Moduretic is used for treating fluid retention (edema) and high blood pressure. It may be used alone or with other medicines.
Other names for this medication:
Also known as: Amiloride hydrochlorothiazide.
Moduretic is a diuretic (water pill) and a combination of a potassium-sparing diuretic (amiloride) and a thiazide diuretic (hydrochlorothiazide). It works by making the kidneys eliminate sodium (salt) and water from the body, which helps to lower blood pressure. The amiloride component helps minimize potassium loss.
Brand name of Moduretic is Moduretic.
Take Moduretic by mouth with food.
Moduretic may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
If you want to achieve most effective results do not stop taking Moduretic suddenly.
If you overdose Moduretic and you don't feel good you should visit your doctor or health care provider immediately.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) away from moisture, light and heat. Do not freeze. Keep container closed tightly. Throw away any unused medicine after the expiration date. Keep out of the reach of children.
The most common side effects associated with Moduretic are:
Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.
Do not take Moduretic if you are allergic to Moduretic components or to any ingredient in Moduretic or any other sulfonamide (eg, sulfamethoxazole).
Be careful with Moduretic if you're pregnant or you plan to have a baby, or you are a nursing mother.
Be careful with Moduretic if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement.
Be careful with Moduretic if you have allergies to medicines, foods, or other substances.
Be careful with Moduretic if you have cirrhosis or liver problems, diabetes, gout, kidney problems or kidney stones, asthma, heart problems, or systemic lupus erythematosus.
Be careful with Moduretic if you have elevated blood acid, low folic acid levels, or electrolyte problems, or are dehydrated.
Be careful with Moduretic if you take potassium-sparing diuretics (eg, spironolactone), potassium supplements, or salt substitutes containing potassium because high blood potassium levels may occur and cause listlessness, confusion, abnormal skin sensations of the arms and legs, heaviness of limbs, slowed heart rate, irregular heart rhythm, or stopping of the heart; cholestyramine or colestipol because they may decrease Moduretic 's effectiveness; nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin) because they may decrease Moduretic 's effectiveness and risk of kidney problems may be increased; barbiturates (eg, phenobarbital), certain chemotherapy medicines, corticosteroids (eg, prednisone), digoxin, dofetilide, ketanserin, narcotic pain medicines (eg, codeine), or medicines for high blood pressure because the risk of their side effects may be increased by Moduretic; diazoxide, lithium, or nondepolarizing neuromuscular blockers (eg, pancuronium) because their actions and the risk of their side effects may be increased by Moduretic; angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril) because the risk of high blood potassium and kidney problems may be increased by Moduretic; diabetes medicines (eg, glipizide) or insulin because their effectiveness may be decreased by Moduretic.
Do not stop taking Moduretic suddenly.
Impaired salivary gland function can be a major cause of late morbidity following the treatment of head and neck cancer with radiotherapy. A large number of commonly prescribed medications can also reduce salivary gland function. We report three patients with already impaired salivary gland function following successful radiotherapy in whom additional prescribed medication led to an increased reduction in salivary flow, thus further impairing the quality of life of these patients. Stopping the medication resulted in subjective and objective improvement in salivary gland function.
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A low-renin status characterized two-thirds of patients with treatment-resistant hypertension, who could be treated efficiently by aldosterone inhibition. Patients with an escape phenomenon (18%) could effectively be treated by increasing the aldosterone inhibitor. Low-renin hypertensives had high prevalence of adrenocortical adenomas and primary aldosteronism.
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The authors assessed in 24 men with stable angina pectoris, using means of ergometry, the antiischaemic and antianginose effects of a combination of the nitrate Iso-Mack retard and the diuretic Moduretic. The effects were compared with the effects of Iso-Mack retard administered alone and with the effects of placebo. The examination was made after a single dose of the drugs and after three-week administration. The authors revealed that a single dose of the diuretic significantly enhanced the effects of nitrate. During long-term administration the diuretic did not prevent a significant diminution of the nitrate effects. Finally the authors discuss possible mechanisms of development of tolerance for nitrates and possibilities how to influence this tolerance by a diuretic.
