-I find the potassium-sparing diuretic amiloride to be underutilized. Not only can potassium chloride cause abdominal discomfort, but certain tablet formulations are difficult to swallow. Moreover, potassium chloride has no antihypertensive properties at low doses.
-In contrast, my patients don't report similar gastrointestinal symptoms or difficulty swallowing amiloride. Also, amiloride likely lowers BP at doses of 10mg and above.
-I commonly prescribe 10 mg which raises serum potassium levels by about 0.3 mEq/L, an adequate dose to correct diuretic-induced hypokalemia. I do find an effect on BP, but not as large as this meta-analysis would suggest.
-Unfortunately, amiloride is only available as 5 mg tablets, thus higher doses increase pill count. The combination form (amiloride 5- hydrochlorthiazide 50) is ill advised as it contains too little amiloride for the hydrochlorothiazide dose.
-If a more potent potassium-sparing diuretic is required, spironolactone will both increase serum potassium levels and significantly lower BP. See this previous
newsletter for details.
-Disclosures: I have no conflicts of interest.