Hyperkalemia

• Like other potassium conserving agents, amiloride may cause hyperkalemia (serum potassium levels greater than 5.5 mEq/Liter) which, if uncorrected, is potentially fatal.

• Hyperkalemia occurs commonly (about 10%) when amiloride 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 amiloride is used concomitantly with a thiazide diuretic in patients without these complications, the risk of hyperkalemia is reduced to about 1% to 2%. It is thus essential to monitor serum potassium levels carefully in any patient receiving amiloride, particularly when it is first introduced, at the time of diuretic dosage adjustments and during any illness that could affect renal function.