amiloride/hydrochlorothiazide / Generic mfg. - LARVOL DELTA

A Case of Severe Polyuria: Diagnostic Challenges and Management of Nephrogenic Diabetes Insipidus (ENDO 2025) - "Treatment with hydrochlorothiazide (50 mg daily), amiloride (5 mg daily), and a low-salt, low-protein diet decreased urinary output to about 5 liters per day. Hereditary AVP-R, as seen in this patient, is a rare condition characterized by varying degrees of resistance to AVP. Approximately 90% of hereditary cases are linked to X-linked AVPR2 mutations (2,3), underscoring the importance of genetic testing. This case shows the difficulties in distinguishing AVP-R (NDI) from other causes of polyuria and demonstrates the pivotal role of desmopressin testing in confirming the diagnosis."

Clinical • Cardiovascular • Endocrine Disorders • Hypertension • Infectious Disease • Metabolic Disorders • Pneumonia • Respiratory Diseases

Congenital nephrotic syndrome due to MAGI2 mutation in two Brazilian siblings, one with concomitant galactosemia (GALT-1): A case report (IPNA 2025) - "Eventually, intravenous albumin was tapered to weekly infusions and then discontinued, with edema managed enterally using captopril, furosemide, amiloride, hydrochlorothiazide, and dietary optimization. Conclusions Genetic testing was crucial in diagnosing the older sister, and it enabled a swift suspicion in the case of the younger brother. Conducting WGS facilitated the diagnosis of another concurrent comorbidity, which wouldn't have been possible with a genetic panel."

Case report • Clinical • Cardiovascular • Cholestasis • Dyslipidemia • Focal Segmental Glomerulosclerosis • Glomerulonephritis • Hepatology • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Septic Shock

Combination of Diuretics in States of Resistant Nephrotic Edema: a Case Presentation. (PubMed, Maedica (Bucur)) - "We report the case of a 36-year-old man presenting with nephrotic edema managed with a combination of furosemide and human albumin...On the third day, a regimen comprising amiloride (5 mg/day) and hydrochlorothiazide (50 mg/day) was initiated, resulting in complete resolution of edema after 11 days. No hyperkalemia was observed, with only a slight elevation in serum creatinine levels. Although clinical trials are limited, mounting evidence from human and animal studies supports the concept of nephrotic syndrome as an overfill phenomenon and underscores the potential benefits of ENaC blockers in the management of nephrotic edema."

Journal • Glomerulonephritis • Nephrology • Renal Disease

Involvement of Cholinergic and Cyclooxygenase Pathways in the Diuretic Effects of Rosmarinic Acid. (PubMed, Chem Biodivers) - "To investigate this, we examined the diuretic activity of RA alone and in combination with hydrochlorothiazide (HCTZ), amiloride (AML), atropine (ATR), and indomethacin (INDO) to see if any of these drugs could interfere with RA's activity in an 8-hour acute diuresis animal model. ATR and INDO prevented RA from increasing urine excretion, suggesting a potential interaction with muscarinic receptors or a role in promoting prostaglandin production. Additionally, molecular docking analysis indicated possible interactions with key receptors involved in increased diuresis or free-electrolyte water excretion."

Journal • Acute Myelogenous Leukemia

5/6 Nephrectomy Impairs Acute Kaliuretic Responses and Predisposes to Postprandial Hyperkalemia. (PubMed, Am J Physiol Renal Physiol) - "The natriuretic and kaliuretic responses to furosemide, hydrochlorothiazide, and amiloride were largely similar between 5/6Nx and sham rats except for a significantly reduced kaliuretic response to hydrochlorothiazide in 5/6Nx rats. In contrast, the acute K+ load decreased the Na+/hydrogen exchanger 3 (NHE3) and increased serum- and glucocorticoid-regulated kinase 1 (SGK1) and the α-subunit of the epithelial sodium channel (ENaC) only in sham rats. Together, our data show that 5/6Nx impairs the natriuretic and kaliuretic response to an acute dietary K+ load which is further characterized by a loss of ENaC adaptation and the development of postprandial hyperkalemia."

