The effects of amiloride hydrochloride on thiazide-induced hypokalemia were evaluated. In metabolic balance studies, amiloride reversed thiazide-induced urinary potassium loss, restored plasma bicarbonate concentration and pH to pretreatment levels, and produced further increases in aldosterone secretion. Effects of long-term administration of hydrochlorothiazide and an amiloride-hydrochlorothiazide combination were compared in outpatients who had experienced thiazide-induced hypokalemia while receiving oral potassium supplements. After eight weeks, those given hydrochlorothiazide alone had an average serum potassium level of 3.01± 0.10 (SD) mEq/L, significantly lower than the control level (3.75 ±0.08 mEq/L). Those given the amiloride-hydrochlorothiazide combination had an average serum potassium level of 3.75 ±0.08 mEq/L, not significantly different from the control value (3.82 ±0.08 mEq/L). Both groups had increased plasma aldosterone concentrations and plasma renin activity. The potassium-conserving effect of amiloride persisted with extended therapy.
Maronde RF, Milgrom M, Vlachakis ND, Chan L. Response of Thiazide-lnduced Hypokalemia to Amiloride. JAMA. 1983;249(2):237-241. doi:10.1001/jama.1983.03330260055032