Moduretic Side Effects

Generic Name: amiloride / hydrochlorothiazide

Note: This page contains information about the side effects of amiloride / hydrochlorothiazide. Some of the dosage forms included on this document may not apply to the brand name Moduretic.

Not all side effects for Moduretic may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to amiloride / hydrochlorothiazide: oral tablet

In addition to its needed effects, some unwanted effects may be caused by amiloride / hydrochlorothiazide. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking amiloride / hydrochlorothiazide:

More common
  • Abdominal pain
  • confusion
  • difficulty breathing
  • irregular heartbeats
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • shortness of breath
  • weakness or heaviness of the legs
Less common
  • Dizziness
  • fainting
  • fast or slow heartbeat
  • labored breathing
  • tightness in the chest
  • wheezing
Rare
  • Ankle, knee, or great toe joint pain
  • arm, back, or jaw pain
  • blistering, peeling, or loosening of the skin
  • bloody or black, tarry stools
  • bloody urine
  • burning while urinating
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain, discomfort, or heaviness
  • chills
  • cloudy urine
  • cold sweats
  • coma
  • constipation
  • convulsions
  • cough
  • cracks in the skin
  • decreased awareness or responsiveness
  • decreased frequency or amount of urine
  • diarrhea
  • difficult or painful urination
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • dry mouth
  • fever
  • headache
  • increase in heart rate
  • increased blood pressure
  • increased thirst
  • itching
  • joint pain, stiffness, or swelling
  • lightheadedness
  • loss of appetite
  • loss of heat from the body
  • lower back or side pain
  • muscle pain or cramps
  • pounding heartbeat or pulse
  • rapid breathing
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • red, swollen skin
  • scaly skin
  • severe sleepiness
  • severe stomach pain
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • sunken eyes
  • sweating
  • swelling of the face, ankles, hands, fingers, or lower legs
  • troubled breathing
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds
  • weight gain
  • wrinkled skin

If any of the following symptoms of overdose occur while taking amiloride / hydrochlorothiazide, get emergency help immediately:

Symptoms of overdose
  • Drowsiness
  • irritability
  • mood changes
  • pain or weakness in the hands or feet
  • trembling
  • weak pulse

Some of the side effects that can occur with amiloride / hydrochlorothiazide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Rash
  • weight loss
Less common
  • Leg ache
  • stomach pain
Rare
  • Bad taste
  • bloated, full feeling
  • blurred or loss of vision
  • changes in appetite
  • decreased interest in sexual intercourse
  • discouragement
  • disturbed color perception
  • double vision
  • excess air or gas in the stomach or intestines
  • feeling of constant movement of self or surroundings
  • feeling of warmth
  • feeling sad or empty
  • general feeling of discomfort or illness
  • hair loss or thinning of hair
  • hiccups
  • inability to have or keep an erection
  • increased sweating
  • increased urge to urinate during the night
  • indigestion
  • loss in sexual ability, desire, drive, or performance
  • loss of bladder control
  • loss of interest or pleasure
  • muscle spasm
  • night blindness
  • overbright appearance of lights
  • passing of gas
  • redness of the face, neck, arms, and occasionally upper chest
  • seeing halos around lights
  • sensation of spinning
  • sleepiness
  • sleeplessness
  • stomach fullness or discomfort
  • stuffy nose
  • swelling of the breasts or breast soreness in both females and males
  • trouble concentrating
  • trouble sleeping
  • tunnel vision
  • unable to sleep
  • waking to urinate at night

For Healthcare Professionals

Applies to amiloride / hydrochlorothiazide: oral tablet

Metabolic

Cases of severe hyperkalemia associated with paralysis, cardiac arrhythmias, and even death have been reported.

Patients who are at particular risk for thiazide-induced hyponatremia include the elderly, frail women, and those with hypovolemia or who are in the postoperative state. In the latter two cases, antidiuretic hormone levels tend to be elevated, which may contribute to the development of hyponatremia.

Hyperkalemia is more likely in patients with underlying renal dysfunction.[Ref]

Metabolic side effects are common. Hyperkalemia occurs in 1% to 2% of patients. Hyperkalemia is more likely in women, patients with diabetes (even without signs of diabetic nephropathy), and patients with renal insufficiency. Hyponatremia may occur in up to 20% of patients.

Increases in serum uric acid, total cholesterol, and total triglycerides have been associated with the use of HCTZ. This may be important in some patients at risk for or who have a history of gout or coronary artery disease.[Ref]

Hypersensitivity

A 50-year-old woman with a history of congestive heart failure developed acute noncardiogenic pulmonary edema within 10 minutes after ingesting HCTZ-amiloride. Inadvertent rechallenge resulted in a recurrence. Subsequent selective skin patch testing revealed an allergy to HCTZ and not to amiloride.[Ref]

Hypersensitivity reactions to HCTZ-amiloride are rare. A case of allergic pneumonitis and noncardiogenic pulmonary edema has been associated with the use of this drug. Acute pulmonary edema, interstitial cystitis, interstitial nephritis, and anaphylaxis have been associated with the use of HCTZ.[Ref]

Genitourinary

Genitourinary problems include rare complaints of impotence among male patients. Polyuria and urinary frequency have been reported in less than 1% of patients.[Ref]

Gastrointestinal

Gastrointestinal side effects are unusual. Diarrhea, nausea, constipation, anorexia, and general abdominal pain occur in less than 5% of patients.[Ref]

Rare instances of pancreatitis and acute cholecystitis have been associated with the use of HCTZ.[Ref]

Nervous system

Nervous system side effects occur in less than 3% of patients. They include headache, weakness, and fatigue.[Ref]

Cardiovascular

Cardiovascular side effects are mainly limited to the increased risk of hyperkalemia-induced arrhythmias in patients at risk for arrhythmias. Angina pectoris, arrhythmias, and orthostatic hypotension have been reported in less than 1% of patients.[Ref]

Dermatologic

Dermatologic side effects associated with hydrochlorothiazide (HCTZ) include isolated cases of subacute cutaneous lupus, erythema annular centrifugum, and acute eczematous dermatitis. Thiazides may induce phototoxic dermatitis.[Ref]

Renal

A 74-year-old woman developed acute renal failure and granulomatous interstitial nephritis during amiloride-HCTZ therapy. Her renal function slightly improved after stopping the drug and after 20 months of oral steroid therapy.[Ref]

New or worsened renal insufficiency has rarely been associated with each component of this drug. Granulomatous interstitial nephritis has been associated with amiloride-HCTZ.[Ref]

References

1. Kuller L, Farrier N, Caggiula A, Borhani N, Dunkle S "Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial." Am J Epidemiol 122 (1985): 1045-59

2. Freeman SJ, Fale AD "Muscular paralysis and ventilatory failure caused by hyperkalaemia." Br J Anaesth 70 (1993): 226-7

3. Hollifield JW, Slaton PE "Thiazide diuretics, hypokalemia and cardiac arrhythmias." Acta Med Scand Suppl 647 (1981): 67-73

4. Burge PS, Montuschi E "Long-term effects of an amiloride / hydrochlorothiazide combination ('Moduretic') on electrolyte balance." Curr Med Res Opin 4 (1976): 260-6

5. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery 11 (1983): 283-96

6. Peters RW, Hamilton J, Hamilton BP "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J 82 (1989): 966-9,

7. Macleod MD, Bell GM, Irvine WJ "Nephrogenic diabetes insipidus associated with Dyazide (triamterene- hydrochlorothiazide)." Br Med J (Clin Res Ed) 283 (1981): 1155-6

8. Bain PG, Egner W, Walker PR "Thiazide-induced dilutional hyponatraemia masquerading as subarachnoid haemorrhage ." Lancet 2 (1986): 634

9. Gould L, Reddy CV, Zen B, Singh BK "Life-threatening reaction to thiazides." N Y State J Med 80 (1980): 1975-6

10. Klimiuk PS, Davies M, Adams PH "Primary hyperparathyroidism and thiazide diuretics." Postgrad Med J 57 (1981): 80-3

11. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet 2 (1982): 1293-5

12. Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z "Cardiac conduction defects associated with hyponatremia." Clin Cardiol 14 (1991): 165-8

13. Ragnarsson J, Hardarson T, Snorrason SP "Ventricular dysrhythmias in middle-aged hypertensive men treated either with a diuretic agent or a beta-blocker." Acta Med Scand 221 (1987): 143-8

14. Itescu S, Haskell LP, Tannenberg AM "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2

15. Kone B, Gimenez L, Watson AJ "Thiazide-induced hyponatremia." South Med J 79 (1986): 1456-7

16. Holland OB, Kuhnert L, Pollard J, Padia M, Anderson RJ, Blomqvist G "Ventricular ectopic activity with diuretic therapy." Am J Hypertens 1 (1988): 380-5

