Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For potassium-sparing diuretics and hydrochlorothiazide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to amiloride, spironolactone, triamterene, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, methazolamide, or to hydrochlorothiazide or any of the other thiazide diuretics. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. They should not be taken during pregnancy unless recommended by your doctor.

Breast-feeding—Hydrochlorothiazide and spironolactone pass into breast milk. It is not known whether amiloride or triamterene passes into breast milk. Hydrochlorothiazide may also decrease the flow of breast milk. Therefore, you should avoid use of potassium-sparing diuretic and hydrochlorothiazide combinations during the first month of breast-feeding.

Children—Studies on this combination medicine have been done only in adult patients, and there is no specific information comparing use of potassium-sparing diuretic and hydrochlorothiazide combinations in children with use in other age groups.

Older adults—Dizziness or lightheadedness and signs and symptoms of too much potassium in the body or too little potassium in the body may be more likely to occur in the elderly, who are more sensitive than younger adults to the effects of this medicine.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking potassium-sparing diuretics and hydrochlorothiazide, it is especially important that your health care professional know if you are taking any of the following:

• Angiotensin-converting enzyme (ACE) inhibitors (benazepril [e.g., Lotensin], captopril [e.g., Capoten], enalapril [e.g., Vasotec], fosinopril [e.g., Monopril], lisinopril [e.g., Prinivil, Zestril], quinapril [e.g., Accupril], ramipril [e.g., Altace]) or
• Cyclosporine (e.g., Sandimmune) or
• Potassium-containing medicines or supplements—Use with potassium-sparing diuretic and hydrochlorothiazide combinations may cause high blood levels of potassium, which may increase the chance of side effects

• Cholestyramine or
• Colestipol—Use with potassium-sparing diuretic and hydrochlorothiazide combinations may prevent the diuretic from working properly; take the diuretic at least 1 hour before or 4 hours after cholestyramine or colestipol

• Digitalis glycosides (heart medicine)—Use with diuretics may cause high blood levels of digoxin, which may increase the chance of side effects

• Lithium (e.g., Lithane)—Use with diuretics may cause high blood levels of lithium, which may increase the chance of side effects

Other medical problems—The presence of other medical problems may affect the use of potassium-sparing diuretics and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes mellitus (sugar diabetes) or
• Kidney disease or
• Liver disease—Higher blood levels of potassium may occur, which may increase the chance of side effects

• Gout (history of) or
• Kidney stones (history of)—Triamterene and hydrochlorothiazide combination may make these conditions worse

• Heart or blood vessel disease—These medicines may cause high cholesterol levels or high triglyceride levels

• Lupus erythematosus (history of) or
• Pancreatitis (inflammation of pancreas)—Potassium-sparing diuretic and hydrochlorothiazide combinations may make these conditions worse

• Menstrual problems in women or breast enlargement in men—Spironolactone and hydrochlorothiazide combination may make these conditions worse