Journal • Chronic Kidney Disease • Nephrology • Renal Disease

THE PREVENTION OF STROKE IN HIGH-RISK HYPERTENSIVE PATIENTS (ESOC 2024) - " In a prospective, randomized, open-label, blinded-endpoint trial, 13542 hypertensive patients at high risk for cardiovascular events were assigned to receive treatment with either amlodipine plus amiloride/hydrochlorothiazide (n = 6776) or telmisartan (n = 6766). The diuretics-based combination treatment was more efficacious in preventing stroke than telmisartan-based therapy in hypertensive patients with high cardiovascular risk, independent of blood pressure reduction."

Clinical • Cardiovascular • Ischemic stroke

A Rare Case of Congenital Nephrogenic Diabetes Insipidus Associated with Aquaporin 2 Gene Mutation and Subsequent Acute Lymphoblastic Leukemia: Impact of Steroids on Kidney Function. (PubMed, Am J Case Rep) - "He was treated with hydrochlorothiazide and amiloride. CONCLUSIONS We report a rare case of NDI caused by a missense mutation in the aquaporin 2 gene. One year later, the child developed ALL, and treatment with dexamethasone led to an uncompensated state of polydipsia and polyuria."

Journal • Acute Lymphocytic Leukemia • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Leukemia • Metabolic Disorders • Nephrology • Oncology • Renal Disease • T Acute Lymphoblastic Leukemia

Evaluation of the translation of multiple cardiovascular regulatory mechanisms in the anesthetized dog. (PubMed, J Pharmacol Toxicol Methods) - "The hemodynamic effects of 11 drugs (atropine, itraconazole, atenolol, ivabradine, milrinone, enalaprilat, fasudil, amlodipine, prazosin, amiloride, and hydrochlorothiazide) were profiled in an anesthetized dog cardiovascular model. Interestingly but not unexpected, 1 of 11 failed to display their predicted CV pattern which is likely due to a delay in pharmacodynamic effect that is beyond the duration of the experimental model (hydrochlorothiazide). The analysis from the current study supports the strategic use of the anesthetized dog model early in the drug discovery process for a comprehensive cardiovascular evaluation with good translation to human."

Journal • Anesthesia • Cardiovascular

Oral Furosemide and Hydrochlorothiazide/Amiloride versus Intravenous Furosemide for the Treatment of Resistant Nephrotic Syndrome. (PubMed, J Clin Med) - "A combination of oral diuretics based on furosemide, amiloride and hydrochlorothiazide is non-inferior to i.v. furosemide in weight control of patients with RNE and a similar safety profile."

Journal • Acute Kidney Injury • Glomerulonephritis • Hypotension • Nephrology • Renal Disease

COMBINED ORAL DIURETICS: A BETTER ALTERNATIVE FOR NEPHROTIC EDEMA THAN INTRAVENOUS FUROSEMIDE? (ERA-EDTA 2023) - "Combined oral diuretics with furosemide, amiloride and hydrochlorothiazide is more effective and safer than intravenous furosemide for the treatment of refractory nephrotic edema. These results make amiloride a promising diuretic and further trials with larger sample sizes and longer follow-up are needed in this regard."

Acute Kidney Injury • CNS Disorders • Glomerulonephritis • Hypotension • Immunology • Inflammatory Arthritis • Insomnia • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Sleep Disorder

Mineralocorticoid Excess Syndrome with Abiraterone (ENDO 2023) - "Here we discuss a case of MES and strategies we implemented on treatment.Clinical Case: An 82-year-old patient with prostate cancer was treated with leuprolide, abiraterone, and prednisone. The patient later started furosemide for edema and hypertension...His prednisone was changed to dexamethasone to avoid any additional mineralocorticoid receptor agonist effect. To treat his MES, spironolactone and eplerenone were avoided to prevent potential androgen receptor agonism in the setting of his prostate cancer...Amiloride and hydrochlorothiazide were stopped... There is minimal literature on abiraterone induced endocrine side effects. This case will increase awareness of these and help endocrinologists individualize management of adverse effects experienced by prostate cancer patients on abiraterone."

Cardiovascular • Genito-urinary Cancer • Hypertension • Oncology • Prostate Cancer • Solid Tumor • AR

Diuretic and Natriuretic Effects of Hesperidin, a Flavanone Glycoside, in Female and Male Hypertensive Rats. (PubMed, Plants (Basel)) - "When given HSP in combination with hydrochlorothiazide (HCTZ) or amiloride (AMLR), urine volume and Na elimination were significantly increased compared to the group that received only HSP...Pre-treatment with a non-selective cholinergic receptor antagonist, atropine, partially prevented HSP-induced diuresis and natriuresis in male SHR, but this effect was not demonstrated with the non-selective inhibitor of the enzyme cyclooxygenase, indomethacin. This study shows the diuretic action of HSP in hypertensive rats, an activity probably associated with the cholinergic pathway. Although various biological actions have already been defined for HSP, this pioneering research reveals its potential as a diuretic medicine."

