Potassium-Sparing Diuretic + Loop Diuretic (Fixed-Dose Combination) Pregnancy: No adequate data in pregnant women; should not be used during pregnancy unless clearly necessary and only when the potential benefit justifies the potential risk to the foetus. Breast-feeding: insufficient information on excretion in breast milk — should not be taken by nursing mothers. Fertility: no specific data.

Amiloride with Bumetanide

Brand names: Burinex A

A fixed-dose oral combination of amiloride (a potassium-sparing diuretic) and bumetanide (a loop diuretic), used for oedema where loop diuresis is needed while limiting potassium loss.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 to 2 tablets daily (each tablet contains bumetanide 1 mg / amiloride 5 mg)

Route: Oral

Frequency: Daily; dose adjusted according to response

Source is the fixed-combination SPC 'Bumetanide/Amiloride 1mg/5mg Tablets': the normal adult dose is 1 to 2 tablets daily, adjusted according to response. Elderly: adjust the dose according to needs, and monitor serum electrolytes and urea carefully. Paediatric: the product should not be used in children and adolescents under 18 years, and is contraindicated in children as safety in this age group has not been established. Patients require regular supervision with monitoring of fluid and electrolyte status to avoid excessive fluid loss; hyponatraemia, hypochloraemia and raised blood urea may occur during vigorous diuresis, especially in seriously ill patients. Discontinue before a glucose tolerance test. §4.2 states no maximum dose beyond the 1–2 tablet daily range.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients; known sensitivity to bumetanide or amiloride
Hyperkalaemia (serum potassium above 5.3 mmol/litre); severe electrolyte imbalance
Acute renal insufficiency; severe progressive renal disease; anuria
Severe liver disease; hepatic coma; precomatose states associated with cirrhosis
Adrenocortical insufficiency (Addison's disease)
Concurrent potassium supplements or potassium-sparing agents
Children — safety in this age group has not been established

Side effects

Electrolyte imbalance — hypokalaemia, hyponatraemia, dehydration, hypomagnesaemia, hypocalcaemia, hypochloraemic alkalosis (bumetanide); hyperkalaemia and hyponatraemia (amiloride)
Gout, hyperuricaemia, hyperglycaemia, hyperlipidaemia
Headache, dizziness; paraesthesia, encephalopathy (amiloride)
Orthostatic hypotension, hypotension
Gastrointestinal disorder — nausea, vomiting, diarrhoea, abdominal pain
Rash, urticaria, dermatitis, photosensitivity, pruritus; severe cutaneous adverse reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (frequency not known) — withdraw bumetanide and never restart if these occur
Tinnitus, deafness (bumetanide); acute renal failure; blood dyscrasias including thrombocytopenia, leukopenia, agranulocytosis, bone marrow failure

Interactions

Lithium — serum lithium levels may be increased when given concurrently with bumetanide, with increased lithium toxicity including cardiotoxic and neurotoxic effects; monitor lithium levels carefully (§4.5)
Potassium supplements or potassium-sparing agents — must not be given concurrently (§4.3)
Nephrotoxic or ototoxic drugs — use with caution in patients already receiving them (§4.4)
Hypoglycaemic agents — the tablets may unmask latent diabetes; it may be necessary to increase the dose of hypoglycaemic agents in diabetic patients (§4.4)
NOTE: SPC §4.5 was truncated in the fetched extract — clinician to review the full interactions section

Clinical monograph

How it works

Bumetanide inhibits the sodium-potassium-chloride co-transporter in the thick ascending limb of the loop of Henle to produce a brisk diuresis, while amiloride blocks epithelial sodium channels in the distal nephron, reducing the potassium and hydrogen ion excretion that the loop component would otherwise cause.

Prescribing in practice

The amiloride component can cause hyperkalaemia, so avoid combining with potassium supplements or other potassium-sparing agents and use caution with renal impairment, ACE inhibitors and angiotensin receptor blockers.
Confirm a genuine need for the potassium-sparing element rather than defaulting to a fixed combination, since the bumetanide dose cannot be titrated independently.
Loop diuresis can cause dehydration, postural hypotension and gout flares, so review volume status and use cautiously in the elderly.

Monitoring

Monitor renal function and serum electrolytes, particularly potassium and sodium, at baseline and periodically during treatment.

Counselling the patient

Take in the morning to avoid disturbed sleep from increased urination.
Avoid potassium-containing salt substitutes unless advised by your prescriber.
Report muscle weakness, palpitations or marked dizziness.

Evidence & guidelines

Diuretic combinations of this type are long-established in UK practice for managing oedema while mitigating diuretic-induced hypokalaemia, consistent with current prescribing references.

Reference: NICE NG133 (Hypertension); ESC/ESH Guidelines on Hypertension (2023); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways