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Drug

Amiloride-Hydrochlorothiazide

Pronounced

"a-MIL-oh-ride/HYE-droe-KLOR-oh-THYE-a-zide"

Drug Interactions

See also How To Use and Precautions section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug are: cisapride, dofetilide, lithium, sodium phosphate products, other products that may affect potassium levels (such as eplerenone, tacrolimus, cyclosporine, birth control pills containing drospirenone, other diuretics like spironolactone/triamterene, ACE inhibitors like benazepril/captopril, angiotensin receptor antagonists like losartan/valsartan).

Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

This medication may interfere with certain laboratory tests (including glucose tolerance testing, parathyroid test, protein-bound iodide test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

  • Negative Interactions

    9
    • Hydrochlorothiazide

      Dandelion

      Potential Negative Interaction

      This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.

      Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may increase the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.
      Dandelion
      Hydrochlorothiazide
      ×
      1. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102-3.
    • Amiloride

      Dandelion

      Potential Negative Interaction

      This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.

      Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may increase the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.
      Dandelion
      Amiloride
      ×
      1. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102-3.
    • Amiloride-Hydrochlorothiazide

      Dandelion

      Potential Negative Interaction

      This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.

      Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may increase the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.
      Dandelion
      Amiloride-Hydrochlorothiazide
      ×
      1. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102-3.
    • Hydrochlorothiazide

      Digitalis

      Potential Negative Interaction

      Digitalis (Digitalis purpurea) refers to a family of plants commonly called foxglove, which contains digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin. Thiazide diuretics can increase the risk of digitalis-induced heart disturbances. Thiazide diuretics and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

      Digitalis
      Hydrochlorothiazide
      ×
      1. Threlkeld DS, ed. Diuretics and Cardiovasculars, Thiazides and Related Diuretics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1993, 135a-7c.
    • Hydrochlorothiazide

      Diuretic Herbs

      Potential Negative Interaction

      Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may enhance the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.

      Use buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.

      Diuretic Herbs
      Hydrochlorothiazide
      ×
      1. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102-3.
      2. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: University of Exeter, Centre for Complementary Health Studies, 1997.
    • Hydrochlorothiazide

      Ginkgo

      Potential Negative Interaction

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.

      Ginkgo
      Hydrochlorothiazide
      ×
      1. Shaw D et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56.
    • Hydrochlorothiazide

      Licorice

      Potential Negative Interaction

      Licorice (Glycyrrhiza glabra) may increase the side effects of potassium-depleting diuretics, including thiazide diuretics. Thiazide diuretics and licorice should be used together only under careful medical supervision. At the time of this writing, no evidence was found of interactions between deglycyrrhizinated licorice (DGL) and any diuretic was found in the medical literature.

      Licorice
      Hydrochlorothiazide
      ×
      1. Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992;32:44-51.
    • Amiloride

      Magnesium

      Potential Negative Interaction

      Preliminary research in animals suggests that amiloride may reduce the urinary excretion of magnesium. It is unknown if this same effect would occur in humans. Nevertheless, persons taking more than 300 mg of magnesium per day and amiloride should consult with a doctor, as this combination may lead to potentially dangerous elevations in levels of magnesium in the body. The combination of amiloride and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

      Magnesium
      Amiloride
      ×
      1. Devane J, Ryan MP. The effects of amiloride and triamterene on urinary magnesium excretion in conscious saline-loaded rats. Br J Pharmacol 1981;72:285-9.
    • Amiloride

      Potassium

      Potential Negative Interaction

      As a potassium-sparing drug, amiloride reduces urinary loss of potassium. This can cause potassium levels to build up in the body. People taking this drug should avoid use of potassium chloride–containing products, such as Morton Salt Substitute, No Salt, Lite Salt, and others. Even eating several pieces of fruit per day can sometimes cause problems for people taking potassium-sparing diuretics, due to the high potassium content of fruit.

      However, one medication (Moduretic) contains the combination of the potassium-sparing drug amiloride and the potassium-depleting drug hydrochlorothiazide. With the use of Moduretic, potassium excess and potassium depletion are both possible. People taking this combination drug should have their potassium levels monitored by a doctor to determine whether their potassium intake should be increased, reduced, or kept the same.

      Potassium
      Amiloride
      ×
      1. Ramsay LE, Hettiarachchi J, Fraser R, Morton JJ. Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients. Clin Pharmacol Ther 1980;27:533-43.
  • Supportive Interactions

    5
    • Hydrochlorothiazide

      Folic Acid

      Replenish Depleted Nutrients

      One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics. Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

      Folic Acid
      Hydrochlorothiazide
      ×
      1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70.
    • Amiloride

      Folic Acid

      Replenish Depleted Nutrients

      One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics. Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

      Folic Acid
      Amiloride
      ×
      1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70.
    • Amiloride-Hydrochlorothiazide

      Folic Acid

      Replenish Depleted Nutrients

      One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics. Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

      Folic Acid
      Amiloride-Hydrochlorothiazide
      ×
      1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866-70.
    • Hydrochlorothiazide

      Magnesium and Potassium

      Replenish Depleted Nutrients

      Potassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion, although this deficiency may not be reflected by a low blood level of magnesium. Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.

