Midamor Uses

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What is Midamor?

Midamor is used in combination with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Midamor is also used to treat water retention (edema) in patients with congestive heart failure.

Midamor is a type of diuretic (water pill) that helps prevent your body from losing too much potassium. It reduces the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure.

Midamor is available only with your doctor's prescription.

Midamor indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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MIDAMOR (Midamor) is indicated as adjunctive treatment with thiazide diuretics or other kaliuretic-diuretic agents in congestive heartfailure or hypertension to:

The use of potassium-conserving agents is often unnecessary in patients receiving diuretics for uncomplicated essential hypertension when such patients have a normal diet. MIDAMOR (Midamor) has little additive diuretic or antihypertensive effect when added to a thiazide diuretic.

MIDAMOR (Midamor) should rarely be used alone. It has weak (compared with thiazides) diuretic and antihypertensive effects. Used as single agents, potassium sparing diuretics, including MIDAMOR (Midamor), result in an increased risk of hyperkalemia (approximately 10% with Midamor). MIDAMOR (Midamor) should be used alone only when persistent hypokalemia has been documented and only with careful titration of the dose and close monitoring of serum electrolytes.

How should I use Midamor?

Use Midamor as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Midamor.

Uses of Midamor in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Heart failure or hypertension: Counteracts potassium loss induced by other diuretics in the treatment of hypertension or heart failure; usually used in conjunction with more potent diuretics such as thiazides or loop diuretics

Note: Potassium-sparing diuretics are not recommended for the initial treatment of hypertension (ACC/AHA [Whelton 2017]).

Off Label Uses

Ascites

Data from a small randomized controlled trial in patients with nonazotemic cirrhosis treated with Midamor or potassium canrenoate support use of Midamor (although less effective than potassium canrenoate) for management of ascites in patients who do not tolerate treatment with spironolactone.

Midamor description

A pyrazine compound inhibiting sodium reabsorption through sodium channels in renal epithelial cells. This inhibition creates a negative potential in the luminal membranes of principal cells, located in the distal convoluted tubule and collecting duct. Negative potential reduces secretion of potassium and hydrogen ions. Midamor is used in conjunction with diuretics to spare potassium loss. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p705)

Midamor dosage

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Midamor Dosage

Generic name: Midamor

Dosage form: tablets

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

MIDAMOR should be administered with food.

MIDAMOR, one 5 mg tablet daily, should be added to the usual antihypertensive or diuretic dosage of a kaliuretic diuretic. The dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets of MIDAMOR daily usually are not needed, and there is little controlled experience with such doses. If persistent hypokalemia is documented with 10 mg, the dose can be increased to 15 mg, then 20 mg, with careful monitoring of electrolytes.

In treating patients with congestive heart failure after an initial diuresis has been achieved, potassium loss may also decrease and the need for MIDAMOR should be re-evaluated. Dosage adjustment may be necessary. Maintenance therapy may be on an intermittent basis.

If it is necessary to use MIDAMOR alone, the starting dosage should be one 5 mg tablet daily. This dosage may be increased to 10 mg per day, if necessary. More than two 5 mg tablets usually are not needed, and there is little controlled experience with such doses. If persistent hypokalemia is documented with 10 mg, the dose can be increased to 15 mg, then 20 mg, with careful monitoring of electrolytes.

More about Midamor (Midamor)

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Midamor interactions

See also:
What other drugs will affect Midamor?

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When Midamor is administered concomitantly with an angiotensin-converting enzyme inhibitor, the risk of hyperkalemia may be increased. Therefore, if concomitant use of these agents is indicated because of demonstrated hypokalemia, they should be used with caution and with frequent monitoring of serum potassium.

Lithium generally should not be given with diuretics because they reduce its renal clearance and add a high risk of lithium toxicity. Read circulars for lithium preparations before use of such concomitant therapy.

In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, when MIDAMOR (Midamor) and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained. Since indomethacin and potassium-sparing diuretics, including MIDAMOR (Midamor), may each be associated with increased serum potassium levels, the potential effects on potassium kinetics and renal function should be considered when these agents are administered concurrently.

Midamor side effects

See also:
What are the possible side effects of Midamor?