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In a randomized double blind study 100 men (mean age 46 (22-64) years) with mild to moderate hypertension were followed every 3rd month for one year. Fifty were randomized to atenolol 50 mg and 50 to hydrochlorothiazide 25 mg+amiloride 5 mg (co-amiloride) once daily. The doses were doubled at 3 or 6 months if diastolic blood pressure (DBP) remained > or = 95 mmHg. If DBP was > or = 95 mmHg even at 6 or 9 months, patients were classified as non-responders, and nifedipine 20 mg b.i.d. was added. After one year 31/50 randomized to atenolol and 17/50 randomized to co-amiloride had responded to monotherapy (p < 0.05). Neither clinical findings nor haemodynamic measurements by Doppler at baseline could distinguish between co-amiloride responders and non-responders. Conversely, non-responders to atenolol as compared with atenolol responders had higher body weight (p = 0.02), higher systolic BP (p = 0.03), higher DBP (p = 0.009), stroke volume (p = 0.04), and cardiac output (p = 0.0002) combined with lower total systemic vascular resistance (p = 0.02). This suggests that some were apparent non-responders due to too low dosing of atenolol rather than true non-responders. Measurements of haemodynamics may be of importance in the assessment of optimal antihypertensive therapy according to baseline and follow-up haemodynamic aberrations.
The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS)
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A new beta-adrenoreceptor blocking drug (timolol) was used in two clinical studies. In the first double blind study administration of hydrochlorothiazide and timolol reduced the mean (formula: see text) blood pressure by 23 mm Hg, compared with a fall of nine mm Hg with administration of hydrochlorothiazide and a placebo. Plasma potassium (K+) levels fell with the administration of hydrochlorothiazide alone, but rose back to control values when patients were given timolol. In the second study (patient blind), Moduretic (hydrochlorothiazide, 50 mg and amiloride, 5 mg) and timolol were given once daily. The mean blood pressure fell by 20 +/- 2 mm Hg allowing hypertension to be controlled by this once-daily regimen; the control persisted throughout the day. Plasma potassium (K+) levels fell slightly after treatment with Moduretic, but the fall was not as great as with hydrochlorothiazide. Of the 65 patients who entered these studies, 35 had not been previously treated and had diastolic blood pressure between 105 mm Hg and 130 mm Hg. In 18 patients the diastolic blood pressure was reduced below 95 mm Hg after treatment with a diuretic alone, in 15 patients treatment with a diuretic and timolol (5 mg to 20 mg) reduced the diastolic blood pressure below 95 mm Hg. In two patients, the diastolic blood pressure was between 95 mm Hg and 100 mm Hg. The response achieved with a relatively simple therapeutic regimen that can be administered once daily suggests that the therapy of most hypertensive patients could be supervised by paramedical personnel.
The authors have performed a between-patient study in 76 patients with mild or moderate essential arterial hypertension, with the aim of comparing the results of atenolol 100 mg daily, hydrochlorothiazide 50 mg + amiloride 5 mg 1 tablet daily, and the combination of the above two agents at the same daily doses. Thirty-one patients received the free combination diuretic-beta-blocker throughout the study period; 26 patients non-responders to atenolol 100 mg daily (supine diastolic blood pressure greater than 90 mmHg) after a one-month treatment period received the above combination for a further four months; and 19 patients non-responders to hydrochlorothiazide 50 mg + amiloride 5 mg, 1 tablet daily, after a one-month treatment period received the above combination for a further four months. In the patients who were non-responders to either atenolol or the diuretic, supine and upright blood pressure showed a further and clinically consistent decrease as a result of the combination therapy. A similar consistent decrease was seen in the patients receiving the combination therapy throughout the study. Plasma levels of glucose, urea, creatinine, sodium, potassium and uric acid were not modified either by the single agents or during administration of the combination therapy. In particular, plasma potassium concentration did not show any statistical or clinical changes. Any side-effects were of little clinical importance and never required discontinuation of therapy. In conclusion, atenolol combined with hydrochlorothiazide + amiloride (100 mg + 50 mg + 5 mg) provides an effective and well tolerated blood pressure control in most patients with mild or moderate arterial hypertension, including non-responders to diuretic or beta-blocker alone.
Three patients with impaired renal function suffered complications of hyperkalaemia within 10 days of beginning therapy with hydrochlorothiazide and amiloride combination (Moduretic). The possible relationship between hyperkalaemia and this diuretic is discussed.
