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Amiloride Hydrochloride

Pronunciation

Class: Potassium-sparing Diuretics
VA Class: CV704
CAS Number: 17440-83-4
Brands: Midamor, Moduretic

Warning(s)

  • Hyperkalemia (i.e., serum potassium concentrations >5.5 mEq/L) may occur with all potassium-sparing agents, including amiloride.a b c

  • Hyperkalemia occurs in about 10% of patients not receiving a kaliuretic diuretic and more frequently in patients with renal impairment or diabetes (even without evidence of renal impairment) and in geriatric patients.b In patients without the mentioned complications, incidence of hypercalcemia is reduced to 1–2% by concomitant use of amiloride with a thiazide diuretic.b

  • Uncorrected hyperkalemia may be fatal; monitor serum potassium concentrations carefully, especially during initial therapy or dosage adjustments, and in patients with concurrent illness that may affect renal function.a b c

Introduction

Potassium-sparing diuretic; pyrazinecarbonyl guanidine derivative.a b

Uses for Amiloride Hydrochloride

Amiloride should rarely be used alone, because such use may result in increased risk of hyperkalemia.a b Use alone only when persistent hypokalemia has been documented.b

Hypokalemia Induced by Kaliuretic Diuretics

Treatment or prevention of hypokalemia induced by thiazide or other kaliuretic diuretics in patients with CHF or hypertension.a b c

May be particularly useful for preventing diuretic-induced hypokalemia in patients in whom the clinical consequences of hypokalemia represent an important risk, such as patients receiving cardiac glycosides or those with cardiac arrhythmias.a b c

Also useful in patients with hypokalemia who do not respond to potassium supplements or those who cannot tolerate potassium supplements.a

Potassium-sparing effect of amiloride generally persists during prolonged therapy with the drug, but may diminish with time in some patients.a

Potassium-sparing effect of amiloride is additive with that of spironolactone.a May be effective in some patients unresponsive to spironolactone; unlike spironolactone, diuretic effect of amiloride is independent of aldosterone concentrations.a

Edema

Management of edema associated with CHF, cirrhosis of the liver, or secondary hyperaldosteronism.a

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Generally, use in combination with other more effective, rapidly acting diuretics, such as thiazides, chlorthalidone, or loop diuretics (e.g., furosemide), to decrease potassium excretion caused by kaliuretic diuretics.a b

Used in fixed combination with hydrochlorothiazide for treatment of edema in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked.c

CHF

In the management of edema associated with CHF, generally used in conjunction with other more effective, rapidly acting diuretics (e.g., thiazides, chlorthalidone, loop diuretics).a

Most experts state that all patients with symptomatic CHF who have evidence or a prior history of fluid retention generally should receive diuretic therapy in conjunction with moderate sodium restriction (≤3 g of sodium daily), an ACE inhibitor, and usually a β-adrenergic blocking agent, with or without a cardiac glycoside.a 103

Most experts state that the diuretics of choice for most patients with CHF are loop diuretics (e.g., bumetanide, ethacrynic acid, furosemide, torsemide).a

Do not use diuretics as monotherapy in CHF even if symptoms (e.g., peripheral edema, pulmonary congestion) are well controlled; diuretics alone do not prevent progression of heart failure.

Once fluid retention in CHF has resolved, diuretic therapy should be maintained to prevent its recurrence. Ideally, diuretic therapy should be adjusted according to changes in body weight (as an indicator of fluid retention) rather than maintained at a fixed dosage.

Diuretics should be continued in CHF and comorbid conditions (e.g., hypertension) where ongoing therapy with the drugs is indicated.

Hypertension

Amiloride alone has mild hypotensive activity. a b

In hypertensive patients, is used concomitantly with a thiazide diuretic mainly to prevent or treat diuretic-induced hypokalemia.a b (See Hypokalemia Induced by Kaliuretic Diuretics under Uses.)

The manufacturers state that amiloride produces little additive hypotensive activity when used concurrently with a thiazide diuretic.a b

JNC 7 recommends that thiazides be used as initial therapy for the treatment of uncomplicated hypertension in most patients, either alone or combined with other classes of antihypertensive drugs that have demonstrated benefit (e.g., ACE inhibitors, angiotensin II receptor antagonists, β-adrenergic blocking agents, calcium-channel blocking agents).

Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked.c

Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who develop hypokalemia during hydrochlorothiazide monotherapy.c

Use the amiloride/hydrochlorothiazide fixed combination alone or as an adjunct to other antihypertensive agents (e.g., methyldopa, β-adrenergic blocking agent).c

Hyperaldosteronism

Has been used to control hypertension and correct electrolyte abnormalities associated with primary hyperaldosteronism.a

Also has been used for the management of secondary hyperaldosteronism (Bartter’s syndrome) to correct hypokalemia.a

Diuretic-induced Metabolic Alkalosis

Has been used to correct the metabolic alkalosis produced by thiazides and other kaliuretic diuretics.a

Calcium Nephrolithiasis

Has been used in combination with hydrochlorothiazide in patients with recurrent calcium nephrolithiasis.a

Lithium-induced Polyuria

Has been used for the management of lithium-induced polyuria (secondary to lithium-induced nephrogenic diabetes insipidus).100 a (See Specific Drugs, Foods, and Laboratory Tests under Interactions.)

Amiloride Hydrochloride Dosage and Administration

General

  • Monitor serum potassium and other electrolyte concentrations following changes in dosage or with concurrent illness or drug therapy.a b (See Hyperkalemia under Cautions and also see Interactions.)

  • According to some clinicians, amiloride hydrochloride dosage should be reduced to the lowest effective level in any disease state, following initial diuresis with a kaliuretic diuretic.a

  • Do not use fixed-combination amiloride/hydrochlorothiazide tablets for initial therapy of edema or hypertension, except in patients in whom the clinical consequences of hypokalemia represent an important risk (e.g., patients receiving cardiac glycosides, patients with cardiac arrhythmias).a c Adjust dosage by administering each drug separately.a If the optimum maintenance dosage corresponds to the ratio in the commercial combination preparation, the fixed combination may be used.a If dosage adjustment is necessary, administer each drug separately.a

Administration

Oral Administration

Administer orally, preferably with food to decrease GI adverse effects.a b

Fixed-combination amiloride/hydrochlorothiazide tablets: Administer orally with food.c

Dosage

Available as amiloride hydrochloride; dosage expressed in terms of the salt.b c

Individualize dosage according to patient’s requirements and response.a

Pediatric Patients

Usual Dosage
Oral

A dosage of 0.625 mg/kg daily has been used in children weighing 6–20 kg.a

Hypertension
Oral

Initially, 0.4–0.625 mg/kg daily given once daily.111 a Increase dosage as necessary up to a maximum of 20 mg once daily.111 a

Adults

Hypokalemia Induced by Kaliuretic Diuretics in Patients with CHF
Combination Therapy
Oral

Usually combined with a kaliuretic diuretic (e.g., hydrochlorothiazide).a b

Initially, 5 mg daily.a b

Increase dosage as necessary to 10 mg daily.a b

If hypokalemia persists after an adequate trial of 10 mg daily may increase dosage to 15 and then 20 mg daily.a b

Dosages exceeding 10 mg daily usually are not necessary, and there is little controlled clinical experience with dosages exceeding 10 mg daily.a b

According to some clinicians, maximum effective daily dosage may be as high as 40 mg daily.a

Reevaluate need for amiloride therapy following initial diuresis with a kaliuretic diuretic, since potassium loss may decrease.a Subsequent dosage adjustment may be necessary, or amiloridemay be used intermittently.a b

Hypokalemia Induced by Kaliuretic Diuretics in Patients with Hypertension
Monotherapy
Oral

Use amiloride hydrochloride alone only if it is necessary.a b

Initially, 5 mg daily.a b

Increase dosage as necessary to 10 mg daily.a b

Titrate dosage carefully and monitor serum electrolytes closely because of increased risk of hyperkalemia with monotherapy.a

If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily.a b

Dosages exceeding 10 mg daily usually are not necessary, and there is little controlled clinical experience with dosages exceeding 10 mg daily.a b

According to some clinicians, maximum effective daily dosage may be as high as 40 mg daily.a

Combination Therapy
Oral

Usually combined with a kaliuretic diuretic (e.g., hydrochlorothiazide).a b

Initially, 5 mg daily.a b

Increase dosage as necessary to 10 mg daily.a b

If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily with careful monitoring of serum electrolytes.a b

Dosages exceeding 10 mg daily usually are not necessary, and there is little controlled clinical experience with dosages exceeding 10 mg daily.a b

In some patients, it may be beneficial to administer the usual 5- to 10-mg daily dosage in 2 divided doses daily.110

According to some clinicians, maximum effective daily dosage may be as high as 40 mg daily.a

The fixed combination preparation with hydrochlorothiazide may be used in selected patients in whom the potential development of thiazide-induced hypokalemia cannot be risked.a c (See General under Dosage and Administration.)

