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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK547934_"><span class="title" itemprop="name">Amiloride</span></h1><p class="fm-aai"><a href="#_NBK547934_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Amiloride.OVERVIEW"><h2 id="_Amiloride_OVERVIEW_">OVERVIEW</h2><div id="Amiloride.Introduction"><h3>Introduction</h3><p>Amiloride is a potassium-sparing diuretic used in the therapy of edema often in combination with thiazide diuretics. Amiloride has been linked to rare cases of clinically apparent drug induced liver disease.</p></div><div id="Amiloride.Background"><h3>Background</h3><p>Amiloride (a mil' oh ride) is a pyrazinoylguanidine derivative that acts on the sodium channels of renal epithelial cells causing an increase in sodium excretion with little or no effect on potassium excretion, thus accounting for its potassium-sparing characteristics. Amiloride is similar in action to triamterene, but differs in chemical structure. Amiloride was approved for use in the United States in 1986, but is not widely used. Amiloride is available in 5 mg tablets in generic forms and under the brand name of Midamor. The typical dose of amiloride is 5 to 20 mg in one or two doses daily. Amiloride causes only a modest diuresis and it is often used in combination with a thiazide diuretic (such as hydrochlorothiazide: Moduretic), which takes advantage of it potassium-sparing characteristics to offset the potassium-wasting characteristics of the thiazides. The major side effects of amiloride include hyperkalemia, headache, dizziness, gastrointestinal upset and rash.</p></div><div id="Amiloride.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Amiloride therapy has not been associated with serum aminotransferase elevations. Idiosyncratic, clinically apparent liver injury from amiloride is rare, but several instances have been reported as isolated case reports in which the combination of amiloride with hydrochlorothiazide was used (Case 1). The numbers of cases have been too few to characterize the clinical features, but the latency to onset was ranged from 2 to 12 months and the pattern of injury either hepatocellular or mixed. Immunoallergic features and autoantibodies have not been associated with the liver injury from amiloride.</p><p>Likelihood score: D (possible rare cause of liver injury).</p></div><div id="Amiloride.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism of amiloride hepatic injury is unknown, but is likely due to metabolic idiosyncrasy.</p></div><div id="Amiloride.Outcome_and_Management"><h3>Outcome and Management</h3><p>The rare instances of clinically apparent liver injury due to amiloride/hydrochlorothiazide combinations have been associated with jaundice and at least one case resulted in cirrhosis and ultimately death from liver disease. There is unlikely to be cross reactivity to the liver injury with other potassium-sparing diuretics, which have quite different chemical structures.</p><p>Drug Class: <a href="/books/n/livertox/Diuretics/?report=reader">Diuretics</a>, Potassium-Sparing Diuretics</p><p>Other Drugs in the Subclass: <a href="/books/n/livertox/Eplerenone/?report=reader">Eplerenone</a>, <a href="/books/n/livertox/Spironolactone/?report=reader">Spironolactone</a>, <a href="/books/n/livertox/Triamterene/?report=reader">Triamterene</a></p></div></div><div id="Amiloride.CASE_REPORT"><h2 id="_Amiloride_CASE_REPORT_">CASE REPORT</h2><div id="Amiloride.Case_1_Amiloridehydrochlorothi"><h3>Case 1. Amiloride/hydrochlorothiazide induced acute liver injury.(<a class="bibr" href="#Amiloride.REF.1" rid="Amiloride.REF.1">1</a>)</h3><p>A 37 year old man with hypertension developed jaundice and hepatitis 2 months after starting the combination of amiloride (2.5 mg) and hydrochlorothiazide (25 mg). On examination, he was jaundiced and had mild fever (37.6<sup>o</sup> C), but no rash or organomegaly. Laboratory testing showed serum bilirubin of 5.8 mg/dL with marked elevations in serum aminotransferase levels (Table). White blood cell counts, eosinophil counts, prothrombin time, and serum albumin were normal. Tests for hepatitis B and for autoantibodies were negative. Magnetic resonance imaging of the liver and biliary system were normal. The diuretics were stopped, but liver tests worsened for the next three weeks, serum bilirubin rising to as high as 28.3 mg/dL. A liver biopsy showed an intrahepatic cholestasis typical of drug induced hepatic injury with some degree of bile duct injury. Prednisolone (60 mg daily) was initiated, and he improved slowly. Four months later and 6 weeks after stopping prednisolone therapy, he was asymptomatic, but serum enzyme levels were still mildly elevated. A note in follow up mentioned that he developed pancytopenia and was retreated with corticosteroids, but that serum bilirubin and aminotransferase levels were normal.</p><div id="Amiloride.Key_Points"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figAmilorideTc"><a href="/books/NBK547934/table/Amiloride.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figAmilorideTc" rid-ob="figobAmilorideTc"><img class="small-thumb" src="/books/NBK547934/table/Amiloride.Tc/?report=thumb" src-large="/books/NBK547934/table/Amiloride.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Amiloride.Tc"><a href="/books/NBK547934/table/Amiloride.Tc/?report=objectonly" target="object" rid-ob="figobAmilorideTc">Table</a></h4></div></div></div><div id="Amiloride.Laboratory_Values"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figAmilorideTd"><a href="/books/NBK547934/table/Amiloride.Td/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figAmilorideTd" rid-ob="figobAmilorideTd"><img class="small-thumb" src="/books/NBK547934/table/Amiloride.Td/?report=thumb" src-large="/books/NBK547934/table/Amiloride.Td/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Amiloride.Td"><a href="/books/NBK547934/table/Amiloride.Td/?report=objectonly" target="object" rid-ob="figobAmilorideTd">Table</a></h4></div></div></div><div id="Amiloride.Comment"><h4>Comment</h4><p>This patient developed an acute hepatitis-like illness followed by deep jaundice 2 months after starting a combination of amiloride and a thiazide diuretic for hypertension. A liver biopsy suggested bile duct paucity and the course was typical with prolonged jaundice and persistent alkaline phosphatase elevations in follow up. The course was complicated by the development of pancytopenia during recovery. It is not clear whether the amiloride or the hydrochlorothiazide was responsible for the hepatic injury (and the bone marrow failure). Certainly, other cases of thiazide diuretic induced liver injury have been quite different with a shorter latency and more benign course. No other similar cases of liver injury implicating amiloride have been reported.