      People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels. A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death. Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

      Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides. Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.

      Magnesium and Potassium
      Hydrochlorothiazide
      ×
      1. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768-71.
      2. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553-6.
      3. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med 1992;152:40-5.
      4. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA 1999;281:2203-10.
      5. Franse LV, Pahor M, Di Bari M, et al. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 2000;35:1025-30.
      6. Ruml LA, Gonzalez G, Taylor R, et al. Effect of varying doses of potassium-magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Ther 1999;6:45-50.
      7. Ruml LA, Pak CYO. Effect of potassium magnesium citrate on thiazide-induced hypokalemia and magnesium loss. Am J Kidney Dis 1999;34:107-13.
    • Hydrochlorothiazide

      Zinc

      Replenish Depleted Nutrients

      Thiazide diuretics can increase urinary zinc loss.

      Zinc
      Hydrochlorothiazide
      ×
      1. Reyes AJ, Leary WP, Lockett CJ, et al. Diuretics and zinc. S Afr Med J 1982;62:373-5.
  • Explanation Required

    7
    • Amiloride-Hydrochlorothiazide

      Alder Buckthorn

      Needs Explanation

      Use buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.

      Alder Buckthorn
      Amiloride-Hydrochlorothiazide
      ×
      1. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: University of Exeter, Centre for Complementary Health Studies, 1997.
    • Amiloride-Hydrochlorothiazide

      Buckthorn

      Needs Explanation

      Use buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.

      Buckthorn
      Amiloride-Hydrochlorothiazide
      ×
      1. European Scientific Cooperative on Phytotherapy (ESCOP). Frangulae cortex, frangula bark. Monographs on the Medicinal Uses of Plant Drugs. Exeter, UK: University of Exeter, Centre for Complementary Health Studies, 1997.
    • Hydrochlorothiazide

      Calcium

      Needs Explanation

      Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys. As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.

      Calcium
      Hydrochlorothiazide
      ×
      1. Threlkeld DS, ed. Diuretics and Cardiovasculars, Thiazides and Related Diuretics. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jul 1993, 135a-7c.
    • Hydrochlorothiazide

      Hibiscus

      Needs Explanation
      In experimental animals, co-administration of hibiscus (Hibiscus sabdariffa L.) extract and hydrochlorothiazide increased blood levels of hydrochlorothiazide and decreased the rate at which the body cleared the drug. Therefore, treatment with hibiscus could increase both the efficacy and the adverse effects of hydrochlorothiazide. People taking hydrochlorothiazide should not take hibiscus without medical supervision.
      Hibiscus
      Hydrochlorothiazide
      ×
      1. Ndu OO, Nworu CS, Ehiemere CO, et al. Herb-drug interaction between the extract of Hibiscus sabdariffa L. and hydrochlorothiazide in experimental animals. J Med Food 2011;14:640-4.
    • Hydrochlorothiazide

      Sodium

      Needs Explanation

      Diuretics, including thiazide diuretics, cause increased loss of sodium in the urine. By removing sodium from the body, diuretics also cause water to leave the body. This reduction of body water is the purpose of taking diuretics. Therefore, there is usually no reason to replace lost sodium, although strict limitation of salt intake in combination with the actions of diuretics can sometimes cause excessive sodium depletion. On the other hand, people who restrict sodium intake, and in the process reduce blood pressure, may need to have their dose of diuretics lowered.

    • Amiloride

      Sodium

      Needs Explanation

      Diuretics, including amiloride, cause increased loss of sodium in urine. By removing sodium from the body, diuretics cause water to leave the body as well. This reduction of water in the body is the purpose of taking amiloride. Therefore, there is usually no reason to replace lost sodium, although strict limitation of salt intake in combination with the action of diuretics can sometimes cause excessive sodium depletion. On the other hand, people who restrict sodium intake and in the process reduce blood pressure may need to have the dose of their diuretics lowered.

    • Hydrochlorothiazide

      Vitamin D

      Needs Explanation

      The reduction in urinary calcium loss resulting from treatment with thiazide diuretics is due primarily to changes in kidney function and may also be due, in part, to changes in vitamin D metabolism. However, there is no evidence to suggest that people taking diuretics have different requirements for vitamin D.

      Vitamin D
      Hydrochlorothiazide
      ×
      1. Riis B, Christiansen C. Actions of thiazide on vitamin D metabolism: A controlled therapeutic trial in normal women early in the postmenopause. Metabolism 1985;34:421-4.

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