Potassium-Sparing Diuretic + Loop Diuretic (Fixed-Dose Combination)

Amiloride with Bumetanide

Brand names: Burinex A

Adult dose

Dose: 1–2 tablets once daily

Route: Oral

Frequency: Once daily in the morning

Clinical pearls

Potassium-balanced combination: bumetanide causes K⁺ loss; amiloride retains K⁺ — may maintain near-normal potassium
Burinex A = amiloride 5 mg + bumetanide 1 mg per tablet
Useful where thiazides/loop diuretics alone cause persistent hypokalaemia
Monitor K⁺ and Na⁺ — not guaranteed to maintain perfect balance
Same considerations as individual components apply

Contraindications

Hyperkalaemia
Severe renal impairment
Hepatic coma associated with cirrhosis
Addison's disease

Side effects

Electrolyte disturbances (hypokalaemia or hyperkalaemia — balance of two components)
Hyponatraemia
Hyperuricaemia / gout (bumetanide)
Hypotension
Muscle cramps
Ototoxicity (bumetanide — rare; risk increased with rapid IV use)

Interactions

Lithium — loop diuretic reduces renal lithium excretion → toxicity risk; monitor levels
NSAIDs — reduced diuretic efficacy, worsened renal function
ACE inhibitors/ARBs — hypotension and hyperkalaemia risk (amiloride component)
Aminoglycosides — additive ototoxicity (bumetanide)

Monitoring

Serum electrolytes (K⁺, Na⁺) at baseline, 1–2 weeks after initiation, then 3–6 monthly
eGFR
Blood pressure and fluid balance

Reference: BNF; NICE NG133 (Hypertension); ESC/ESH Guidelines on Hypertension (2023); https://bnf.nice.org.uk/drugs/amiloride-with-bumetanide/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways