Amiloride HCl should be administered with food.
Amiloride HCl, 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
amiloride HCl 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
In treating patients with congestive heart failure after an initial diuresis has
been achieved, potassium loss may also decrease and the need for amiloride HCl
should be re-evaluated. Dosage adjustment may be necessary. Maintenance therapy
may be on an intermittent basis.
If it is necessary to use amiloride HCl alone, the starting dosage should be one
5 mg tablet daily. This dosage may be increased to 10 mg per day, if necessary.
More than two 5 mg tablets 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.
Impaired Renal Function
Anuria, acute or chronic renal insufficiency, and evidence of diabetic
nephropathy are contraindications to the use of amiloride HCl. Patients
with evidence of renal functional impairment (blood urea nitrogen [BUN]
levels over 30 mg per 100 mL or serum creatinine levels over 1.5 mg per
100 mL) or diabetes mellitus should not receive the drug without
careful, frequent and continuing monitoring of serum electrolytes,
creatinine, and BUN levels. Potassium retention associated with the use
of an antikaliuretic agent is accentuated in the presence of renal
impairment and may result in the rapid development of 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. 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 amiloride HCl 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.
National Institutes of Health, U.S. National Library of Medicine,
DailyMed Database. Provides access to the latest drug monographs submitted to the
Food and Drug Administration (FDA). Please review the latest applicable package insert for
additional information and possible updates. A local search
option of this data can be found here.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical
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