Amiloride - Attn Kwame

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J Clin Endocrin Metab. First published ahead of print June 13, 2008 as

doi:10.1210/jc.2008-0104

Case Detection, Diagnosis, and Treatment of Patients with Primary

Aldosteronism: An

Endocrine Society Clinical Practice Guideline

Co-sponsoring Organizations: European Society of Endocrinology, European

Society of

Hypertension, International Society of Endocrinology, International Society

of Hypertension,

The Japanese Society of Hypertension

Authors: W. Funder, M. Carey, Fardella, Celso E.

Gomez-, Franco

Mantero, Stowasser, F. Young Jr, and Victor M. Montori

Upregulation of distal tubular sodium epithelial channel activity is a major

mechanism whereby

aldosterone exerts its actions on sodium and potassium handling. Of the

available epithelial

sodium channel antagonists (amiloride and triamterene), amiloride has been

the most studied as

a mode of treatment for PA. Although less efficacious than spironolactone,

amiloride may be

useful (28, 137). Being a potassium-sparing diuretic, amiloride can

ameliorate both

hypertension and hypokalemia in patients with PA and is generally well

tolerated, lacking the

sex steroid-related side effects of spironolactone, but without the

beneficial effects on

endothelial function (138, 139).

__________________

138. Farquharson CA, Struthers AD 2000 Spironolactone increases nitric oxide

bioactivity,

improves endothelial vasodilator dysfunction, and suppresses vascular

angiotensin

I/angiotensin II conversion in patients with chronic heart failure.

Circulation 101:594-7

139. Farquharson CA, Struthers AD 2002 Increasing plasma potassium with

amiloride

shortens the QT interval and reduces ventricular extrasystoles but does not

change

endothelial function or heart rate variability in chronic heart failure.

Heart 88:475-80