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Physicians' prescribing of anti-hypertensive drug combinations in a tertiary care setting in southwestern Nigeria is considerable. However, this practice does not appear to have positively impacted on blood pressure control among hypertensive patients nor being modulated by an Institutionalised standard guide.
Twenty hypertensive outpatients WHO stage I or II, with supine diastolic blood pressure greater than or equal to 95 mmHg at the end of a 4-week treatment period with atenolol (Tenormin) 100 mg daily, continued atenolol in free association with half a tablet of Moduretic (i.e., hydrochlorothiazide 25 mg + amiloride 2.5 mg) for a further 4 weeks. Atenolol monotherapy induced a drop of systolic blood pressure from 175.0 +/- 11 (mean +/- s.d.) mmHg to 158.7 +/- 6 mmHg (p less than 0.01), and of diastolic blood pressure from 113.5 +/- 8 mmHg to 102.7 +/- 5 mmHg (p less than 0.01). After 4 weeks with atenolol in association with half a tablet of Moduretic, systolic blood pressure further decreased to 145.7 +/- 8 mmHg (p less than 0.01), and diastolic blood pressure to 90.2 +/- 10 mmHg (p less than 0.01). Seven out of 20 patients remained with diastolic blood pressure greater than or equal to 95 mmHg despite the above combination therapy. In these patients, the doubling of diuretic dose (hydrochlorothiazide 50 mg + amiloride 5 mg) in combination with atenolol resulted in a further drop in systolic pressure (to 142.1 +/- 9 mmHg) and diastolic (to 92.1 +/- 6 mmHg) (both p less than 0.01). Plasma potassium concentration showed a slight and non-significant increase during atenolol monotherapy (from 4.4 +/- 0.5 mEq/l to 4.6 +/- 0.7 mEq/l; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)
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A comparative study was made of the effects of a new therapeutic agent consisting of 50 mg captopril and 25 mg hydrochlorothiazide (Capozide) with an already existing agent Moduretic (50 mg hydrochlorothiazide and 5 mg amiloride). In the Capozide group (32 patients), 20 achieved normal blood pressure, 8 responded but were not brought under control, and 3 were non-responders. In the Moduretic group (31 patients), 17 achieved normal blood pressure, 10 were partially controlled and 4 were non-responders. Moduretic appeared to be most effective in patients previously untreated or who had been taking only one drug, while Capozide controlled patients who had been taking 1 or 2 antihypertensive drugs which had been either ineffective or poorly tolerated. The long-acting effect of a single dose of Capozide was demonstrated by blood pressure measurements taken at least 10 hours later. Both drugs were generally well tolerated and no significant changes were observed in the laboratory measurements. The combination of an angiotensin converting enzyme inhibitor with a diuretic proved more effective than single agents in lowering raised blood pressure. We therefore conclude that Capozide is an effective alternative to traditional medication in the treatment of moderate hypertension.
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An open parallel study was carried out in general practice on 70 patients with uncomplicated mild to moderate hypertension to compare the hypotensive efficacy of hydrochlorothiazide/amiloride with that of cyclopenthiazide/potassium. After a 2-week baseline period on placebo, patients were allocated at random to receive treatment with one or other of the diuretics starting with 1 tablet per day and increasing up to a maximum of 4 tablets per day or until their supine diastolic blood pressure was 90 mmHg or less. They were then continued at their optimum dose for a further 4 weeks. Analysis of the results from 62 patients showed that the hydrochlorothiazide/amiloride preparation produced both a greater decrease and better control of blood pressure in a greater percentage of patients that did the comparison diuretic. In addition, the beneficial effects were attained with fewer tablets, of importance for patient compliance.
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A method has been developed for the separation of hydrochlorothiazide and amiloride by high-performance liquid chromatographic (HPLC) method on a C18 column with detection at 280 nm. The optimal conditions of separation were determined with the aid of 'window diagram' technique of Laub and Purnell. The effect of simultaneously varying the pH, proportion aqueous acetic acid and methanol in the mobile phase were studied to optimize the separation. A response surface diagram was used to optimize the experimental conditions for the separation. The mobile phase composition that provides an acceptable resolution hydrochlorothiazide and amiloride in a short elution time is water:methanol (60:40) and pH 3.2 (pH adjusted to 3.2 with CH3COOH). A method is applied for the quantitative analysis of Moduretic tablets (Merck Sharp & Dokme International). The powdered tablets are extracted with methanol, containing caffeine as the internal standard, and assayed by comparison of peak areas after liquid chromatography.