</p></div></div></div><div id="Amiloride.PRODUCT_INFORMATION"><h2 id="_Amiloride_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Amiloride – Generic, Midamor®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Diuretics</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Amiloride" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Amiloride.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Amiloride_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figAmilorideTe"><a href="/books/NBK547934/table/Amiloride.Te/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figAmilorideTe" rid-ob="figobAmilorideTe"><img class="small-thumb" src="/books/NBK547934/table/Amiloride.Te/?report=thumb" src-large="/books/NBK547934/table/Amiloride.Te/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Amiloride.Te"><a href="/books/NBK547934/table/Amiloride.Te/?report=objectonly" target="object" rid-ob="figobAmilorideTe">Table</a></h4></div></div></div><div id="Amiloride.CITED_REFERENCES"><h2 id="_Amiloride_CITED_REFERENCES_">CITED REFERENCES</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="Amiloride.REF.1">Valhovd M, Kildahl-Andersen O. <span><span class="ref-journal">Tidsskr Nor Laegeforen. </span>2003;<span class="ref-vol">123</span>:1202–3.</span> [Drug-induced severe jaundice] Norwegian. [<a href="https://pubmed.ncbi.nlm.nih.gov/12789790" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12789790</span></a>]</div></dd></dl></dl></div><div id="Amiloride.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Amiloride_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 13 October 2021</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Amiloride.REF.zimmerman.1999">Zimmerman HJ. Diuretic drugs. Drugs used in cardiovascular disease. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 662-4.<div><i>(Expert review of hepatotoxicity of diuretics published in 1999 mentions that clinically apparent liver injury due to diuretics is rare; hepatocellular jaundice has been reported with triamterene; no mention of amiloride).</i></div></div></li><li><div class="bk_ref" id="Amiloride.REF.de_marzio.2013">De Marzio DH, Navarro VJ. Hepatotoxicity of cardiovascular and antidiabetic drugs. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 519-40.<div><i>(Review of hepatotoxicity of cardiovascular agents, mentions that thiazide diuretics can rarely cause cholestatic hepatitis; no mention of potassium sparing diuretics).</i></div></div></li><li><div class="bk_ref" id="Amiloride.REF.jackson.2018">Jackson EK. Drugs affecting renal excretory function. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 445-70.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Amiloride.REF.valhovd.2003.1202">Valhovd M, Kildahl-Andersen O. <span><span class="ref-journal">Tidsskr Nor Laegeforen. </span>2003;<span class="ref-vol">123</span>:1202–3.</span> [Drug-induced severe jaundice] Norwegian. [<a href="https://pubmed.ncbi.nlm.nih.gov/12789790" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12789790</span></a>]<div>
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<i>(37 year old man developed jaundice 2 months after starting hydrochlorothiazide and amiloride for hypertension [bilirubin 5.8 rising to 28.3 mg/dL, ALT 2930 U/L, Alk P twice ULN, INR 1.4], with prolonged jaundice leading to 8 week course of prednisone, recovered but then developed pancytopenia: Case 1).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.russo.2004.1018">Russo MW, Galanko JA, Shrestha R, Fried MW, Watkins P. Liver transplantation for acute liver failure from drug-induced liver injury in the United States. <span><span class="ref-journal">Liver Transpl. </span>2004;<span class="ref-vol">10</span>:1018–23.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15390328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15390328</span></a>]<div>
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<i>(Among ~50,000 liver transplants reported to UNOS between 1990 and 2002, 137 [0.5%] were done for idiosyncratic drug induced acute liver failure, none were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.bj_rnsson.2005.1095">Björnsson E, Jerlstad P, Bergqvist A, Olsson R. Fulminant drug-induced hepatic failure leading to death or liver transplantation in Sweden. <span><span class="ref-journal">Scand J Gastroenterol. </span>2005;<span class="ref-vol">40</span>:1095–101.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16165719" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16165719</span></a>]<div>
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<i>(Survey of all cases of DILI with fatal outcome from Swedish Adverse Drug Reporting system from 1966-2002; 103 cases were identified one of which was associated with hydrochlorothiazide and one with amiloride use, but other more likely agents were being taken in both instances).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.andrade.2005.512">Andrade RJ, Lucena MI, Fernández MC, Pelaez G, Pachkoria K, García-Ruiz E, García-Muñoz B, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish Registry over a 10-year period. <span><span class="ref-journal">Gastroenterology. </span>2005;<span class="ref-vol">129</span>:512–21.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16083708" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16083708</span></a>]<div>
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<i>(Reports of drug induced liver injury to a Spanish network found 570 cases; diuretics not mentioned as cause).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.bj_rnsson.2006.33">Björnsson E, Olsson R. Suspected drug-induced liver fatalities reported to the WHO database. <span><span class="ref-journal">Dig Liver Dis. </span>2006;<span class="ref-vol">38</span>:33–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16054882" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16054882</span></a>]<div>
