Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective. Maximum 40 mg daily. 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. online pamelor rezeptfrei pamelor
Midamor is a potassium-conserving antikaliuretic drug that possesses weak compared with thiazide diuretics natriuretic, diuretic, and antihypertensive activity. These effects have been partially additive to the effects of thiazide diuretics in some clinical studies. When administered with a thiazide or loop diuretic, Midamor has been shown to decrease the enhanced urinary excretion of magnesium which occurs when a thiazide or loop diuretic is used alone. Midamor has potassium-conserving activity in patients receiving kaliuretic-diuretic agents. Zinc can attach to tetracyclines in the stomach. This decreases the amount of tetracyclines that can be absorbed. Taking zinc with tetracyclines might decrease the effectiveness of tetracyclines. To avoid this interaction, take tetracyclines 2 hours before or 4-6 hours after taking zinc supplements.
Clinical studies of Midamor did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. Hyperkalemia, b nausea, b vomiting, b diarrhea, b abdominal pain, b flatulence, b anorexia, b mild skin rash, b headache.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. This may not be a complete list of all interactions that may occur. Ask your health care provider if Midamor may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Safety and efficacy have not been established in patients younger than 18 years.
The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. 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 drugs you are taking, check with your doctor, nurse or pharmacist. 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. 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. Such concomitant therapy can be associated with rapid increases in serum potassium levels. If potassium supplementation is used, careful monitoring of the serum potassium level is necessary. Use Midamor with caution in the ELDERLY; they may be more sensitive to its effects. Yellow 10, iron oxide, lactose, magnesium stearate and starch. Registered trademark of Paddock Laboratories, Inc. Reactions occurring in 3% to 8% of patients treated with Midamor. Those reactions occurring in less than 3% of the patients are unmarked. Hummel SL, Konerman MC. Dietary Sodium Restriction in Heart Failure: A Recommendation Worth its Salt? Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Your doctor may increase your dose if needed. Treatment of edematous conditions in patients with nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response. If your symptoms do not improve or if they become worse, check with your doctor. Excreted in urine 50% as unchanged drug and in feces 40% possibly as unabsorbed drug.
For treating the common cold: one zinc gluconate or acetate lozenge, providing 9-24 mg elemental zinc, dissolved in the mouth every two hours while awake when cold symptoms are present. 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. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. Wilson JR, Reichek N, Dunkman WB et al. Effect of diuresis on the performance of the failing left ventricle in man. Am J Med. The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. 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 7. Bethesda, MD: National Institutes of Health; 2004 Aug. NIH publication No. 04-5230. To increase growth and weight gain in children with sickle cell disease who have not reached puberty: 10 mg elemental zinc per day. AMILoride and ethanol may have additive effects in lowering your blood pressure. Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. 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. 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. rifadin
Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking amiloride. AHFS Drug Information 2017. McEvoy GK, ed. Amiloride hydrochloride. Disclaimer: Every effort has been made to ensure that the information provided by Multum, Truven Health Analytics, Inc. Different salt forms provide different amounts of elemental zinc. Zinc sulfate contains 23% elemental zinc; 220 mg zinc sulfate contains 50 mg zinc. Midamor should rarely be used alone. It has weak compared with thiazides diuretic and antihypertensive effects. Used as single agents, potassium sparing diuretics, including Midamor, result in an increased risk of hyperkalemia approximately 10% with amiloride. Midamor should be used alone only when persistent hypokalemia has been documented and only with careful titration of the dose and close monitoring of serum electrolytes. Used concomitantly with a thiazide diuretic mainly to prevent or treat diuretic-induced hypokalemia. a b See Hypokalemia Induced by Kaliuretic Diuretics under Uses. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee JNC 8. JAMA. 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. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Midamor while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while taking Midamor. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. Midamor should not be given to patients receiving other potassium-conserving agents, such as spironolactone or triamterene. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Drugs. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Three-character codes are assigned only in situations when more than one reference listed drug of the same strength has been designated under the same heading. Two or more reference listed drugs are generally selected only when there are at least two potential reference drug products which are not bioequivalent to each other. If a study is submitted that demonstrates bioequivalence to a specific listed drug product, the generic product will be given the same three-character code as the reference listed drug it was compared against. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Significantly elevated serum uric acid, cholesterol, and triglyceride levels have been associated with combination hydrochlorothiazide-amiloride therapy. These metabolic abnormalities may not be due to amiloride since they are reported during hydrochlorothiazide monotherapy. Teratogenicity studies with amiloride HCl in rabbits and mice given 20 and 25 times the maximum human dose, respectively, revealed no evidence of harm to the fetus, although studies showed that the drug crossed the placenta in modest amounts. Reproduction studies in rats at 20 times the expected maximum daily dose for humans showed no evidence of impaired fertility. At approximately 5 or more times the expected maximum daily dose for humans, some toxicity was seen in adult rats and rabbits and a decrease in rat pup growth and survival occurred. For the long test, correction of hypokalemia and hypertension provides presumptive evidence of primary hyperaldosteronism. If hyperkalemia occurs in patients taking Midamor, the drug should be discontinued immediately. Co. Midamor amiloride hydrochloride tablets prescribing information. West Point, PA; 1992 Apr. prescription procrit side effects
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. Moderate Be cautious with this combination. For muscle cramps in zinc deficient people with liver disease: zinc sulfate 220 mg twice daily. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Midamor should not be used in CHILDREN; safety and effectiveness in children have not been confirmed. The presence of other medical problems may affect the use of this medicine. Has been used to correct the metabolic alkalosis produced by thiazides and other kaliuretic diuretics.