Lithium-induced Polyuria
Monotherapy
Oral

Dosages of 5–10 mg twice daily have been effective in the management of lithium-induced polyuria in adults.100 a (See Specific Drugs, Foods, and Laboratory Tests under Interactions.)

Prescribing Limits

Pediatric Patients

Hypertension
Oral

Maximum 20 mg once daily.111 a

Adults

Hypokalemia Induced by Kaliuretic Diuretics in Patients with CHF
Oral

Maximum 40 mg daily.a

Hypokalemia Induced by Kaliuretic Diuretics in Patients with Hypertension
Oral

Maximum 40 mg daily.a

Special Populations

Geriatric Patients

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.b

Cautions for Amiloride Hydrochloride

Contraindications

  • Anuria, acute or chronic renal insufficiency, diabetic nephropathy.a b

  • Preexisting hyperkalemia (≥5.5 mEq/L).b

  • Concurrent potassium supplementation (e.g., potassium salts, potassium-containing salt substitutes) except in severe and/or refractory hypokalemia when may be used with careful monitoring of serum potassium concentrations.a b (See Specific Drugs, Foods, and Laboratory Tests under Interactions.)

  • Concurrent therapy with potassium-sparing agents (e.g., spironolactone, triamterene).a b (See Specific Drugs, Foods, and Laboratory Tests under Interactions.)

  • Known hypersensitivity to amiloride or any ingredient in the formulation.a b c

Warnings/Precautions

Warnings

Hyperkalemia

Hyperkalemia (i.e., serum potassium concentrations >5.5 mEq/L) may occur with all potassium-sparing agents, including amiloride.a b c (See Boxed Warning.)

If hyperkalemia occurs, discontinue amiloride immediately.a b

Serum potassium concentrations >6.5 mEq/L require specific measures such as administration of sodium bicarbonate and/or oral or parenteral glucose with a rapid-acting insulin preparation to correct the hyperkalemia.a b If necessary, a cation exchange resin (e.g., sodium polystyrene sulfonate) may be administered orally or as a retention enema.b

Patients with persistent hyperkalemia may require dialysis.a b

Evaluate BUN and serum potassium and creatinine concentrations regularly, especially in patients with suspected or confirmed renal insufficiency.a b Monitor serum potassium concentrations closely in geriatric and diabetic patients.a b Avoid use in diabetic patients, if possible, because of the risk of hyperkalemia.a b

Warning signs of hyperkalemia include paresthesias, muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, and shock.a b

Hyperkalemia has been associated with cardiac irregularities.a b ECG changes associated with hyperkalemia are mainly characterized by tall, peaked T waves or elevations since previous tracings.a b Lowering of the R wave and increased depth of the S wave, widening or absence of the P wave, progressive widening of the QRS complex, prolongation of the PR interval, and/or depression of the ST segment also may occur.a b ECG changes do not usually occur in patients who develop mild hyperkalemia during amiloride therapy.a b

Metabolic or Respiratory Acidosis

Use with caution in patients with cardiopulmonary disease or uncontrolled diabetes mellitus because of risk of developing metabolic or respiratory acidosis, which may result in rapid increases in serum potassium concentration.a b Monitor acid-base balance frequently in such patients.a b

General Precautions

Use of Fixed Combinations

When amiloride is used in fixed combination with hydrochlorothiazide, consider the cautions, precautions, and contraindications associated with hydrochlorothiazide.c

Electrolyte Imbalance

Electrolyte disturbance (e.g., hyponatremia, hypochloremia) may occur when amiloride is used with other diuretics.a b

Hypochloremia usually does not require specific treatment except in patients with severe hepatic or renal disease.a

Use appropriate replacement therapy in those who are sodium depleted.a Use water restriction rather than replacement of sodium chloride in edematous patients with dilutional hyponatremia during hot weather, except in rare instances when hyponatremia is life-threatening.a

Despite amiloride’s potassium-sparing effect, hypokalemia may develop in patients receiving amiloride with other diuretics.a

Although amiloride usually prevents hypokalemia associated with thiazide diuretics, some clinicians (using the fixed-dose combination of amiloride and hydrochlorothiazide) have questioned whether 5 mg of amiloride hydrochloride is sufficient to counteract the potassium loss produced by 50 mg of hydrochlorothiazide.a

Renal Effects

Increased BUN concentration may occur, most frequently during forced diuresis in debilitated patients with hepatic cirrhosis with ascites and metabolic alkalosis or in those with resistant edema.a b In such patients, monitor BUN concentration carefully when amiloride is used with other diuretics.a b

Specific Populations

Pregnancy

Category B.b c

Lactation

Distributed into milk in animals.a b c Discontinue nursing or the drug.a b

Pediatric Use

Safety and efficacy of amiloride alone or in fixed combination with hydrochlorothiazide;a b c however, some experts have suggested an amiloride dosage for hypertension based on limited clinical experience.a (See Pediatric Patients under Dosage and Administration.)