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<i>(Survey of drug induced liver fatalities reported to WHO database between 1968-2003 revealed 4690 reports [89% from the US]; no diuretic found in the 20 most commonly implicated agents).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.sabat_.2007.1401">Sabaté M, Ibáñez L, Pérez E, Vidal X, Buti M, Xiol X, Mas A, et al. Risk of acute liver injury associated with the use of drugs: a multicentre population survey. <span><span class="ref-journal">Aliment Pharmacol Ther. </span>2007;<span class="ref-vol">25</span>:1401–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17539979" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17539979</span></a>]<div>
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<i>(Population based survey of 126 cases of acute liver injury [24 with acute liver failure] due to drugs between 1993-1999 in Spain calculated relative risk of injury compared to the general population: hydrochlorothiazide was being taken by 7 and furosemide by 8 patients, but relative risk was not increased in comparison to a control group).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
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<i>(Among 300 cases of drug induced liver disease in the US collected between 2004 and 2008, no case was attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF12">Drugs for hypertension. <span><span class="ref-journal">Treat Guidel Med Lett. </span>2009;<span class="ref-vol">7</span>:1–10.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19107095" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19107095</span></a>]<div>
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<i>(Brief overview of currently available drugs for hypertension with guidelines on their use and information on prices and toxicities: “thiazide diuretics are the first-line therapy for many patients with hypertension”).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.bj_rnsson.2009.511">Björnsson E, Davidsdottir L. The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice. <span><span class="ref-journal">J Hepatol. </span>2009;<span class="ref-vol">50</span>:511–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19155082" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19155082</span></a>]<div>
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<i>(Among 685 patients with drug induced liver injury, 23 [3.4%] were later hospitalized for chronic liver disease and 8 were showed to have cirrhosis, one of whom had acute icteric liver injury 3 years earlier attributed to the combination of amiloride and hydrochlorothiazide).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.devarbhavi.2010.2396">Devarbhavi H, Dierkhising R, Kremers WK, Sandeep MS, Karanth D, Adarsh CK. Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality. <span><span class="ref-journal">Am J Gastroenterol. </span>2010;<span class="ref-vol">105</span>:2396–404.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20648003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20648003</span></a>]<div>
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<i>(Among 313 cases of drug induced liver injury seen over a 12 year period at a large hospital in Bangalore, India, none were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.ferrajolo.2010.721">Ferrajolo C, Capuano A, Verhamme KM, Schuemie M, Rossi F, Stricker BH, Sturkenboom MC. Drug-induced hepatic injury in children: a case/non-case study of suspected adverse drug reactions in VigiBase. <span><span class="ref-journal">Br J Clin Pharmacol. </span>2010;<span class="ref-vol">70</span>:721–8.</span> [<a href="/pmc/articles/PMC2997312/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2997312</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21039766" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21039766</span></a>]<div>
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<i>(Among 624,673 adverse event reports in children between 2000 and 2006 in the WHO VigiBase, no diuretic was mentioned among the 30 most common causes of liver injury).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
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<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, of which none were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.bj_rnsson.2013.1419">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. <span><span class="ref-journal">Gastroenterology. </span>2013;<span class="ref-vol">144</span>:1419–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div>
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<i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, none of which were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.hern_ndez.2014.231">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A, Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports. <span><span class="ref-journal">Ann Hepatol. </span>2014;<span class="ref-vol">13</span>:231–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div>
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<i>(Among 176 reports of drug induced liver injury from Latin America published between 1996 and 2012, none were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.e7.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
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<i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, none were attributed to a diuretic).</i>
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</div></div></li><li><div class="bk_ref" id="Amiloride.REF20">Drugs for hypertension. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2020;<span class="ref-vol">62</span>(1598):73–80.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32555118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32555118</span></a>]<div>
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<i>(Concise summary of efficacy, safety and costs of drug therapy of hypertension including the diuretics, focusing upon relative usefulness; no mention of hepatic adverse events).</i>
