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Drug Interactions between K-Lyte/Cl and Moduretic

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

aMILoride potassium chloride

Applies to: Moduretic (amiloride / hydrochlorothiazide) and K-Lyte / Cl (potassium bicarbonate / potassium chloride)

GENERALLY AVOID: The concomitant use of potassium-sparing diuretics and potassium preparations may result in hyperkalemia. Death has been reported.

MANAGEMENT: The use of potassium preparations in patients treated with potassium-sparing diuretics is generally not recommended. Caution is advised if coadministration is required, particularly in patients with renal impairment, diabetes, old age, worsening heart failure, and/or a risk for dehydration. Serum potassium and renal function should be checked regularly, and oral potassium supplementation should be avoided in patients with severe congestive heart failure who have serum potassium levels above 3.5 mEq/L. Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, and irregular heartbeat.

References

  1. Walmsley RN, White GH, Cain M, McCarthy PJ, Booth J "Hyperkalemia in the elderly." Clin Chem 30 (1984): 1409-12
  2. McNay JL, Oran E "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism 19 (1970): 58-70
  3. Ponce SP, Jennings AE, Madias NE, Harrington JT "Drug-induced hyperkalemia." Medicine (Baltimore) 64 (1985): 357-70
  4. O'Reilly MV, Murnaghan DP, Williams MB "Transvenous pacemaker failure induced by hyperkalemia." JAMA 228 (1974): 336-7
  5. Shapiro S, Slone D, Lewis GP, Jick H "Fatal drug reactions among medical inpatients." JAMA 216 (1971): 467-72
  6. Greenblatt DJ, Koch-Weser J "Adverse reactions to spironolactone: a report from the Boston Collaborative Drug Surveillance Program." JAMA 225 (1973): 40-3
  7. Lawson DH, O'Connor PC, Jick H "Drug attributed alterations in potassium handling in congestive cardiac failure." Eur J Clin Pharmacol 23 (1982): 21-5
  8. Mashford ML, Robertson MB "Spironolactone and ammonium and potassium chloride." Br Med J 4 (1972): 298-9
  9. "Product Information. Aldactone (spironolactone)." Searle PROD (2001):
  10. Lawson DH "Adverse reactions to potassium chloride." Q J Med 43 (1974): 433-40
  11. "Product Information. K-Dur (potassium chloride)." Schering Corporation PROD (2001):
  12. Walker BR, Hoppe RC, Alexander F "Effect of triamterene on the renal clearance of calcium, magnesium, phosphate, and uric acid in man." Clin Pharmacol Ther 13 (1972): 245-50
  13. Bozkurt B, Agoston I, Knowlton AA "Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines." J Am Coll Cardiol 41 (2003): 211-4
  14. Martin J, Mourton S, Nicholls G "Severe hyperkalaemia with prescription of potassium-retaining agents in an elderly patient." N Z Med J 116 (2003): U542
  15. Jarman PR, Mather HM "Diabetes may be independent risk factor for hyperkalaemia." BMJ 327 (2003): 812
  16. Svensson M, Gustafsson F, Galatius S, Hildebrandt PR, Atar D "Hyperkalaemia and impaired renal function in patients taking spironolactone for congestive heart failure: retrospective study." BMJ 327 (2003): 1141-2
  17. Masoudi FA, Gross CP, Wang Y, et al. "Adoption of spironolactone therapy for older patients with heart failure and left ventricular systolic dysfunction in the United States, 1998-2001." Circulation 112 (2005): 39-47
  18. Marcy TR, Ripley TL "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm 63 (2006): 49-58
  19. Perazella MA "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med 109 (2000): 307-14
  20. Berry C, McMurray JJ "Serious adverse events experienced by patients with chronic heart failure taking spironolactone." Heart 85 (2001): E8
  21. Jarman PR, Kehely AM, Mather HM "Hyperkalaemia in diabetes: prevalence and associations." Postgrad Med J 71 (1995): 551-2
  22. Perazella MA, Mahnensmith RL "Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis." J Gen Intern Med 12 (1997): 646-56
View all 22 references

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Major

aMILoride potassium bicarbonate

Applies to: Moduretic (amiloride / hydrochlorothiazide) and K-Lyte / Cl (potassium bicarbonate / potassium chloride)

GENERALLY AVOID: The concomitant use of potassium-sparing diuretics and potassium preparations may result in hyperkalemia. Death has been reported.