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.b

Substantially eliminated by kidneys; assess renal function periodically since geriatric patients are more likely to have decreased renal function.b

Hepatic Impairment

Use with caution in patients with severe, preexisting hepatic insufficiency because of risk of hepatic encephalopathy; monitor such patients carefully for signs and symptoms of hepatic encephalopathy.a

Monitor serum electrolyte and BUN concentrations closely in patients with hepatic cirrhosis with ascites and metabolic alkalosis receiving amiloride in combination with other diuretics.a b

Renal Impairment

Use with caution in patients with impaired renal function (BUN concentration >30 mg/dL or Scr >1.5 mg/dL), because of risk of hyperkalemia.a b

Monitor serum electrolyte, creatinine, and BUN periodically; some clinicians recommend weekly determinations during initiation of therapy.a

Common Adverse Effects

Hyperkalemia,b nausea,b vomiting,b diarrhea,b abdominal pain,b flatulence,b anorexia,b mild skin rash,b headache.b

Interactions for Amiloride Hydrochloride

Specific Drugs, Foods, and Laboratory Tests

Drug, Food, or Test

Interaction

Comments

ACE inhibitors

Increased risk of hyperkalemiaa b

Use caution with concomitant ACE inhibitor therapy; monitor serum potassium concentrations frequentlya b

Risk of hyperkalemia may be increased in patients with renal impairmenta

Discontinue or reduce dosage of amiloride as necessary in patients receiving an ACE inhibitora

Angiotensin II receptor antagonists

Increased risk of hyperkalemiab

Use caution with concomitant angiotensin II receptor antagonist therapy; monitor serum potassium concentrations frequentlyb

Antihypertensive agents

Possible additive antihypertensive effectsa

Adjust amiloride dosage carefully when drug is added to an antihypertensive regimena

Cyclosporine

Increased risk of hyperkalemiab

Use caution with concomitant cyclosporine therapy; monitor serum potassium concentrations frequentlyb

Digoxin

Possible alteration of response to digoxin therapya

Observe patient carefully for altered response to digoxin therapya

Diuretics, potassium-sparing (e.g. spironolactone, triamterene)

Increased risk of hyperkalemiab

Concomitant use contraindicatedb

Lithium

Reduced renal clearance of lithium and increased risk of lithium toxicitya b

Concomitant use generally contraindicated; if concomitant therapy is necessary, monitor serum electrolyte and lithium concentrations, urine output, and serum and urine osmolality and adjust lithium dosage as necessary100 a

NSAIAs (e.g., indomethacin)

Concomitant use with indomethacin may affect potassium kinetics and renal functiona b

Possible decrease in the diuretic, natriuretic, and hypotensive effects of amiloride with concomitant use of NSAIAs101 a b

Consider potential effects on potassium kinetics and renal function101 a b

Observe patient closely to determine whether the desired effect of amiloride is attained101 a b

Potassium supplements, potassium-containing medications (e.g., parenteral penicillin G potassium), and/or foods containing potassium (e.g., salt substitutes, low-salt milk)

Increased risk of hyperkalemia, especially in patients with renal insufficiencya b

Concomitant use generally contraindicatedb

Tacrolimus

Increased risk of hyperkalemiab

Use with caution; monitor serum potassium concentrations frequentlyb

Tests, glucose tolerance

Possible severe hyperkalemia following IV glucose tolerance testing in patients with uncontrolled diabetic mellitus receiving short-term administration of amiloridea

Discontinue amiloride in patients with diabetes mellitus at least 3 days prior to glucose tolerance testinga b

Amiloride Hydrochloride Pharmacokinetics

Absorption

Bioavailability

About 50% of an oral dose is absorbed.a

Onset

Diuretic activity usually occurs within 2 hours.a b

Peak urinary electrolyte excretion within 6–10 hours.a b

Duration

Effect on urinary electrolyte excretion persists for about 24 hours.a b

Food

Food decreases the extent of GI absorption to about 30%, but does not affect the rate of absorption.a

Distribution

Extent

Crosses the placenta in animals; not known whether crosses placenta in humans.a

Distributed into milk in animals; not known whether distributed into human milk.a

Elimination

Metabolism

Not metabolized in the liver.b

Elimination Route

Excreted in urine (50%) as unchanged drug and in feces (40%), possibly as unabsorbed drug.a b