Journal • Preclinical

KCC3a, a Pathway for Potassium Loss in Alkalemia (KIDNEY WEEK 2022) - "We further show that treatment of wild-type mice with hydrochlorothiazide, amiloride, or fed a K + deficient diet up-regulated KCC3a levels, suggesting that volume depletion increases KCC3a abundance. In addition, KCC3a abundance increased significantly alongside pendrin abundance in bicarbonate-treated alkalotic mice, providing a credible mechanism for K + loss in metabolic alkalosis. Conclusion We showed that KCC3a is expressed in pendrin-expressing intercalated cells and propose a possible mechanism for K + loss in metabolic alkalemia."

Cardiovascular • Hypertension • Metabolic Disorders • Pain • CALB1 • SLC26A4 • TERC

Experimental CKD Increases Per-Nephron Sodium Reabsorption and Impairs Acute Kaliuresis (KIDNEY WEEK 2022) - "We compared Na + and K + transporter activity in CKD and sham-operated rats by assessing the response to furosemide, hydrochlorothiazide (HCTZ), or amiloride. These alterations in Na + and K + handling may explain the tendency towards salt-sensitive hypertension and hyperkalemia in CKD. Table"

Cardiovascular • Chronic Kidney Disease • Hypertension • Nephrology • Renal Disease

KCC3a, a Strong Candidate Pathway for K Loss in Alkalemia. (PubMed, Front Cell Dev Biol) - "We further show that treatment of wild-type mice with hydrochlorothiazide, amiloride, or fed a K-deficient diet up-regulates KCC3a level, suggesting that volume depletion increases KCC3a abundance. More importantly, abundance of the Cl/HCO exchanger, pendrin, which is known to secrete bicarbonate in alkalotic conditions, was significantly diminished in KCC3-knockout mice. In addition, KCC3a abundance increased significantly alongside pendrin abundance in bicarbonate-treated alkalotic mice, providing a credible mechanism for K loss in metabolic alkalosis."

Journal • Cardiovascular • Hypertension • Metabolic Disorders • Pain • CALB1 • SLC26A4

Nephrogenic diabetes insipidus induced by amphotenicin-B in a patient with rhinosinusal mucormycosis. About a case (Euroanaesthesia 2022) - "The dose was reduced to 3mg/kg/day and treated with hydrochlorothiazide and amilorine. A stimulation test with desmopressin (4mcg) was performed without obtaining a response.She was discharged on the 7th day, with GSC 15, ions and glycemia in range with insulin perfusion and reduction in the rate of diuresis. Although the new formulations of Amphotericin B have reduced its adverse effects, at doses of ≥10gr/kg, it can cause a “NDI like”, altering the tubular membrane and preventing endogenous ADH from acting in the collecting duct, so that ADH exogenous does not present a response, as happened with our patient.Maintained hyperglycemia, emetic symptoms, and the use of nephrotoxic drugs could perpetuate polyuria and worsen the internal environment and renal function.Although treatment is not clear, fluid replacement, electrolyte correction, and certain drugs such as Indomethacin, Hydrochlorothiazide, and Amiloride appear to be effective."

Clinical • Immunology • Infectious Disease • Metabolic Disorders • Pain

Nalfurafine, a G-Protein-Biased KOR (Kappa Opioid Receptor) Agonist, Enhances the Diuretic Response and Limits Electrolyte Losses to Standard-of-Care Diuretics. (PubMed, Hypertension) - "Here, we examined the cardiovascular and renal responses to intravenous and oral nalfurafine alone and in combination with furosemide, hydrochlorothiazide, or amiloride. Further, both intravenous and oral coadministration of nalfurafine enhanced the diuresis to amiloride and decreased sodium excretion. Together, these findings demonstrate that nalfurafine enhances the diuresis to standard-of-care diuretics without causing an excessive loss of electrolytes, offering a new approach to treat several cardiovascular conditions."