17. Otterstad JE, Froeland G, Soeyland AK, Illingworth JM "Lipid profile in 100 men with moderate hypertension treated for 1 year with atenolol or hydrochlorothiazide plus amiloride: a double-blind, randomized study." Scand J Clin Lab Invest 52 (1992): 83-93

18. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2

19. Schiffl H, Schollmeyer P "Clinical efficacy and safety of long-term diuretic treatment in renal parenchymal hypertension." Int J Clin Pharmacol Ther Toxicol 23 (1985): 585-8

20. Benfield GF, Haffner C, Harris P, Stableforth DE "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Lancet 2 (1986): 341

21. Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8

22. Polanska AI, Baron DN "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 175-6

23. Seelig CB "Magnesium deficiency in two hypertensive patient groups." South Med J 83 (1990): 739-42

24. Papademetriou V, Price M, Notargiacomo A, Gottdiener J, Fletcher RD, Freis ED "Effect of diuretic therapy on ventricular arrhythmias in hypertensive patients with or without left ventricular hypertrophy." Am Heart J 110 (1985): 595-9

25. Rosenberg L, Shapiro S, Slone D, Kaufman DW, Miettinen OS, Stolley PD "Thiazides and acute cholecystitis." N Engl J Med 303 (1980): 546-8

26. Jones IG, Pickens PT "Diabetes mellitus following oral diuretics." Practitioner 199 (1967): 209-10

27. 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

28. Strykers PH, Stern RS, Morse BM "Hyponatremia induced by a combination of amiloride and hydrochlorothiazide." JAMA 252 (1984): 389

29. Bell DS "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med 93 (1993): 99-103,

30. Maddox RW, Arnold WS, Dewell WM "Extreme hyperkalemia associated with amiloride ." South Med J 78 (1985): 365

31. Millar JA, Fraser R, Mason P, Leckie B, Cumming AM, Robertson JI "Metabolic effects of high dose amiloride and spironolactone: a comparative study in normal subjects." Br J Clin Pharmacol 18 (1984): 369-75

32. Jaffey L, Martin A "Malignant hyperkalaemia after amiloride / hydrochlorothiazide treatment ." Lancet 1 (1981): 1272

33. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22

34. Berlin I "Prazosin, diuretics, and glucose intolerance." Ann Intern Med 119 (1993): 860

35. Vidt DG "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic." Pharmacotherapy 1 (1981): 179-86

36. Fichman MP, Vorherr H, Kleeman CR, Telfer N "Diuretic-induced hyponatremia." Ann Intern Med 75 (1971): 853-63

37. Tarssanen L, Huikko M, Rossi M "Amiloride-induced hyponatremia." Acta Med Scand 208 (1980): 491-4

38. Krishna GG, Narins RG "Hemodynamic consequences of diuretic-induced hypokalemia." Am J Kidney Dis 12 (1988): 329-31

39. Mahabir RN, Laufer ST "Clinical evaluation of diuretics in congestive heart failure. A detailed study in four patients." Arch Intern Med 124 (1969): 1-7

40. Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H, Giese J "Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients." Clin Pharmacol Ther 34 (1983): 448-53

41. Pinnock CA "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 48

42. Duarte CG, Winnacker JL, Becker KL, Pace A "Thiazide-induced hypercalcemia." N Engl J Med 284 (1971): 828-30

43. Hornick P, Allen P "Acute hyponatraemia following total hip replacement." Br J Clin Pract 44 (1990): 776-7

44. Davidson C, Burkinshaw L, Morgan DB "The effects of potassium supplements, spironolactone or amiloride on the potassium status of patients with heart failure." Postgrad Med J 54 (1978): 405-9

45. Barnes CC "Lisinopril and hydrochlorothiazide/amiloride: a comparative study in the treatment of patients with mild-to-moderate hypertension." Curr Ther Res Clin Exp 55 (1994): 1455-64

46. Prupas HM, Brown D "Acute idiosyncratic reaction to hydrochlorothiazide ingestion." West J Med 138 (1983): 101-2

47. Grace AA, Morgan AD, Strickland NH "Hydrochlorothiazide causing unexplained pulmonary oedema." Br J Clin Pract 43 (1989): 79-81