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The purpose of this study was to identify the frequency of cardiac dysrhythmias in two similar groups of hypertensive middle-aged males (age 45-66). They had previously been randomized either to a diuretic treatment (n = 42), or a beta-blocking agent (n = 41). A 24-hour ambulatory Holter monitoring, and serum potassium, was obtained in all patients, serum magnesium was measured in 35 patients. The mean number of ventricular premature beats (VPBs) and the frequency of complex arrhythmias (19 vs. 5) was significantly higher in the diuretic group (p less than 0.01). The serum potassium was significantly lower (p less than 0.001) in the diuretic group, and there was a significant (p less than 0.005) inverse correlation between the number of VPBs and the serum potassium in all treated patients. The patients with complex arrhythmias were older (p less than 0.01) than the remainder of the patients. No correlation between serum magnesium and VPBs or complex arrhythmias was found. This study demonstrates increased frequency of VPBs in older hypertensive males, treated with diuretics, and that hypokalaemia predisposes to increased cardiac arrhythmias. We conclude that in older mildly hypertensive men hypokalaemia should be avoided.
Common carotid artery intima-media thickness (IMT) progression was compared between 4 years of treatment with nifedipine and diuretic.
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In a controlled double-blind crossover study followed by an open longterm continuation period, the antihypertensive effect of timolol (Blocadren), a new beta-receptor antagonist, was investigated in 24 ambulatory patients with mild to moderate essential hypertension who were concomitantly receiving Moduretic as baseline diuretic therapy. The addition of timolol to one tablet daily Moduretic resulted in a clinically and statistically significant further reduction of supine and upright systolic and diastolic blood pressures. The average total daily dosage schedule for timolol ranged between 15 and 20 mg, with the same blood pressure lowering effect whether the divided dose was given twice or three times. Significant sinus bradycardia was consistently observed but well tolerated, with only one patient requiring dose reduction. After 48 weeks of treatment (comprising 46 weeks Moduretic and 36 weeks timolol) 20 of 22 patients were normotensive (supine diastolic blood pressure below 90 mm Hg) while in two the hypotensive response proved inadequate. One patient was dropped from the study after 3 days of timolol treatment because of acute bronchial asthma. When specifically questioned, one-third of the patients admitted experiencing cold extremities. One patient exhibited Raynaud's syndrome which was treated symptomatically while continuing in the study. In terms of electrolyte balance, the fixed combination of hydrochlorothiazide and the antikaluretic amiloride (Moduretic) as baseline therapy essentially proved adequate. On occasion, however, two subject revealed hypokalemia requiring short-term oral potassium supplement. During the initial 10 to 16 weeks a steady decline in serum potassium was observed but this stabilized itself thereafter. The concomitant administration of Moduretic and timolol (Blocadren) was shown to be an effective therapeutic regimen in patients with mild to moderate essential hypertension. This combination is particularly suitable for patient compliance in longterm therapy, as timolol can be given twice daily.
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A study was carried out of plasma electrolyte estimations made before and after long-term use of a combination of amiloride and hydrochlorothiazide in 23 patients. The mean duration of use was 20.3 months. No significant differences were found in plasma potassium, sodium, bicarbonate or urea from baseline levels.
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A cross-over study comparing the effects of doxazosin, moduretic and amlodipine on fasting blood glucose and blood pressure levels in 9 adult hypertensive Nigerians is presented. The results showed that doxazosin, moduretic and amlodipine were effective in reducing diastolic blood pressure and thus confirmed our previous observation of blood pressure reduction during the monotherapies of these antihypertensive agents. The study further indicated the effectiveness of doxazosin in the management of severe essential hypertension in Nigerian patients. Fasting blood glucose level significantly decreased during doxazosin treatment phase and increased during moduretic phase, while amlodipine treatment did not have any effect on blood glucose level. In conclusion, the cross-over study seem to confirm the effectiveness of doxazosin therapy and its antidiabetic effect in hypertensive patients. The effectiveness of amlodipine therapy in controlling blood pressure was also observed, but no effect on blood glucose level, while moduretic therapy has hyperglycemic effect despite its effectiveness in blood pressure control in African patients.
