page107
Hepatic impairment
see notes above
Renal impairment
see notes above
Pregnancy
see notes above
Breast-feeding
no information available;
may inhibit
lactation
Side-effects
see notes above;
also gynaecomastia,
breast pain,
musculoskeletal pain (associated with
high doses in renal failure)
Dose
. By mouth,
1 mg in the morning, repeated after 6–8
hours if necessary; severe cases, 5 mg daily increased
by 5 mg every 12–24 hours according to response;
ELDERLY
,
500 micrograms daily may be sufficient
. By intravenous injection,
1–2 mg,
repeated after 20
minutes if necessary;
ELDERLY
,
500 micrograms daily
may be sufficient
. By intravenous infusion, 2–5 mg over 30–60 minutes;
ELDERLY
,
500 micrograms daily may be sufficient
. By intramuscular injection,
1 mg initially then
adjusted according to response;
ELDERLY
,
500 micr-
ograms daily may be sufficient
Bumetanide
(Non-proprietary) A
Tablets
,
bumetanide 1 mg,
net price 28-tab pack =
£1.12;
5 mg,
28-tab pack = £4.33
Oral liquid
, bumetanide 1 mg/5 mL, net price 150 mL
= £128.00
Injection
, bumetanide 500 micrograms/mL, net price
4-mL amp = £1.79
Burinex
c
(LEO) A
Tablets
,
scored,
bumetanide 1 mg,
net price 28-tab
pack = £1.52;
5 mg,
28 = £9.67
TORASEMIDE
Indications
oedema (see notes above),
hypertension
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
see notes above
Pregnancy
manufacturer advises avoid—toxicity in
animal
studies
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see notes above;
also dry mouth;
rarely
limb paraesthesia
Dose
. Oedema,
5 mg once daily,
preferably in the morning,
increased if required to 20 mg once daily; usual max.
40 mg daily
. Hypertension,
2.5 mg daily,
increased if necessary to
5 mg once daily
Torasemide
(Non-proprietary) A
Tablets
,
torasemide 5 mg,
net price 28-tab pack =
£10.36;
10 mg,
28-tab pack = £13.71
Torem
c
(Meda) A
Tablets
,
torasemide 2.5 mg,
net price 28-tab pack =
£3.78;
5 mg (scored),
28-tab pack = £5.53;
10 mg
(scored),
28-tab pack = £8.14
2.2.3
Potassium-sparing
diuretics and aldosterone
antagonists
Amiloride and triamterene on their
own are weak
diuretics.
They cause retention of
potassium and are
therefore given with thiazide or loop diuretics as a more
effective alternative
to potassium supplements.
See
section 2.2.4 for compound preparations with thiazides
or loop diuretics.
Potassium supplements must not be given with potas-
sium-sparing diuretics.
Administration of
a potassium-
sparing diuretic to a patient receiving an ACE inhibitor
or an angiotensin-II receptor antagonist can also cause
severe hyperkalaemia.
AMILORIDE HYDROCHLORIDE
Indications
oedema; potassium conservation when
used as an adjunct to thiazide or loop diuretics for
hypertension,
congestive heart failure,
or hepatic
cirrhosis with ascites
Cautions
monitor electrolytes;
diabetes mellitus;
elderly;
interactions: Appendix 1 (diuretics)
Contra-indications
hyperkalaemia;
anuria;
Addison’s
disease
Renal impairment
monitor plasma-potassium con-
centration (high risk of hyperkalaemia in renal
impairment);
manufacturers advise avoid in severe
impairment
Pregnancy
not used to treat gestational hypertension
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
include gastro-intestinal disturbances,
dry mouth,
rashes,
confusion,
postural hypotension,
hyperkalaemia,
hyponatraemia
Dose
. Used alone,
initially 10 mg daily
or
5 mg twice daily,
adjusted according to response;
max.
20 mg daily
. With other diuretics,
congestive heart failure and
hypertension,
initially 5–10 mg daily; cirrhosis with
ascites,
initially 5 mg daily
Amiloride
(Non-proprietary) A
Tablets
,
amiloride hydrochloride 5 mg,
net price 28-
tab pack = 96p
Oral solution
,
sugar-free,
amiloride hydrochloride
5 mg/5 mL,
net price 150 mL = £39.73
Brands include
Amilamont
c
(Excipients include propylene glycol,
see Excipients, p.
2)
Compound preparations with thiazide or loop
diuretics
Section 2.2.4
TRIAMTERENE
Indications
oedema, potassium conservation with
thiazide and loop diuretics
Cautions
see under Amiloride Hydrochloride;
may
cause blue fluorescence of urine
Contra-indications
see under Amiloride Hydro-
chloride
Renal impairment
monitor plasma-potassium con-
centration (high risk of hyperkalaemia in renal
BNF 61
2.2.3 Potassium-sparing diuretics and aldosterone antagonists
87
2
Cardiovascular system