$Unique_ID{BRK01821}
$Pretitle{}
$Title{AMILORIDE AND HYDROCHLOROTHIAZIDE COMBINATION}
$Subject{Moduretic (Merck Sharp & Dohme)}
$Volume{}
$Log{
Moduretic*0182101.scf}

Copyright (C) 1991 Publications International, Ltd.


AMILORIDE AND HYDROCHLOROTHIAZIDE COMBINATION
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BRAND NAME (Manufacturer):
     Moduretic (Merck Sharp & Dohme)
TYPE OF DRUG:
     Diuretic and antihypertensive
INGREDIENT:
     Samiloride and hydrochlorothiazide
DOSAGE FORM:
     Tablets (5 mg amiloride and 50 mg hydrochlorothiazide)
STORAGE:
     Amiloride and hydrochlorothiazide combination should be stored at room
       temperature in a tightly closed container.

USES

     Amiloride and hydrochlorothiazide combination is prescribed to treat high
blood pressure.  It is also used to reduce fluid accumulation in the body
caused by conditions such as heart failure, cirrhosis of the liver, kidney
disease, and the long-term use of some medications.  This medication reduces
fluid accumulation by increasing the elimination of salt and water through the
kidneys.  Amiloride is combined with hydrochlorothiazide to prevent potassium
loss from the body.

TREATMENT

     To avoid stomach upset, you can take this medication with food or with a
full glass of milk or water (unless your doctor directs you to do otherwise).
Try to take it at the same time every day.  Avoid taking a dose after 6:00
P.M.; otherwise, you may have to get up during the night to urinate.
     If you miss a dose of this medication, take the missed dose as soon as
possible, unless it is almost time for the next one.  In that case, do not
take the missed dose at all; just wait until the next scheduled dose.  Do not
double the dose.
     This medication does not cure high blood pressure, but it will help to
control the condition as long as you take it.

SIDE EFFECTS

     Minor.

     Constipation, cramps, diarrhea, dizziness, drowsiness, headache,
heartburn, loss of appetite, restlessness, or upset stomach.  As your body
adjusts to this medication, these side effects should disappear.
     This medication can cause increased sensitivity to sunlight.  Avoid
prolonged exposure to sunlight and sunlamps, wear protective clothing, and use
an effective sunscreen.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads) and exercise more
(unless your doctor directs you to do otherwise).
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising.  Do this by
alternately pushing one foot against the floor while raising the other foot
slightly, so that you are "pumping" your legs in a pedaling motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
anxiety; blurred vision; bruising; confusion; difficulty in breathing; dry
mouth; excessive thirst; excessive weakness or tiredness; fever; impotence;
itching; joint pain; mood changes; muscle spasms; nausea; nervousness;
palpitations; skin rash; sore throat; tingling in your fingers, lips, or toes;
unusual bleeding; vomiting; or yellowing of the eyes or skin.

INTERACTIONS

     Amiloride and hydrochlorothiazide combination interacts with several
other types of medications and certain foods:
     1. Concurrent use with triamterene, spironolactone, potassium salts,
low-salt milk, salt substitutes, captopril, enalapril, or laxatives can cause
serious side effects from hyperkalemia (high levels of potassium in the
blood).
     2. This drug may decrease the effectiveness of oral anticoagulants,
antigout medications, insulin, oral antidiabetic medicines, and methenamine.
     3. Indomethacin may decrease the blood-pressure-lowering effects of this
drug, which can be dangerous.
     4. Fenfluramine may increase the blood-pressure-lowering effects of this
drug, which can be dangerous.
     5. Cholestyramine and colestipol can decrease the absorption of amiloride
and hydrochlorothiazide from the gastrointestinal tract.  Therefore, this drug
should be taken one hour before or four hours after a dose of cholestyramine
or colestipol.
     6. The side effects of amphotericin B, calcium, cortisone and
cortisone-like steroids (such as hydrocortisone, prednisone, and
prednisolone), digoxin, digitalis, lithium, quinidine, sulfonamide
antibiotics, and vitamin D may be increased when these drugs are taken
concurrently with amiloride and hydrochlorothiazide.
     BE SURE TO TELL YOUR DOCTOR about any medications you are currently
taking, especially any of those listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to amiloride, hydrochlorothiazide, or any other
diuretic or to any sulfa drug, including acetazolamide, oral antidiabetic
medications, or sulfonamide antibiotics.
     * Tell your doctor if you now have or if you have ever had kidney disease
or problems with urination, diabetes mellitus, gout, liver disease, asthma,
pancreatic disease, systemic lupus erythematosus, acidosis, or hyperkalemia.
     * This drug can occasionally cause potassium loss from the body.  Signs
of potassium loss include dry mouth, thirst, weakness, muscle pain or cramps,
nausea, and vomiting.  If you experience any of these symptoms, call your
doctor.
     * Amiloride can cause hyperkalemia (high levels of potassium in the
blood).  Signs of hyperkalemia include palpitations (rapid or irregular
heartbeat); confusion; numbness or tingling in the hands, feet, or lips;
anxiety; and unusual tiredness or weakness.  In order to avoid this problem,
do not alter your diet and do not use salt substitutes unless your doctor
tells you to do so.
     * While taking this medication, limit your intake of alcoholic beverages
in order to prevent dizziness.
     * Do not take any over-the-counter (nonprescription) medication for
weight control or for cough, cold, asthma, allergy, or sinus problems unless
you first check with your doctor.
     * To prevent dehydration while taking this medication, check with your
doctor if you have any illness that causes severe or continuous nausea,
vomiting, or diarrhea.
     * This drug can raise the blood sugar level in diabetic patients.
Therefore, blood sugar levels should be monitored carefully with blood or
urine tests when this drug is being taken.
     * A doctor does not usually prescribe this drug or other "fixed-dose"
products as the first choice in the treatment of high blood pressure.  Usually
the patient first receives each ingredient singly.  If the response is
adequate to the fixed dose contained in this product, it can then be
substituted.  The advantage of a combination product is increased convenience
and (often) decreased cost.
     * Be sure to tell your doctor if you are pregnant.  Hydrochlorothiazide
crosses the placenta and may cause adverse effects in the developing fetus.
Also, tell your doctor if you are breast-feeding an infant.  Small amounts of
this drug pass into breast milk.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