Half-life

6–9 hours or longer.a b

Special Populations

Renal clearance may be reduced in patients with renal impairment.a b

Stability

Storage

Oral

Tablets

<40°C (preferably 15–30°C);a protect from moisture, freezing, and excessive heat.a b

Fixed Combination Tablets with Hydrochlorothiazide

15–30°C; protect from light, moisture, and freezing.c

Actions

  • Exhibits potassium-sparing effect when used with kaliuretic diuretics.b

  • Exerts potassium-sparing effect by decreasing sodium reabsorption in the distal tubule and reducing both potassium and hydrogen secretion and subsequent excretion.a b

  • Exhibits weak natriuretic, diuretic, and hypotensive effects.a b

  • Does not competitively inhibit aldosterone; activity is independent of aldosterone concentrations.a b

  • Does not inhibit carbonic anhydrase and has no effect on free water clearance or concentrating mechanisms.a

  • Increases urinary excretion of sodium, calcium, and bicarbonate with little, if any, increase in chloride excretion.a

  • Concomitant administration with a more potent natriuretic diuretic results in approximately additive effects of the drugs on urinary sodium excretion and an antagonistic effect on potassium excretion.a

  • May increase urinary aldosterone and plasma renin concentrations, probably as a compensatory feedback mechanism caused by potassium retention and natriuresis.a

  • Unlike thiazide diuretics, does not consistently inhibit the excretion of uric acid; has variable effects on serum uric acid concentration.a

  • Does not appear to be diabetogenic or to alter carbohydrate metabolism in humans.a

Advice to Patients

  • Importance of taking drug with food to help avoid stomach upset.a b

  • Importance of avoiding ingestion of potassium supplements, salt substitutes, or excessive amounts of potassium-rich foods.b

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Amiloride Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg*

Amiloride Hydrochloride Tablets

Par

Midamor

Merck

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Amiloride Hydrochloride and Hydrochlorothiazide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg Amiloride Hydrochloride and Hydrochlorothiazide 50 mg*

Amiloride Hydrochloride and Hydrochlorothiazide Tablets

Barr, Mylan, Sandoz, Teva, UDL, Watson

Moduretic (scored)

Merck

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Amiloride-Hydrochlorothiazide 5-50MG Tablets (MYLAN): 90/$31.99 or 180/$51.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions October 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Battle DC, von Riotte AB, Gaviria M et al. Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. N Engl J Med. 1985; 312:408-14. [IDIS 198719] [PubMed 3969096]

101. Merck & Co. Midamor (amiloride hydrochloride) tablets prescribing information. West Point, PA; 1992 Apr.

102. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Bethesda, MD: National Institutes of Health. (NIH publication No. 98-4080.)

103. Anon. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Part II. Management of heart failure: approaches to the prevention of heart failure. Am J Cardiol. 1999; 83:9-38A.

104. The Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA. 1988; 259:539-44. [IDIS 237362] [PubMed 2447297]

105. Richardson A, Bayliss J, Scriven AJ et al. Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure. Lancet. 1987; 2:709-11. [IDIS 234108] [PubMed 2888942]

106. Sherman LG, Liang CS, Baumgardner S et al. Piretanide, a potent diuretic with potassium-sparing properties, for the treatment of congestive heart failure. Clin Pharmacol Ther. 1986; 40:587-94. [IDIS 224725] [PubMed 3533372]

107. Patterson JH, Adams KF Jr, Applefeld MM et al. Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Pharmacotherapy. 1994; 14:514-21. [IDIS 336083] [PubMed 7997385]

108. Wilson JR, Reichek N, Dunkman WB et al. Effect of diuresis on the performance of the failing left ventricle in man. Am J Med. 1981;70:234-9.

109. Parker JO. The effects of oral ibopamine in patients with mild heart failure—a double blind placebo controlled comparison to furosemide. Int J Cardiol. 1993; 40:221-7. [PubMed 8225657]

110. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) Express. Bethesda, MD: May 14 2003. From NIH website. (). (Also published in JAMA. 2003; 289.

111. National high blood pressure education program working group on hypertension control in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76. [PubMed 15286277]

a. AHFS Drug Information 2007. McEvoy GK, ed. Amiloride hydrochloride. American Society of Health-System Pharmacists; 2007: 2699-703.

b. Merck & Co., Inc. Midamor (amiloride HCl) tablets prescribing information. Whitehouse Station, NJ; 2002 Nov.

c. Merck & Co., Inc. Moduretic (amiloride HCl-hydrochlorothiazide) tablets prescribing information. Whitehouse Station, NJ; 2002 Nov.

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