From the Guidelines
Amiloride is used as a potassium-sparing diuretic to treat conditions such as heart failure, hypertension, and edema, particularly in patients with hypokalemia or those at risk of developing hypokalemia.
Key Uses of Amiloride
- Treatment of edema associated with heart failure, cirrhosis, and nephrotic syndrome
- Management of hypertension, particularly in patients with hypokalemia or those at risk of developing hypokalemia
- Prevention of hypokalemia in patients taking loop or thiazide diuretics
Dosage and Administration
- Initial dose: 5 mg once daily, with a maximum dose of 20 mg daily 1
- Usual daily dose: 5-10 mg daily 1
Important Considerations
- Amiloride should not be combined with other potassium-sparing diuretics, such as spironolactone or triamterene, due to the increased risk of hyperkalemia 1
- Monitor serum potassium levels regularly, especially in patients with renal impairment or those taking other medications that can increase potassium levels 1
- Amiloride may be less effective than spironolactone in treating ascites in patients with liver cirrhosis, but it has fewer anti-androgenic side effects 1
From the FDA Drug Label
INDICATIONS AND USAGE Amiloride HCl is indicated as adjunctive treatment with thiazide diuretics or other kaliuretic-diuretic agents in congestive heart failure or hypertension to: a. help restore normal serum potassium levels in patients who develop hypokalemia on the kaliuretic diuretic b prevent development of hypokalemia in patients who would be exposed to particular risk if hypokalemia were to develop, e.g., digitalized patients or patients with significant cardiac arrhythmias.
The use of Amiloride is to help restore normal serum potassium levels and prevent development of hypokalemia in patients with congestive heart failure or hypertension, particularly those at risk of hypokalemia, such as digitalized patients or patients with significant cardiac arrhythmias 2.
- It is used as an adjunctive treatment with thiazide diuretics or other kaliuretic-diuretic agents.
- Amiloride should rarely be used alone due to its weak diuretic and antihypertensive effects and increased risk of hyperkalemia.
From the Research
Uses of Amiloride
- Amiloride is a potassium-sparing diuretic that is used to treat edematous states, hypertension, congestive heart failure, and hepatic cirrhosis with ascites 3, 4, 5, 6
- It is also used as a potassium-conserving agent in combination with thiazide or loop diuretics 4, 5, 6
- Amiloride has been shown to be effective in reducing the need for oral potassium supplements in peritoneal dialysis patients 7
- It has been used to treat resistant hypertension and has been shown to be as effective as spironolactone in this context 6
Mechanism of Action
- Amiloride works by blocking the epithelial sodium channel (ENaC) in the distal tubule of the kidney, which inhibits sodium-potassium exchange 3, 5, 6
- It also inhibits the Na(+)/H(+) exchangers (NHE) and the Na(+)/Ca(2+) exchangers at higher doses 3
Clinical Utility
- Amiloride has been shown to be well-tolerated and effective in maintaining normal serum potassium levels in peritoneal dialysis patients 7
- It has been used in combination with thiazide diuretics to counteract the adverse metabolic effects of the thiazides and has demonstrated convincing outcome benefits on stroke and coronary events 6