How does it work?

This medicine contains two active ingredients, amiloride hydrochloride and hydrochlorothiazide. These are both medicines called diuretics (sometimes referred to as 'water tablets'). Diuretics work by causing the kidneys to increase the amount of salts such as potassium and sodium that are filtered out of the blood and into the urine. When these salts are filtered out of the blood by the kidneys, water is also drawn alongside. As diuretics increase the removal of salts from the blood, they also cause more water to be drawn out of the blood and into the urine. Removing water from the blood decreases the volume of fluid circulating through the blood vessels. This subsequently decreases the pressure within the blood vessels. Diuretics are therefore used to lower high blood pressure. As diuretics remove fluid from the body, they are also used to treat conditions where excess fluid has been retained in the body (oedema). In heart failure for example, fluid can accumulate in the lungs, causing shortness of breath. Diuretics are used to help the body remove this excess fluid and therefore relieve the symptoms of heart failure. The decreased pressure in the blood vessels caused by the diuretic also decreases the effort required by the heart to pump blood around the body, which is useful in heart failure where the pumping mechanism of the heart is less effective. The loss of fluid caused by diuretics is also used to remove excess fluid that can accumulate in people with cirrhosis of the liver. This fluid may accumulate in the abdomen (ascites) or in the legs (oedema). Hydrochlorothiazide is type of diuretic known as a thiazide diuretic. As it works by making the kidneys remove salts from the blood it can, when used alone, cause low levels of potassium in the blood (hypokalaemia). Amiloride is a different type of diuretic known as a potassium-sparing diuretic, and it, as the name would suggest, does not have this effect. It has a weak diuretic effect by itself, but is included in this medicine to prevent excessive loss of potassium from the body.

What is it used for?

Fluid retention (ascites and oedema) in liver cirrhosis

Heart failure

High blood pressure

Warning!

This medicine can cause the amount of potassium in your bloodstream to increase. For this reason you should avoid consuming large amounts of foods that have a high potassium content, for example dried fruit, bananas, tomatoes and 'low sodium' salt, while you are taking the medicine. You should also avoid potassium supplements.

People taking this medicine should have regular blood tests to monitor their kidney function.

It is recommended that individuals taking this medicine have their fluid and salt (electrolyte) balance monitored regularly.

If you experience any of the following symptoms while taking this medicine you should inform your doctor promptly, so that the amount of fluids and salts in your body can be checked: thirst, lethargy, confusion, weakness, drowsiness, muscle cramps, scanty production of urine, abnormal heart rhythm, seizures, nausea and vomiting.

As diuretics cause your kidneys to produce more urine, you may prefer to take this medicine in the morning rather than before going to bed, as this will reduce the likelihood of you needing to get up in the night to visit the toilet. Seek further advice from your doctor or pharmacist.

If you need a test to assess the functioning of your parathyroid gland your doctor may ask you to stop taking this medicine beforehand, as it may interfere with the test results.

Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.

Dizziness and weariness may occasionally occur during treatment with blood pressure lowering medicines. If you are affected, caution is required when driving or operating machinery.

Use with caution in

Diabetes

Disease involving the heart and lungs (cardiopulmonary disease)

Elderly people

Gout

High acid levels in the blood and tissues (acidosis)

High blood urea levels (uraemia)

High levels of fats

Kidney disease

Liver disease

Long-term inflammation of skin and some internal organs (systemic lupus erythematosus)

Not to be used in

Acute kidney failure

Allergy to medicines from the sulphonamide group, eg the antibiotic sulphamethoxazole

Breastfeeding

Children or adolescents under 18 years of age

Diabetic kidney disease

Failure of the kidneys to produce urine (anuria)

High levels of calcium in the blood (hypercalcaemia)

High levels of potassium in the blood (hyperkalaemia)

Inadequate production of natural steroid hormones by the adrenal glands

Liver cirrhosis that is causing the patient to become unconscious(precomatose state)

Pregnancy

Severe kidney disease

Severe liver failure

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine may be harmful to a developing foetus. It should not normally be given to pregnant women unless the potential benefits outweigh the potential risks to the foetus. Seek medical advice from your doctor.

This medicine passes into breast milk and women taking this medicine should therefore not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Headache

Thirst

Disturbed sleep

A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)

Inability of a man to have an erection (impotence)

Confusion

Fatigue

Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain

Weakness

Abnormal heart beats (arrhythmias)

Dizziness

Loss of appetite

Chest pain

Disturbances in the levels of chemical components (electrolytes) in the blood

A general feeling of being unwell (malaise)

Rash or itching

Kidney disorders

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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