Frusemide is anthranilic acid derivative, effective in the treatment of several disease states, including renal failure, hepatic disease and edema associated with congestive heart failure. It is also used for patients with thiazide refractory fluid retention or patients experiencing impaired renal function.
Amiloride is a potassium-retaining agent with mild diuretic, natriuretic, and antihypertensive properties. Its main clinical use is in the concomitant administration with a thiazide or a loop diuretic to prevent hypokalemia while also lowering blood pressure. The diuretic and antihypertensive action of amiloride can significantly potentiate the action of thiazide or loop diuretic.
Frusemide is a potent loop diuretic with significant natriuretic and antihypertensive properties. However, therapy with frusemide almost invariably causes hypokalemia. This necessitates the use of a potassium sparing diuretic like amiloride.
Amiloride is a potassium-retaining agent, with mild diuretic, natriuretic and antihypertensive properties. Amiloride counters the potassium depletion and hydrogen ion loss produced by frusemide and thus minimizes the risk of developing hypokalemia. Amiloride also potentiates the diuretic and natriuretic activity of frusemide.
AMF-40 is indicated in the treatment of oedematous states particularly in conditions where potassium ion conservation is important eg: Congestive cardiac failure, nephrosis, corticosteroid therapy, and ascites associated with cirrhosis.
AMF-40 is also indicated in the treatment of mild and moderate degrees of essential hypertension.
Dosage And Administration
AMF-40: 1 tablet per day.
Frusemide is an extremely potent diuretic. The common unwanted reactions to this drug are acid base disturbances, electrolyte disturbances, and volume depletion, which are extensions of its pharmacologic action of inhibition Na and H2O reabsorption in the ascending loop of Henle.
Sudden alterations of fluid and electrolyte balance in patients with cirrhosis may precipitate hepatic coma.
If increasing azotemia and oliguria occur during treatment of severe progressive renal disease, frusemide should be discontinued.
Excessive diuresis may result in dehydration and reduction in volume with circulatory collapse and has the possibility of vascular thrombosis and embolism, particularly in elderly patients.
Elderly patients on amiloride appear to be susceptible to hyperkalemia, since glomerular filtration rate decreases with age. Therefore, renal function studies are necessary.
Acidosis causes a shift of potassium ions from the intracellular to the extracellular space and predisposes to hyperkalemia.
Periodic serum electrolyte, CO2, and BUN determinations are advisable in cases of abnormalities. Either the same can be corrected or the drug temporarily withdrawn.