Amiloride-Hydrochlorothiazide

One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics. Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

Thiazide diuretics can increase urinary zinc loss.

Licorice (Glycyrrhiza glabra) may increase the side effects of potassium-depleting diuretics, including thiazide diuretics. Thiazide diuretics and licorice should be used together only under careful medical supervision. At the time of this writing, no evidence was found of interactions between deglycyrrhizinated licorice (DGL) and any diuretic was found in the medical literature.

As a potassium-sparing drug, amiloride reduces urinary loss of potassium. This can cause potassium levels to build up in the body. People taking this drug should avoid use of potassium chloride–containing products, such as Morton Salt Substitute, No Salt, Lite Salt, and others. Even eating several pieces of fruit per day can sometimes cause problems for people taking potassium-sparing diuretics, due to the high potassium content of fruit.

However, one medication (Moduretic) contains the combination of the potassium-sparing drug amiloride and the potassium-depleting drug hydrochlorothiazide. With the use of Moduretic, potassium excess and potassium depletion are both possible. People taking this combination drug should have their potassium levels monitored by a doctor to determine whether their potassium intake should be increased, reduced, or kept the same.

One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.

Preliminary research in animals suggests that amiloride may reduce the urinary excretion of magnesium. It is unknown if this same effect would occur in humans. Nevertheless, persons taking more than 300 mg of magnesium per day and amiloride should consult with a doctor, as this combination may lead to potentially dangerous elevations in levels of magnesium in the body. The combination of amiloride and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys. As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.

The reduction in urinary calcium loss resulting from treatment with thiazide diuretics is due primarily to changes in kidney function and may also be due, in part, to changes in vitamin D metabolism. However, there is no evidence to suggest that people taking diuretics have different requirements for vitamin D.

Use buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.

Use buckthorn (Rhamnus catartica, Rhamnus frangula, Frangula alnus) or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.