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ARTICLE |

Response of Thiazide-lnduced Hypokalemia to Amiloride FREE

Robert F. Maronde, MD; Mildred Milgrom, MD; Nicolas D. Vlachakis, MD; Linda Chan, PhD
[+] Author Affiliations

Reprint requests to Clinical Pharmacology Section, University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Maronde).


JAMA. 1983;249(2):237-241. doi:10.1001/jama.1983.03330260055032
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The effects of amiloride hydrochloride on thiazide-induced hypokalemia were evaluated. In metabolic balance studies, amiloride reversed thiazide-induced urinary potassium loss, restored plasma bicarbonate concentration and pH to pretreatment levels, and produced further increases in aldosterone secretion. Effects of long-term administration of hydrochlorothiazide and an amiloride-hydrochlorothiazide combination were compared in outpatients who had experienced thiazide-induced hypokalemia while receiving oral potassium supplements. After eight weeks, those given hydrochlorothiazide alone had an average serum potassium level of 3.01± 0.10 (SD) mEq/L, significantly lower than the control level (3.75 ±0.08 mEq/L). Those given the amiloride-hydrochlorothiazide combination had an average serum potassium level of 3.75 ±0.08 mEq/L, not significantly different from the control value (3.82 ±0.08 mEq/L). Both groups had increased plasma aldosterone concentrations and plasma renin activity. The potassium-conserving effect of amiloride persisted with extended therapy.

(JAMA 1983;249:237-241)

REFERENCES

Baer JE, Jones CB, Spitzer SA, et al:  The potassium-sparing and natriuretic activity of N-amidino-3, 5-diamino-6-chloropyrazine-carboxamide hydrochloride dihydrate (amiloride hydrochloride) . J Pharmacol Exp Ther 1967;; 157:472-485.
Wiebelhaus VD, Brennan FT, Sosnowski G, et al:  The natriuretic and diuretic characteristics of triamterene in the dog . Arch Int Pharmacodyn 1967;;169:429-451.
Nash DT:  Antihypertensive effect and serum potassium homeostasis: Comparison of hydrochlorothiazide and spironolactone alone and in combination . J Med 1977;;8:367-377.
Ramsay LE, Hettiarachchi J, Fraser R, et al:  Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients . Clin Pharmacol Ther 1980;;27:533-543.
Maronde RF, Milgrom M, Dickey JM:  Potassium loss with thiazide therapy . Am Heart J 1969;;78:16-21.
Ito T, Wo J, Haning R, et al:  A rapid immunoassay for aldosterone in human peripheral plasma . J Clin Endocrinol 1972;;34:106-112.
Golub MS, Speckart PF, Zin PK, et al:  The effect of prostaglandin A1 on renin and aldosterone in man . Circ Res 1976;;39:574-579.
Berliner RW, Kennedy TJ Jr, Hilton JG:  Renal mechanisms for excretion of potassium . Am J Physiol 1950;;162:348-367.
Peterson LN, Wright FS:  Effect of sodium intake on renal potassium excretion . Am J Physiol 1977;;235:226-234.
Espiner EA, Tucci JR, Jagger PI, et al:  The effect of acute diuretic-induced extracellular volume depletion on aldosterone secretion in normal man . Clin Sci 1967;;33:125-134.
Edmonds CJ, Wilson GM:  The action of hydroflumethiazide in relation to adrenal steroids and potassium loss . Lancet 1960;;1:505-509.
Mitchell JR, Taylor HA, Pool JL, et al:  Renin and aldosterone profiling in hypertension . Ann Intern Med 1977;;87:596-612.

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Baer JE, Jones CB, Spitzer SA, et al:  The potassium-sparing and natriuretic activity of N-amidino-3, 5-diamino-6-chloropyrazine-carboxamide hydrochloride dihydrate (amiloride hydrochloride) . J Pharmacol Exp Ther 1967;; 157:472-485.
Wiebelhaus VD, Brennan FT, Sosnowski G, et al:  The natriuretic and diuretic characteristics of triamterene in the dog . Arch Int Pharmacodyn 1967;;169:429-451.
Nash DT:  Antihypertensive effect and serum potassium homeostasis: Comparison of hydrochlorothiazide and spironolactone alone and in combination . J Med 1977;;8:367-377.
Ramsay LE, Hettiarachchi J, Fraser R, et al:  Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients . Clin Pharmacol Ther 1980;;27:533-543.
Maronde RF, Milgrom M, Dickey JM:  Potassium loss with thiazide therapy . Am Heart J 1969;;78:16-21.
Ito T, Wo J, Haning R, et al:  A rapid immunoassay for aldosterone in human peripheral plasma . J Clin Endocrinol 1972;;34:106-112.
Golub MS, Speckart PF, Zin PK, et al:  The effect of prostaglandin A1 on renin and aldosterone in man . Circ Res 1976;;39:574-579.
Berliner RW, Kennedy TJ Jr, Hilton JG:  Renal mechanisms for excretion of potassium . Am J Physiol 1950;;162:348-367.
Peterson LN, Wright FS:  Effect of sodium intake on renal potassium excretion . Am J Physiol 1977;;235:226-234.
Espiner EA, Tucci JR, Jagger PI, et al:  The effect of acute diuretic-induced extracellular volume depletion on aldosterone secretion in normal man . Clin Sci 1967;;33:125-134.
Edmonds CJ, Wilson GM:  The action of hydroflumethiazide in relation to adrenal steroids and potassium loss . Lancet 1960;;1:505-509.
Mitchell JR, Taylor HA, Pool JL, et al:  Renin and aldosterone profiling in hypertension . Ann Intern Med 1977;;87:596-612.
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