2.2.4 Potassium-sparing diuretics with other diuretics

Prescribing Notes

• It is preferable to prescribe diuretic agents separately. Combination diuretics encourage the use of a potassium-sparing agent when a loop or thiazide diuretic alone may be more appropriate.
• Fixed combinations of diuretics should only be considered if compliance is a problem or to reduce the risk of hypokalaemia.
• Combination products containing a diuretic plus potassium do not contain sufficient potassium to reliably correct hypokalaemia and are not recommended.
• Where combinations of diuretics with amiloride are prescribed generically, the prescriber must state the dose required.

Cautions

• All diuretics have the propensity to cause postural hypotension and potentially lead to collapse and falls. Other side-effects include confusion, dehydration and urinary incontinence. Hyponatraemia is a particular problem in the frail elderly.
• Diuretics should not be used on a long term basis to treat simple gravitational oedema. This will usually respond to increased ambulation, raising the legs and support stockings.
• Potassium-sparing diuretics should be used with caution in renal impairment.
• Potassium-sparing diuretics should be used with caution when co-administered with ACE inhibitors or angiotensin-II receptor antagonists due to the risk of hyperkalaemia.
• Potassium supplements: should not (unless under close supervision and monitoring) be given with: potassium sparing diuretics, aldosterone antagonists, in the presence of renal failure, with ACE inhibitors or with angiotensin-II receptor antagonists, due to the danger of hyperkalaemia.
• Counsel patients on ‘sick day guidance’ with diuretics – click here for further information.