Journal • Cardiovascular

Mathematical Modeling for HPLC Separation and Quantification of an Anti-Hypertensive Combination by Response Surface Methodology. (PubMed, J AOAC Int) - "Response surface design is a powerful tool that could be used for predicting the significant factors for separation in HPLC. Optimization of the method conditions was done using a limited number of preliminary runs. The studied ternary mixture was fully separated in less than five minutes with the aid of experimental design."

Journal

Long-term amlodipine-based combination therapy attenuates seasonal variation of blood pressure in hypertensive patients. (PubMed, Clin Exp Hypertens) - "Among them, 106 patients received amlodipine plus amiloride/hydrochlorothiazide (AA group) and 100 received amlodipine plus telmisartan (AT group) therapies. Meanwhile, similar change was observed in AA and AT groups. Besides lower BP effectively, long-term amlodipine-based combination therapy could alleviate the seasonal BP variation in high-risk hypertensive patients."

Clinical • Combination therapy • Journal • Hypertension

The effect of amiloride in decreasing albuminuria in patients with diabetic kidney diseases: a prospective, crossover, open-label study. (PubMed, Ren Fail) - "The decrease of serum and urinary suPAR in the amiloride/hydrochlorothiazide (HCTZ) group was also significant compared with those patients using HCTZ as the control group. No significant difference in blood pressure, weight, serum sodium, serum potassium, cholesterol, triglyceride, uric acid was seen between the amiloride/HCTZ group and the control group. In summary, among patients with DKD, amiloride could decrease albuminuria without severe side effects, which was accompanied by the significant decline of urinary suPAR."

Clinical • Journal • Chronic Kidney Disease • Diabetic Nephropathy • Nephrology • Renal Disease

"Just had a serum Na 120 after amiloride + hydrochlorothiazide combination." (@huajern)

Dietary sodium intake does not alter renal potassium handling and blood pressure in healthy young males. (PubMed, Nephrol Dial Transplant) - "Neither spontaneous nor diuretic-induced potassium excretion were influenced by sodium intake in healthy male subjects. However, the respective contribution of the distal convoluted tubule and the collecting duct to renal sodium handling was dependent on dietary sodium intake."

Clinical • Journal • Hypertension • Renal Disease

Development and Validation of Two Chromatographic Methods for Simultaneous Determination and Quantification of Amiloride Hydrochloride, Hydrochlorothiazide, and Their Related Substances, in Pure and Tablet Forms. (PubMed, J AOAC Int) - "The methods were successfully applied for assays of the studied drugs in their pure and tablet forms. No significant difference was revealed through application of statistical comparison between results of the suggested methods and those of the reported method regarding both accuracy and precision."

Journal

A Randomized Trial of Distal Diuretics versus Dietary Sodium Restriction for Hypertension in Chronic Kidney Disease. (PubMed, J Am Soc Nephrol) - P4 | "Distal diuretics are noninferior to dietary sodium restriction in reducing BP and extracellular volume in CKD. Diuretic sensitivity in CKD is maintained despite lower diuretic clearance."

Clinical • Journal • Cardiovascular • Chronic Kidney Disease • Heart Failure • Hypertension • Nephrology • Renal Disease

[VIRTUAL] Extracellular Volume and Plasma Potassium Determine Urinary Prostaglandin E2 Excretion in Kidney Disease (KIDNEY WEEK 2020) - " Urinary PGE2 and PGE2 metabolite (PGEM) excretions were measured in two studies in chronic kidney disease patients: 1) a randomized cross-over trial comparing a low sodium (Na+) diet (60 mmol/day) with amiloride/hydrochlorothiazide (n=26, each intervention 2 weeks), 2) a 2-week intervention with potassium chloride supplementation (40 mmol day, n=28), and in patients with diabetic kidney disease from a 12-week randomized trial comparing dapagliflozin (n=23) with gliclazide (n=19). Interventions that decrease extracellular volume increase urinary PGE2 excretion. In addition, plasma renin, urinary Na+ excretion, and plasma potassium are independently associated with urinary PGE2 excretion. Our data suggest that in patients with kidney disease urinary PGE2 excretion not only reflects the kidney’s response to changes in extracellular volume but also plasma potassium."

Chronic Kidney Disease • Diabetic Nephropathy • Nephrology • Renal Disease