Potassium-sparing diuretic; pyrazinecarbonyl guanidine derivative. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If hypokalemia persists after an adequate trial of 10 mg daily may increase dosage to 15 and then 20 mg daily. Studies in rats have shown that amiloride is excreted in milk in concentrations higher than those found in blood, but it is not known whether Midamor is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Midamor, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Talk with your health provider. C; a protect from moisture, freezing, and excessive heat. Midamor usually begins to act within 2 hours after an oral dose. Its effect on electrolyte excretion reaches a peak between 6 and 10 hours and lasts about 24 hours. Peak plasma levels are obtained in 3 to 4 hours and the plasma half-life varies from 6 to 9 hours. Such measures include the intravenous administration of sodium bicarbonate solution or oral or parenteral glucose with a rapid-acting insulin preparation. If needed, a cation exchange resin such as sodium polystyrene sulfonate may be given orally or by enema. Patients with persistent hyperkalemia may require dialysis. All medicines may cause side effects, but many people have no, or minor, side effects. For the short test, increased serum potassium with this drug and a decrease upon discontinuation provide presumptive evidence of primary hyperaldosteronism. Also useful in patients with hypokalemia who do not respond to potassium supplements or those who cannot tolerate potassium supplements. The Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA. dostinex canada price blog
Gupta D, Georgiopoulou VV, Kalogeropoulos AP et al. Dietary sodium intake in heart failure. Circulation. Store at room temperature away from moisture, heat, or freezing temperatures. What happens if I miss a dose? Weber MA, Schiffrin EL, White WB et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens Greenwich. For hypogeusia sense of taste is abnormal: 25-100 mg zinc. 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 amiloride may be used intermittently. In treating patients with congestive heart failure after an initial diuresis has been achieved, potassium loss may also decrease and the need for MIDAMOR should be re-evaluated. Dosage adjustment may be necessary. Maintenance therapy may be on an intermittent basis. Symptoms may include lightheadedness; nausea; vomiting; weakness. Use Midamor as directed by your doctor. Check the label on the medicine for exact dosing instructions.
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. NDC 0574-0291-01 bottles of 100. For diarrhea in malnourished or zinc-deficient children: 10-40 mg elemental zinc daily. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. No data are available in regard to overdosage in humans. 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. 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. Does not competitively inhibit aldosterone; activity is independent of aldosterone concentrations. Severe allergic reactions rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; dry mouth; excessive thirst; slowed heart rate; unusual muscle weakness; unusual tiredness; vomiting. Are there any interactions with medications? Exhibits weak natriuretic, diuretic, and hypotensive effects. cefdinir
Hyponatremia and hypochloremia may occur when Midamor is used with other diuretics and increases in BUN levels have been reported. These increases usually have accompanied vigorous fluid elimination, especially when diuretic therapy was used in seriously ill patients, such as those who had hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant edema. Therefore, when Midamor is given with other diuretics to such patients, careful monitoring of serum electrolytes and BUN levels is important. In patients with pre-existing severe liver disease, hepatic encephalopathy, manifested by tremors, confusion, and coma, and increased jaundice, have been reported in association with diuretics, including amiloride HCl. Please refer to the for information on shortages of one or more of these preparations. 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. If hypokalemia persists after an adequate trial of 10 mg daily, may increase dosage to 15 and then 20 mg daily. It is not known whether the drug is dialyzable. Lynn KL, Bailey RR, Swainson CP, Sainsbury R, Low WI "Renal failure with potassium-sparing diuretics. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. 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. Do not keep outdated medicine or medicine no longer needed. Do not take other medicines unless they have been discussed with your doctor. Anuria, acute or chronic renal insufficiency, and evidence of diabetic nephropathy are contraindications to the use of Midamor. Product Information. Midamor amiloride. 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. Effect on urinary electrolyte excretion persists for about 24 hours. The adverse reactions for Midamor listed in the following table have been arranged into two groups: 1 incidence greater than one percent; and 2 incidence one percent or less. The incidence for group 1 was determined from clinical studies conducted in the United States 837 patients treated with Midamor. The adverse effects listed in group 2 include reports from the same clinical studies and voluntary reports since marketing. The probability of a causal relationship exists between Midamor and these adverse reactions, some of which have been reported only rarely.
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. The most likely signs and symptoms to be expected with overdosage are dehydration and electrolyte imbalance. These can be treated by established procedures. Therapy with Midamor should be discontinued and the patient observed closely. There is no specific antidote. Emesis should be induced or gastric lavage performed. Treatment is symptomatic and supportive. If hyperkalemia occurs, active measures should be taken to reduce the serum potassium levels. Food decreases the extent of GI absorption to about 30%, but does not affect the rate of absorption. American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. Genitourinary problems include rare complaints of impotence. Polyuria and urinary frequency are reported in less than 1% of patients. Midamor should be administered with food. However, some clinicians state maximum effective dosage may be as high as 40 mg daily. procyclidine generic cost walgreens
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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 Midamor 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. qquc.info domperidone
Other reactions have been reported but occurred under circumstances where a causal relationship could not be established. However, in these rarely reported events, that possibility cannot be excluded. Therefore, these observations are listed to serve as alerting information to physicians. Drinking alcohol with this medicine can cause side effects. III to IV when used in addition to standard therapy. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of amiloride in the elderly. Safety and effectiveness in pediatric patients have not been established.
Does not inhibit carbonic anhydrase and has no effect on free water clearance or concentrating mechanisms. The manufacturers state that amiloride produces little additive hypotensive activity when used concurrently with a thiazide diuretic. See Specific Drugs, Foods, and Laboratory Tests under Interactions. Take Midamor by mouth with food.
Patients with persistent hyperkalemia may require dialysis. For treating attention deficit-hyperactivity disorder ADHD in children: doses of zinc sulfate 55 mg 15 mg elemental zinc to 150 mg 40 mg elemental zinc daily. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.