MIDAMOR (Midamor) is usually well tolerated and except for hyperkalemia (serum potassium levels greater than 5.5 mEq per liter † see BOXED WARNING), significant adverse effects have been reported infrequently. Minor adverse reactions were reported relatively frequently (about 20%) but the relationship of many of the reports to Midamor is uncertain and the overall frequency was similar in hydrochlorothiazide treated groups. Nausea/anorexia, abdominal pain, flatulence, and mild skin rash have been reported and probably are related to Midamor. Other adverse experiences that have been reported with Midamor are generally those known to be associated with diuresis, or with the underlying disease being treated.

The adverse reactions for MIDAMOR (Midamor) listed in the following table have been arranged into two groups: (1) incidence greater than one percent; and (2) incidence one percent or less. The incidence for group (1) was determined from clinical studies conducted in the United States (837 patients treated with MIDAMOR (Midamor) ). The adverse effects listed in group (2) include reports from the same clinical studies and voluntary reports since marketing. The probability of a causal relationship exists between MIDAMOR (Midamor) and these adverse reactions, some of which have been reported only rarely.

Incidence >1% Incidence ≤ 1%
Body as a Whole
Headache**

Weakness

Fatigability

Back pain

Chest pain

Neck/shoulder ache

Pain, extremities

Cardiovascular
None Angina pectoris

Orthostatic hypotension

Arrhythmia

Palpitation

Digestive
Nausea/anorexia**

Diarrhea**

Vomiting**

Abdominal pain

Gas pain

Appetite changes

Constipation

Jaundice

GI bleeding

Abdominal fullness

GI disturbance

Thirst

Heartburn

Flatulence

Dyspepsia

Metabolic
Elevated serum potassium levels (> 5.5 mEq per Liter)*** None
Skin
None Skin rash

Itching

Dryness of mouth

Pruritus

Alopecia

Musculoskeletal
Muscle cramps Joint pain

Leg ache

Nervous
Dizziness

Encephalopathy

Paresthesia

Tremors

Vertigo

Psychiatric
None Nervousness

Mental confusion

Insomnia

Decreased libido

Depression

Somnolence

Respiratory
Cough

Dyspnea

Shortness of breath
Special Senses
None Visual disturbances

Nasal congestion

Tinnitus

Increased intraocular pressure

Urogenital
Impotence Polyuria

Dysuria

Urinary frequency

Bladder spasms

Gynecomastia

** Reactions occurring in 3% to 8% of patients treated with MIDAMOR (Midamor). (Those reactions occurring in less than 3% of the patients are unmarked.)

*** See BOXED WARNING.

Causal Relationship Unknown: Other reactions have been reported but occurred under circumstances where a causal relationship could not be established. However, in these rarely reported events, that possibility cannot be excluded. Therefore, these observations are listed to serve as alerting information to physicians.

Midamor contraindications

See also:
What is the most important information I should know about Midamor?

Hyperkalemia

Midamor tablets should not be used in the presence of elevated serum potassium levels (greater than 5.5 mEq per liter).

Antikaliuretic Therapy or Potassium Supplementation

Midamor tablets should not be given to patients receiving other potassium-conserving agents, such as spironolactone or triamterene. Potassium supplementation in the form of medication, potassium-containing salt substitutes or a potassium-rich diet should not be used with Midamor tablets except in severe and/or refractory cases of hypokalemia. Such concomitant therapy can be associated with rapid increases in serum potassium levels. If potassium supplementation is used, careful monitoring of the serum potassium level is necessary.

Impaired Renal Function

Anuria, acute or chronic renal insufficiency, and evidence of diabetic nephropathy are contraindications to the use of Midamor tablets. Patients with evidence of renal functional impairment (blood urea nitrogen [BUN] levels over 30 mg per 100 mL or serum creatinine levels over 1.5 mg per 100 mL) or diabetes mellitus should not receive the drug without careful, frequent and continuing monitoring of serum electrolytes, creatinine, and BUN levels. Potassium retention associated with the use of an antikaliuretic agent is accentuated in the presence of renal impairment and may result in the rapid development of hyperkalemia.

Hypersensitivity

Midamor tablets are contraindicated in patients who are hypersensitive to this product.