48. Magil AB "Drug-induced acute interstitial nephritis with granulomas." Hum Pathol 14 (1983): 36-41

49. Biron P, Dessureault J, Napke E "Acute allergic interstitial pneumonitis induced by hydrochlorothiazide [published erratum appears in Can Med Assoc J 1991 Sep 1;145(5):391]." Can Med Assoc J 145 (1991): 28-34

50. Beaudry C, Laplante L "Severe allergic pneumonitis from hydrochlorothiazide." Ann Intern Med 78 (1973): 251-3

51. Hoss DM, Nierenberg DW "Severe shaking chills and fever following hydrochlorothiazide administration." Am J Med 85 (1988): 747

52. Klein MD "Noncardiogenic pulmonary edema following hydrochlorothiazide ingestion." Ann Emerg Med 16 (1987): 901-3

53. Goette DK, Beatrice E "Erythema annulare centrifugum caused by hydrochlorothiazide-induced interstitial nephritis." Int J Dermatol 27 (1988): 129-30

54. Dorn MR, Walker BK "Noncardiogenic pulmonary edema associated with hydrochlorothiazide therapy." Chest 79 (1981): 482-3

55. Alted E, Navarro M, Cantalapiedra JA, Alvarez JA, Blasco MA, Nunez A "Non-cardiogenic pulmonary edema after oral ingestion of hydrochlorothiazide ." Intensive Care Med 13 (1987): 364-5

56. Levay ID "Hydrochlorothiazide-induced pulmonary edema." Drug Intell Clin Pharm 18 (1984): 238-9

57. Hoegholm A, Rasmussen SW, Kristensen KS "Pulmonary oedema with shock induced by hydrochlorothiazide: a rare side effect mimicking myocardial infarction." Br Heart J 63 (1990): 186

58. Enriquez R, Cabezuelo JB, Gonzalez C, Lacueva J, Teruel A, Fernandez J, Arenas MD "Granulomatous interstitial nephritis associated with hydrochlorothiazide/amiloride." Am J Nephrol 15 (1995): 270-3

59. Keidan H "Letter: Impotence during antihypertensive treatment." Can Med Assoc J 114 (1976): 874

60. Delevett AF, Recalde M "Diuretic-induced renal colic." JAMA 225 (1973): 992

61. Wagner W, Longerbeam JK, Smith LL, Feikes HL "Drug-induced ulcers of the small bowel causing intestinal obstruction or perforation." Am Surg 33 (1967): 7-11

62. Campbell JR, Knapp RW "Small bowel ulceration associated with thiazide and potassium therapy: review of 13 cases." Ann Surg 163 (1966): 291-6

63. Smith BL, Tedeschi A, Lane CD "Pancreatitis with a twist." Hosp Pract (Off Ed) 23 (1988): 150,

64. Holland GW "Stenosing ulcers of the small bowel associated with thiazide and potassium therapy." N Z Med J 64 (1965): 383-5

65. Reinus FZ, Weinberger HA, Fischer WW "Medication-induced ulceration of the small bowel." Am J Surg 112 (1966): 97-101

66. Dietz MW "Iatrogenic jejunal ulcer." Am J Roentgenol Radium Ther Nucl Med 99 (1967): 136-8

67. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5

68. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73

69. Grunwald MH, Halevy S, Livni E "Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation test." Isr J Med Sci 25 (1989): 572-4

70. Goodrich AL, Kohn SR "Hydrochlorothiazide-induced lupus erythematosus: a new variant?" J Am Acad Dermatol 28 (1993): 1001-2

71. Parodi A, Romagnoli M, Rebora A "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Photodermatol 6 (1989): 100-2

72. Diffey BL, Langtry J "Phototoxic potential of thiazide diuretics in normal subjects." Arch Dermatol 125 (1989): 1355-8

73. Robinson HN, Morison WL, Hood AF "Thiazide diuretic therapy and chronic photosensitivity." Arch Dermatol 121 (1985): 522-4

74. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Ann Intern Med 103 (1985): 49-51

75. Leary WP, Reyes AJ, van der Byl K "Effects of hydrochlorothiazide plus sotalol on acute urinary electrolyte excretion in normal subjects." S Afr Med J 66 (1984): 680-1

76. Lynn KL, Bailey RR, Swainson CP, Sainsbury R, Low WI "Renal failure with potassium-sparing diuretics." N Z Med J 98 (1985): 629-33

More about Moduretic (amiloride / hydrochlorothiazide)

Consumer resources

Professional resources

Other formulations

Related treatment guides

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

Hide
(web2)