A comparison of the potassium and magnesium-sparing properties of amiloride and spironolactone in diuretic-treated normal subjects

Br J Clin Pharmacol. 1993 Apr;35(4):373-8. doi: 10.1111/j.1365-2125.1993.tb04153.x.

Abstract

1. The relative potencies of amiloride (5 and 20 mg) and spironolactone (25 and 100 mg) for plasma and erythrocyte electrolytes were investigated in a double-blind, randomised, balanced, crossover study in 12 normal men treated concomitantly with hydrochlorothiazide 100 mg daily for 1 week. 2. Participants satisfied an a priori requirement for a fall in plasma potassium concentration of at least 0.5 mmol l-1 after 7 days of treatment with hydrochlorothiazide alone. 3. After hydrochlorothiazide alone, plasma potassium and sodium concentrations fell (P < 0.001). There were associated reductions in erythrocyte sodium (P < 0.01). Plasma magnesium concentration did not change, although erythrocyte magnesium decreased (P < 0.001). 4. Both amiloride and spironolactone attenuated the thiazide-induced fall in plasma potassium (relative potency, amiloride:spironolactone 10:1, 95% confidence interval 6.3-16.2:1). Amiloride but not spironolactone was associated with a dose-related increase in plasma magnesium; a relative potency estimation was precluded. There was little evidence of influences of amiloride or spironolactone on erythrocyte electrolytes. 5. On a weight basis, amiloride is ten times more potent than spironolactone as a potassium-sparing agent in diuretic-treated subjects but neither agent had major effects on erythrocyte potassium. The drugs may have divergent actions on magnesium handling; hydrochlorothiazide alone had no influence on plasma magnesium.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aldosterone / blood
  • Amiloride / adverse effects
  • Amiloride / blood
  • Amiloride / pharmacology*
  • Double-Blind Method
  • Drug Interactions
  • Erythrocytes / chemistry
  • Humans
  • Hydrochlorothiazide / adverse effects
  • Hydrochlorothiazide / pharmacology*
  • Intracellular Fluid / metabolism
  • Magnesium / blood*
  • Male
  • Potassium / blood*
  • Spironolactone / adverse effects
  • Spironolactone / blood
  • Spironolactone / pharmacology*

Substances

  • Hydrochlorothiazide
  • Spironolactone
  • Aldosterone
  • Amiloride
  • Magnesium
  • Potassium