Precautions to be kept in mind while using Potassium - Sparing Diuretics

Type of Drug:

Diuretics or "water pills."

How the Drug Works:

Potassium-sparing diuretics increase the amount of water and sodium being excreted by the kidneys, but reduce the amount of potassium being excreted by the kidneys.

Uses:

To treat edema (fluid accumulation and swelling) due to congestive heart failure, cirrhosis of the liver, and in certain kidney conditions.

To treat high blood pressure, usually in combination with other drugs. to prevent or treat low potassium levels due to use of other medications (eg, other diuretics).

Precautions:

Spironolactone: To diagnose and treat primary hyperaldosteronism (an abnormality of electrolyte metabolism). To treat edema in children.

Triamterene: To treat edema due to secondary hyperaldosteronism (an abnormality of electrolyte metabolism).

High potassium levels (hyperkalemia): Occasionally hyperkalemia may occur when these agents are used without diuretics. Symptoms include abnormal skin sensations (burning, tingling), muscle weakness, impaired movement and irregular heartbeat.

Pregnancy: Amiloride and triamterene - Studies in pregnant women have not shown a risk to the fetus; however, no drug should be used during pregnancy unless clearly needed.

Spironolactone may cross the placenta. Use only if clearly needed and potential benefits outweigh the possible risks.

Breastfeeding: Spironolactone appears in breast milk. However, it is not known if triamterene or amiloride are excreted in breast milk. Safety for use in breastfeeding has not been established. These drugs can cause serious side effects in a nursing infant. Do not breastfeed while taking these drugs.

Children: Safety and effectiveness of triamterene and amiloride in children have not been established.

Lab Tests: Lab tests should be performed periodically for serum electrolytes, creatinine, BUN and serum potassium. Periodic blood tests should also be performed.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any overA­the-counter or prescription medications or dietary supplements with potassium-sparing diuretics. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with potassium-sparing diuretics:

ACE inhibitors (eg, captopril)

Anesthetics (general)

Antihypertensives (spironolactone and triamterene only)

Chlorpropamide (eg, Diabinese) (triamterene only)

Digoxin (eg, Lanoxin) (spironolactone only)

Indomethacin (eg, Indocin)

(spironolactone and triamterene only)

Lithium (eg, Eskalith) (amiloride and triamterene only)

Nonsteroidal anti inflammatory

Agents (eg, aspirin) (amiloride and triamterene only)

Potassium supplements (eg, Kaon)

Salt substitutes

Skeletal muscle relaxants (triamterene only)

Side Effects:

Every drug is capable of producing side effects. Many potassium-sparing diuretic users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include

Digestive Tract: Stomach or intestinal cramps or pain; nausea; vomiting; thirst; diarrhea; constipation; gas; appetite changes (loss of appetite). Nervous System: Weakness, fatigue; drowsiness; confusion; tingling or numbness of hands or feet; headache; dizziness; lack of coordination.

Circulatory System: Irregular pulse; chest pain. Respiratory System: Shortness of breath; cough.

Skin: Rash; hives; excessive body hair growth; yellowing of the skin or eyes; sensitivity to sunlight; unusual bleeding or bruising

Other: Deepening of the voice, breast enlargement in males (spironolactone only); menstrual abnormalities; fever; muscle weakness or cramping; inability to achieve or maintain an erection; difficult urination; dry mouth; allergic reaction

Guidelines for Use:

Amiloride - May cause stomach upset. Take with food. Notify your doctor if any of the following occurs: Muscular weakness, irregular heartbeat, shortness of breath, rash, fatigue or muscle cramps. May cause dizziness, headache or visual disturbances. Use caution while driving or performing other tasks requiring alertness. Avoid large quantities of potassium-rich food.

Spironolactone - May cause drowsiness, lack of coordination and mental confusion. Use caution while driving or performing other tasks requiring alertness. May cause stomach cramping, diarrhea, lethargy, thirst, headache, skin rash, menstrual abnormalities, deepening of the voice and breast enlargement (in males). Notify your doctor if these effects occur.

Triamterene - May cause stomach upset. Take after meals. May cause weakness, headache, nausea, vomiting and dry mouth. Notify your doctor if these become severe or persistent. Notify your doctor if fever, sore throat, mouth sores, or unusual bleeding or bruising occurs. Avoid prolonged exposure to sunlight. Photosensitivity (sensitivity to sunlight) may Occur. Take protective measures (eg, sunscreens, protective clothing) against exposure to ultraviolet light or sunlight. If single daily dose is prescribed, take in morning to avoid disruption of sleep because of frequent urination.

Do not use dietary potassium supplements, potassium-containing medications, low-salt milk or salt substitutes.

If a dose is missed, take it as soon as possible. If shelter hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed, contact your doctor or pharmacist.

Occasionally hyperkalemia (high potassium levels) may Occur when these agents are used. Symptoms include abnormal skin sensations (burning, tingling), muscle weakness, fatigue, loss of arm and leg movement, irregular heartbeat and shock.

Patients being treated for high blood pressure often feel tired and runA­down for a few weeks after beginning therapy. Continue taking your medication even though you may not feel quite "normal." Contact your doctor or pharmacist about any new symptoms.

Store below 77 Degree F. Protect from light, moisture, freezing and excessive heat.