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In a multicenter open-label clinical trial, eligible patients were randomized to receive treatment with amlodipine 2.5-5 mg plus amiloride/hydrochlorothiazide 1.25-2.5 mg/12.5-25 mg (Group A) or amlodipine 2.5-5 mg plus telmisartan 40-80 mg (Group T). If a target BP was not reached, other antihypertensive agents would be added. The target BP was <130/80 mmHg for patients with diabetes mellitus or chronic kidney disease and <140/90 mmHg for others. Efficacy variables were changes from baseline in systolic BP and diastolic BP at the endpoint of 96 weeks. Safety evaluations included monitoring of any adverse events (AEs).
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Among 54 patients attending a hospital hypertension clinic and receiving the fixed-combination diuretic Moduretic (hydrochlorothiazide 50 mg, amiloride 5 mg), there was a 44.4% incidence of hypokalaemia. The mean drop in plasma potassium level was 0.69 mmol/L (P less than 0.0001), the mean low level being 2.81 mmol/L. Seventy-four per cent of falls occurred within 52 weeks of the start of therapy, 19.5 weeks being the average period between a normal and a low plasma potassium level. There was no difference in the fall in potassium level between male and female subjects, and beta-blockers were not obviously protective, although there was a statistically significant smaller fall in potassium level in females treated with them. The clinical significance of the unexpected hypokalaemia is uncertain; but even with fixed-combination diuretics, it remains necessary to monitor the plasma potassium level regularly in order to avoid complicating situations. The results of the present study would cast doubt on the efficacy of 5 mg of amiloride with 50 mg of hydrochlorothiazide in fixed-combination form in preventing hypokalaemia in this clinical situation.
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A cross-over study was done to compare the effects of doxazosin, moduretic and amlodipine on biochemical values in 9 hypertensive Nigerians aged 35 to 65 years. Doxazosin therapy was characterized by significant increase in the levels of mean plasma total protein and albumin, while moduretic therapy showed significant reduction in the mean values of plasma creatinine and calcium. All other parameters did not show any significant variation during doxazosin and moduretic treatment phases; and amlodipine therapy did not have any effect on the biochemical values of the hypertensive patients.
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Plasma potassium and sodium concentrations were measured in a group of elderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.
This study aims to describe factors associated with cognitive decline among 2584 subjects, aged 65-74, who were followed up for 54 months in the Medical Research Council Elderly Hypertension Trial (1982-1989). The subjects completed a cognitive test, the Paired Associate Learning Test (PALT), five times over this period. Decline on the PALT was associated with advanced age, male sex, rural residence, depression and low intelligence. These effects were modified by gender and level of pre-morbid intelligence. Advanced age, rural residence and number of cigarettes smoked daily were only associated with PALT decline among women of below median intelligence. The association between depression and PALT decline was only apparent in women of below median intelligence and men of above median intelligence. While these findings are consistent with other research into cognitive decline, they differ in some ways from reported risk factors for dementia, suggesting aetiological separateness. That women were more vulnerable than men to the effects of age and smoking raises the question of the impact on cognition of accelerated atherosclerosis after the menopause.
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Thirty-seven patients (19 Blacks and 18 Indians) suffering from mild hypertension were given each of five diuretics separately for 4 weeks after a 'washout' period on placebo of the same duration. The diuretics used were hydrochlorothiazide 25 mg/d (Dichlotride; Frosst MSD), hydrochlorothiazide 25 mg plus triamterene 50 mg (Dyazide; SKF) 1 tablet per day, amiloride hydrochloride 5 mg plus hydrochlorothiazide 50 mg (Moduretic; MSD) 1 tablet per day, chlorthalidone (Hygroton; Geigy) 50 mg/d and indapamide (Natrilix; Servier) 2.5 mg/d. The study showed that during the acute phase of diuretic therapy for the treatment of hypertension plasma potassium levels were decreased by thiazide and thiazide-like diuretics and increased by potassium-sparing diuretics. However, despite the decrease in plasma potassium levels produced by thiazide diuretics and indapamide these levels did not fall to 3.0 mmol/l or less. All the diuretics were effective in lowering the standing mean arterial pressure when compared with placebo values. In the absence of significant hypokalaemia, the choice of a diuretic for the Black hypertensive patient should therefore be determined by its cost.
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