is a potassium-conserving diuretic, and its use is associated with hyperkalemia rather than hypokalemia, which can contribute to gout.
- Amiloride may be considered as it does not cause hypokalemia, a common side effect of other diuretics that can induce gout 1.
From the Research
Potassium-sparing diuretics, such as spironolactone, eplerenone, amiloride, and triamterene, do not typically induce gout and are considered safer options for patients with a history of gout or hyperuricemia. These medications work by blocking sodium reabsorption in the distal tubule without affecting uric acid handling in the kidneys, unlike thiazide and loop diuretics which increase uric acid reabsorption in the proximal tubule leading to hyperuricemia 2, 3.
The most recent and highest quality study, a randomized clinical trial published in 2025, compared the efficacy of spironolactone and amiloride in patients with resistant hypertension, and found that amiloride was noninferior to spironolactone in lowering home-measured systolic blood pressure, with no cases of gynecomastia in either group 4.
Key characteristics of potassium-sparing diuretics include:
- Blocking sodium reabsorption in the distal tubule
- Not affecting uric acid handling in the kidneys
- Being safer options for patients with a history of gout or hyperuricemia
- Possibly being combined with a uric acid lowering therapy if needed for blood pressure management
If a patient requires diuretic therapy but has gout, a potassium-sparing diuretic would be the preferred choice. For patients who must use thiazide or loop diuretics despite gout risk, prophylactic allopurinol may be considered to prevent gout attacks, as supported by studies on gout management 5, 6.