Moduretic 5-50

1 What is Moduretic 5-50?

Brand: Moduretic 5-50

Generic: Amiloride And Hydrochlorothiazide

Moduretic 5-50 is commonly used to treat high blood pressure i.e. hypertension. Besides, this drug combination is also widely prescribed to treat congestive heart failure, hepatic cirrhosis with ascites and edema

Amiloride is an anti kaliuretic with weak natriuretic, diuretic and antihypertensive effects. Some clinical studies found these effects to be partially additive to the effects of thiazide diuretics. Amiloride exerts its potassium-sparing effect by inhibiting Na+ reabsorption at the distal renal tubules. 

On the contrary, hydrochlorothiazide is also a diuretic and antihypertensive drug. It reduces electrolyte reabsorption from the renal tubules. Hydrochlorothiazide increases excretion of Na+ and Clˉ in approximately equal amounts. It exerts its hypotensive effect partly by reducing peripheral resistance.

2 What to Know Before Using

Before using Moduretic 5-50, you must know all about the risks and complications associated with it. This is a decision that your doctor will make with your active participation.

There are certain factors such as present and past ailments, drug interactions, metabolic impairments, hypersensitivity reactions, pregnancy, lactation etc. which may alter the drug action. 

Potassium-sparing diuretics e.g. amiloride lower BP slightly, but it is used only in conjunction with a thiazide diuretic to prevent K+ loss and to augment the antihypertensive action.

These are medium efficacy diuretics with a primary site of action in the cortical diluting segment or the early DT. They inhibit Na+-Clˉ symport at the luminal membrane. Thiazide and related drugs are the diuretic of choice in uncomplicated hypertension.

The proposed mechanism of antihypertensive action is:

  • Initially, the diuresis reduces plasma and extracellular fluid volume by 5-15% resulting in decreased cardiac output.
  • Subsequently, compensatory mechanisms operate to almost regain Na+ balance and plasma volume. As a result, cardiac output is restored.
  • Decrease in intracellular Na+ concentration in the vascular smooth muscle may decrease the stiffness of vessel wall. 

The fall in blood pressure develops gradually over 2-4 weeks. During long-term treatment with thiazides, the heart rate, and cardiac output is unaffected. As these drugs have no effect on capacitance vessels and the sympathetic reflexes are not impaired, there is the least chance of developing postural hypotension.

3 Proper Usage

To use Moduretic 5-50 properly, you must follow all instructions given by your doctor. The dose of this medicine will vary according to patient’s condition or requirements. You should follow the doctor's directions and advice.

The amount of medicine that you take should not exceed the maximum therapeutic dose. Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

Therapeutic administration of amiloride and hydrochlorothiazide is described below:

  • In order to treat hypertension: It is recommended to administer ½ to 1 tab in an adult daily. Each tablet contains amiloride 5 mg and hydrochlorothiazide 50 mg.
  • In order to treat congestive heart failure (CHF): ½ to 2 tablets are recommended by the health professionals. Each tablet contains amiloride 5 mg and hydrochlorothiazide 50 mg.
  • Hepatic cirrhosis with ascites and edema: 1 to 2 tablets are given in a day. Each tab contains Amiloride 5 mg and hydrochlorothiazide 50 mg.

Always try to take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible. But when it is time for your next dose, then skip the missed dose and go back to your regular dosing schedule.

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light.

4 Precautions to Take

In using Moduretic 5-50, you must be careful and take some precautions as advised by your doctor. Some important measures should be taken if you feel any discomfort following any drug therapy.

In the case of such drug therapy, you may not need to discontinue the therapy as there are least chances of drug toxicity. Although Amiloride is well tolerated by most of the patients, but it may bring some unwanted effects like insomnia, mental confusion, nervousness, restlessness, dizziness, cough etc.

This drug combination is contraindicated in hyperkalemia, anuria, acute renal failure, severe progressive renal disease, severe hepatic failure, pre-coma associated with hepatic cirrhosis, Addison’s disease, diabetic neuropathy, diabetes mellitus, child <18 years and lactation.

Monitoring of serum electrolytes and blood urea levels in seriously ill patients e.g. those with hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant edema, or those with the pre-existing severe liver disease is recommended before and during the administration of this therapy. 

Certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some drugs for another health problem.

Sometimes it is must to avoid some particular medicines during this drug therapy in order to get rid of serious drug reactions such as:

  • May reduce arterial responsiveness to pressor amines e.g. norepinephrine.
  • Orthostatic hypotension may occur with alcohol, barbiturates, and narcotics. Discontinue diuretics 2-3 days before initiation of an ACE inhibitor to reduce the likelihood of 1st dose hypotension.
  • Increased hypokalemia with corticosteroids or ACTH. Attenuation of diuretic, natriuretic and antihypertensive effects of diuretics with NSAIDs. 
  • Increased hyponatremia with chlorpropamide. 
  • Increased hyperkalemia with ciclosporin, tacrolimus, indomethacin and angiotensin II receptor antagonists.  
  • Increased risk of hyperkalemia with other potassium-sparing diuretics (e.g. spironolactone or triamterene). 

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Moduretic 5-50. These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Additionally, your health care professional may advise you about the ways how to prevent or reduce those unwanted side-effects. Sometimes you may need to consult with the doctor if you feel any serious discomfort.

The following side effects may warrant medical care immediately:

Electrolyte imbalance:  

  • Hyponatraemia
  • Hypochloraemic alkalosis
  • Hypokalaemia and Hypomagnesaemia

Common side effects:

Rare side effects:

  • Encephalopathy
  • Stupor
  • Tremor
  • Vertigo
  • Decreased libido
  • Depression
  • Agranulocytosis
  • Aplastic anaemia
  • Haemolytic anaemia
  • Leucopenia
  • Neutropenia
  • Purpura and thrombocytopenia
  • Alopecia
  • Dyspnea and respiratory distress
  • Sleepiness and somnolence
  • Nasal congestion
  • Tinnitus
  • Visual disturbance and xanthopsia
  • Bladder spasm
  • Dysuria
  • Impotence
  • Incontinence
  • Polyuria
  • Nocturia
  • Renal dysfunction etc.
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