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MODURETIC (amiloride and hydrochlorothiazide) is usually well tolerated and significant clinical adverse effects have been reported infrequently. The risk of hyperkalemia (serum potassium levels greater than 5.5 mEq per liter) with MODURETIC (amiloride and hydrochlorothiazide) is about 1-2 percent in patients without renal impairment or diabetes mellitus (see WARNINGS). Minor adverse reactions to amiloride HCl have been reported relatively frequently (about 20%) but the relationship of many of the reports to amiloride HCl is uncertain and the overall frequency was similar in hydrochlorothiazide treated groups. Nausea/anorexia, abdominal pain, flatulence, and mild skin rash have been reported and probably are related to amiloride. Other adverse experiences that have been reported with MODURETIC (amiloride and hydrochlorothiazide) are generally those known to be associated with diuresis, thiazide therapy, or with the underlying disease being treated. Clinical trials have not demonstrated that combining amiloride and hydrochlorothiazide increases the risk of adverse reactions over those seen with the individual components.

The adverse reactions for MODURETIC (amiloride and hydrochlorothiazide) listed in the following table have been arranged into two groups: (1) incidence greater than one percent; and (2) incidence one percent or less. The incidence for group (1) was determined from clinical studies conducted in the United States (607 patients treated with MODURETIC (amiloride and hydrochlorothiazide) ). The adverse effects listed in group (2) include reports from the same clinical studies and voluntary reports since marketing. The probability of a causal relationship exists between MODURETIC (amiloride and hydrochlorothiazide) and these adverse reactions, some of which have been reported only rarely.

Incidence > 1% Incidence ≤ 1%
Body as a Whole
   Headache**
   Weakness**
   Fatigue/tiredness
Malaise
Chest pain
Back pain
Syncope
Cardiovascular
Arrhythmia
Tachycardia
Digitalis toxicity
Orthostatic hypotension
Angina pectoris
Digestive
   Nausea/anorexia**
   Diarrhea
   Gastrointestinal pain
   Abdominal pain
Constipation
GI bleeding
GI disturbance
Appetite changes
Abdominal fullness
Hiccups
Thirst
Vomiting
Anorexia
Flatulence
Metabolic
   Elevated serum potassium levels ( > 5.5 mEq per liter)***
Gout
Dehydration
Symptomatic hyponatremiat
Musculoskeletal
   Leg ache
Muscle cramps/spasm
Joint pain
   Nervous
   Dizziness**
Paresthesia/numbness
Stupor
Vertigo
Psychiatric
   None
Insomnia
Nervousness
Depression Sleepiness
Mental confusion
Respiratory
   Dyspnea
None
Skin
   Rash**
   Pruritus
Flushing
Diaphoresis
Erythema multiforme including
Stevens-Johnson syndrome
Exfoliative dermatitis including toxic epidermal necrolysis
Alopecia
Special Senses
   None
Bad taste
Visual disturbance
Nasal congestion
Urogenital
   None
Impotence Nocturia Dysuria Incontinence
Renal dysfunction including renal failure Gynecomastia
** Reactions occurring in 3% to 8% of patients treated with MODURETIC (amiloride and hydrochlorothiazide) . (Those reactions occurring in less than 3% of the patients are unmarked.)
***See WARNINGS.
†See PRECAUTIONS.

Other adverse reactions that have been reported with the individual components and within each category are listed in order of decreasing severity:

Amiloride

Body as a Whole: Painful extremities, neck/shoulder ache, fatigability; Cardiovascular: Palpitation; Digestive: Activation of probable pre-existing peptic ulcer, abnormal liver function, jaundice, dyspepsia, heartburn; Hematologic: Aplastic anemia, neutropenia; Integumentary: Alopecia, itching, dry mouth; Nervous System/Psychiatric: Encephalopathy, tremors, decreased libido; Respiratory: Shortness of breath, cough; Special Senses: Increased intraocular pressure, tinnitus; Urogenital: Bladder spasms, polyuria, urinary frequency.

Hydrochlorothiazide

Digestive: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), sialadenitis, cramping, gastric irritation; Hematologic: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia; Hypersensitivity: Anaphylactic reactions, necrotizing angiitis (vasculitis, cutaneous vasculitis), respiratory distress including pneumonitis and pulmonary edema, photosensitivity, fever, urticaria, purpura; Metabolic: Electrolyte imbalance (see PRECAUTIONS), hyperglycemia, glycosuria, hyperuricemia; Nervous System/Psychiatric: Restlessness; Special Senses: Transient blurred vision, xanthopsia; Urogenital: Interstitial nephritis (see WARNINGS).