MANAGEMENT: The use of potassium preparations in patients treated with potassium-sparing diuretics is generally not recommended. Caution is advised if coadministration is required, particularly in patients with renal impairment, diabetes, old age, worsening heart failure, and/or a risk for dehydration. Serum potassium and renal function should be checked regularly, and oral potassium supplementation should be avoided in patients with severe congestive heart failure who have serum potassium levels above 3.5 mEq/L. Patients should be advised to seek medical attention if they experience signs and symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, and irregular heartbeat.

References

  1. Walmsley RN, White GH, Cain M, McCarthy PJ, Booth J "Hyperkalemia in the elderly." Clin Chem 30 (1984): 1409-12
  2. McNay JL, Oran E "Possible predisposition of diabetic patients to hyperkalemia following administration of potassium-retaining diuretic, amiloride (MK 870)." Metabolism 19 (1970): 58-70
  3. Ponce SP, Jennings AE, Madias NE, Harrington JT "Drug-induced hyperkalemia." Medicine (Baltimore) 64 (1985): 357-70
  4. O'Reilly MV, Murnaghan DP, Williams MB "Transvenous pacemaker failure induced by hyperkalemia." JAMA 228 (1974): 336-7
  5. Shapiro S, Slone D, Lewis GP, Jick H "Fatal drug reactions among medical inpatients." JAMA 216 (1971): 467-72
  6. Greenblatt DJ, Koch-Weser J "Adverse reactions to spironolactone: a report from the Boston Collaborative Drug Surveillance Program." JAMA 225 (1973): 40-3
  7. Lawson DH, O'Connor PC, Jick H "Drug attributed alterations in potassium handling in congestive cardiac failure." Eur J Clin Pharmacol 23 (1982): 21-5
  8. Mashford ML, Robertson MB "Spironolactone and ammonium and potassium chloride." Br Med J 4 (1972): 298-9
  9. "Product Information. Aldactone (spironolactone)." Searle PROD (2001):
  10. Lawson DH "Adverse reactions to potassium chloride." Q J Med 43 (1974): 433-40
  11. "Product Information. K-Dur (potassium chloride)." Schering Corporation PROD (2001):
  12. Walker BR, Hoppe RC, Alexander F "Effect of triamterene on the renal clearance of calcium, magnesium, phosphate, and uric acid in man." Clin Pharmacol Ther 13 (1972): 245-50
  13. Bozkurt B, Agoston I, Knowlton AA "Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines." J Am Coll Cardiol 41 (2003): 211-4
  14. Martin J, Mourton S, Nicholls G "Severe hyperkalaemia with prescription of potassium-retaining agents in an elderly patient." N Z Med J 116 (2003): U542
  15. Jarman PR, Mather HM "Diabetes may be independent risk factor for hyperkalaemia." BMJ 327 (2003): 812
  16. Svensson M, Gustafsson F, Galatius S, Hildebrandt PR, Atar D "Hyperkalaemia and impaired renal function in patients taking spironolactone for congestive heart failure: retrospective study." BMJ 327 (2003): 1141-2
  17. Masoudi FA, Gross CP, Wang Y, et al. "Adoption of spironolactone therapy for older patients with heart failure and left ventricular systolic dysfunction in the United States, 1998-2001." Circulation 112 (2005): 39-47
  18. Marcy TR, Ripley TL "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm 63 (2006): 49-58
  19. Perazella MA "Drug-induced hyperkalemia: old culprits and new offenders." Am J Med 109 (2000): 307-14
  20. Berry C, McMurray JJ "Serious adverse events experienced by patients with chronic heart failure taking spironolactone." Heart 85 (2001): E8
  21. Jarman PR, Kehely AM, Mather HM "Hyperkalaemia in diabetes: prevalence and associations." Postgrad Med J 71 (1995): 551-2
  22. Perazella MA, Mahnensmith RL "Hyperkalemia in the elderly: drugs exacerbate impaired potassium homeostasis." J Gen Intern Med 12 (1997): 646-56
View all 22 references

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Drug and food interactions

Moderate

aMILoride food

Applies to: Moduretic (amiloride / hydrochlorothiazide)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Moderate

hydroCHLOROthiazide food

Applies to: Moduretic (amiloride / hydrochlorothiazide)

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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