WARNINGS

Hyperkalemia

Like other potassium-conserving agents, Midamor may cause hyperkalemia (serum potassium levels greater than 5.5 mEq per liter) which, if uncorrected, is potentially fatal. Hyperkalemia occurs commonly (about 10%) when Midamor is used without a kaliuretic diuretic. This incidence is greater in patients with renal impairment, diabetes mellitus (with or without recognized renal insufficiency), and in the elderly. When Midamor is used concomitantly with a thiazide diuretic in patients without these complications, the risk of hyperkalemia is reduced to about 1-2%. It is thus essential to monitor serum potassium levels carefully in any patient receiving Midamor, particularly when it is first introduced, at the time of diuretic dosage adjustments, and during any illness that could affect renal function.

The risk of hyperkalemia may be increased when potassium-conserving agents, including Midamor, are administered concomitantly with an angiotensin-converting enzyme inhibitor, an angiotensin II receptor antagonist, cyclosporine or tacrolimus. Warning signs or symptoms of hyperkalemia include paresthesias, muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, shock, and ECG abnormalities. Monitoring of the serum potassium level is essential because mild hyperkalemia is not usually associated with an abnormal ECG.

When abnormal, the ECG in hyperkalemia is characterized primarily by tall, peaked T waves or elevations from previous tracings. There may also be lowering of the R wave and increased depth of the S wave, widening and even disappearance of the P wave, progressive widening of the QRS complex, prolongation of the PR interval, and ST depression.

Treatment of hyperkalemia:If hyperkalemia occurs in patients taking Midamor, the drug should be discontinued immediately. If the serum potassium level exceeds 6.5 mEq per liter, active measures should be taken to reduce it. Such measures include the intravenous administration of sodium bicarbonate solution or oral or parenteral glucose with a rapid-acting insulin preparation. If needed, a cation exchange resin such as sodium polystyrene sulfonate may be given orally or by enema. Patients with persistent hyperkalemia may require dialysis.

Diabetes Mellitus

In diabetic patients, hyperkalemia has been reported with the use of all potassium-conserving diuretics, including Midamor, even in patients without evidence of diabetic nephropathy. Therefore, Midamor should be avoided, if possible, in diabetic patients and, if it is used, serum electrolytes and renal function must be monitored frequently.

Midamor should be discontinued at least 3 days before glucose tolerance testing.

Metabolic or Respiratory Acidosis

Antikaliuretic therapy should be instituted only with caution in severely ill patients in whom respiratory or metabolic acidosis may occur, such as patients with cardiopulmonary disease or poorly controlled diabetes. If Midamor is given to these patients, frequent monitoring of acid-base balance is necessary. Shifts in acid-base balance alter the ratio of extracellular/intracellular potassium, and the development of acidosis may be associated with rapid increases in serum potassium levels.



Active ingredient matches for Midamor:

Amiloride in Ireland, United States.

Amiloride Hcl

Amiloride hydrochloride in United States.


Unit description / dosage (Manufacturer)Price, USD
Tablet; Oral; Amiloride Hydrochloride 5 mg
100 tablet in 1 bottle
Midamor tablet 5.0 mg (Aa Pharma Inc (Canada))

List of Midamor substitutes (brand and generic names):

100 tablet in 1 bottle
1000 tablet in 1 bottle
500 tablet in 1 bottle
Amiloride Hydrochloride tablet 5 mg/1 (Physicians Total Care, Inc. (US))
Amiloride hydrochloride Actavis 5 mg x 28's
Amiloride hydrochloride Actavis 5 mg x 250's
Tablet; Oral; Amiloride Hydrochloride 5 mg
Edepin 5 mg x 1000's
Tablet; Oral; Amiloride Hydrochloride 5 mg (Alphapharm)
Tablet; Oral; Amiloride Hydrochloride 5 mg; Hydrochlorothiazide 50 mg (Alphapharm)
Kaluril 5 mg x 50's (Alphapharm)
Tablet; Oral; Amiloride Hydrochloride Anhydrous 5 mg (Merck)

References

  1. PubChem. "AMILORIDE". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  2. DrugBank. "AMILORIDE". http://www.drugbank.ca/drugs/DB00594 (accessed September 17, 2018).
  3. MeSH. "Diuretics". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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