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</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK547934_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">October 13, 2021</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Amiloride. [Updated 2021 Oct 13].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Amikacin/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Aminoglycosides/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobAmilorideTc"><div id="Amiloride.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547934/table/Amiloride.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Amiloride.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Amiloride.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_Amiloride.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiloride (2.5 mg) and hydrochlorothiazide (25 mg daily)</td></tr><tr><th id="hd_b_Amiloride.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_Amiloride.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hepatocellular (R=32.5)</td></tr><tr><th id="hd_b_Amiloride.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_Amiloride.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3+ (jaundice, hospitalization)</td></tr><tr><th id="hd_b_Amiloride.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Latency:</th><td headers="hd_b_Amiloride.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 months</td></tr><tr><th id="hd_b_Amiloride.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_Amiloride.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incomplete at 4 months</td></tr><tr><th id="hd_b_Amiloride.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_Amiloride.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobAmilorideTd"><div id="Amiloride.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547934/table/Amiloride.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Amiloride.Td_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_Amiloride.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Amiloride.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_Amiloride.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ALT<br />U/L)</th><th id="hd_h_Amiloride.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_Amiloride.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Bilirubin*<br />(mg/dL)</th><th id="hd_h_Amiloride.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_Amiloride.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 weeks</td><td headers="hd_h_Amiloride.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2930</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">494</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">11.1</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diuretics stopped</td></tr><tr><td headers="hd_h_Amiloride.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 weeks</td><td headers="hd_h_Amiloride.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 week</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1466</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">351</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18.5</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liver biopsy</td></tr><tr><td headers="hd_h_Amiloride.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 weeks</td><td headers="hd_h_Amiloride.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 weeks</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">697</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">309</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28.3</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisolone started</td></tr><tr><td headers="hd_h_Amiloride.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 months</td><td headers="hd_h_Amiloride.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">176</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.5</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisolone stopped</td></tr><tr><td headers="hd_h_Amiloride.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_Amiloride.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 months</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">196</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">225</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.5</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Amiloride.Td_1_1_1_1 hd_h_Amiloride.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
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<b>Normal Values</b>
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</td><td headers="hd_h_Amiloride.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><50</b>
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</td><td headers="hd_h_Amiloride.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><275</b>
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</td><td headers="hd_h_Amiloride.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<b><1.2</b>
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</td><td headers="hd_h_Amiloride.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>* </dt><dd><div id="Amiloride.TF.d.1"><p class="no_margin">Converted from µmol/L to mg/dL.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobAmilorideTe"><div id="Amiloride.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547934/table/Amiloride.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Amiloride.Te_lrgtbl__"><table><thead><tr><th id="hd_h_Amiloride.Te_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Amiloride.Te_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Amiloride.Te_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Amiloride.Te_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Amiloride.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amiloride</td><td headers="hd_h_Amiloride.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134981473" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">2609-46-3</a>
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</td><td headers="hd_h_Amiloride.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C6-H8-Cl-N7-O</td><td headers="hd_h_Amiloride.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134981473" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134981473" alt="image 134981473 in the ncbi pubchem database" /></a>
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