Moduretic is used for treating fluid retention (edema) and high blood pressure. It may be used alone or with other medicines.
Other names for this medication:
Also known as: Amiloride hydrochlorothiazide.
Moduretic is a diuretic (water pill) and a combination of a potassium-sparing diuretic (amiloride) and a thiazide diuretic (hydrochlorothiazide). It works by making the kidneys eliminate sodium (salt) and water from the body, which helps to lower blood pressure. The amiloride component helps minimize potassium loss.
Brand name of Moduretic is Moduretic.
Take Moduretic by mouth with food.
Moduretic may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
If you want to achieve most effective results do not stop taking Moduretic suddenly.
If you overdose Moduretic and you don't feel good you should visit your doctor or health care provider immediately.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) away from moisture, light and heat. Do not freeze. Keep container closed tightly. Throw away any unused medicine after the expiration date. Keep out of the reach of children.
The most common side effects associated with Moduretic are:
Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.
Do not take Moduretic if you are allergic to Moduretic components or to any ingredient in Moduretic or any other sulfonamide (eg, sulfamethoxazole).
Be careful with Moduretic if you're pregnant or you plan to have a baby, or you are a nursing mother.
Be careful with Moduretic if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement.
Be careful with Moduretic if you have allergies to medicines, foods, or other substances.
Be careful with Moduretic if you have cirrhosis or liver problems, diabetes, gout, kidney problems or kidney stones, asthma, heart problems, or systemic lupus erythematosus.
Be careful with Moduretic if you have elevated blood acid, low folic acid levels, or electrolyte problems, or are dehydrated.
Be careful with Moduretic if you take potassium-sparing diuretics (eg, spironolactone), potassium supplements, or salt substitutes containing potassium because high blood potassium levels may occur and cause listlessness, confusion, abnormal skin sensations of the arms and legs, heaviness of limbs, slowed heart rate, irregular heart rhythm, or stopping of the heart; cholestyramine or colestipol because they may decrease Moduretic 's effectiveness; nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin) because they may decrease Moduretic 's effectiveness and risk of kidney problems may be increased; barbiturates (eg, phenobarbital), certain chemotherapy medicines, corticosteroids (eg, prednisone), digoxin, dofetilide, ketanserin, narcotic pain medicines (eg, codeine), or medicines for high blood pressure because the risk of their side effects may be increased by Moduretic; diazoxide, lithium, or nondepolarizing neuromuscular blockers (eg, pancuronium) because their actions and the risk of their side effects may be increased by Moduretic; angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril) because the risk of high blood potassium and kidney problems may be increased by Moduretic; diabetes medicines (eg, glipizide) or insulin because their effectiveness may be decreased by Moduretic.
Do not stop taking Moduretic suddenly.
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The authors have performed a between-patient study in 76 patients with mild or moderate essential arterial hypertension, with the aim of comparing the results of atenolol 100 mg daily, hydrochlorothiazide 50 mg + amiloride 5 mg 1 tablet daily, and the combination of the above two agents at the same daily doses. Thirty-one patients received the free combination diuretic-beta-blocker throughout the study period; 26 patients non-responders to atenolol 100 mg daily (supine diastolic blood pressure greater than 90 mmHg) after a one-month treatment period received the above combination for a further four months; and 19 patients non-responders to hydrochlorothiazide 50 mg + amiloride 5 mg, 1 tablet daily, after a one-month treatment period received the above combination for a further four months. In the patients who were non-responders to either atenolol or the diuretic, supine and upright blood pressure showed a further and clinically consistent decrease as a result of the combination therapy. A similar consistent decrease was seen in the patients receiving the combination therapy throughout the study. Plasma levels of glucose, urea, creatinine, sodium, potassium and uric acid were not modified either by the single agents or during administration of the combination therapy. In particular, plasma potassium concentration did not show any statistical or clinical changes. Any side-effects were of little clinical importance and never required discontinuation of therapy. In conclusion, atenolol combined with hydrochlorothiazide + amiloride (100 mg + 50 mg + 5 mg) provides an effective and well tolerated blood pressure control in most patients with mild or moderate arterial hypertension, including non-responders to diuretic or beta-blocker alone.
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The clinical pharmacology of the diuretic amyloride was studied in 60 patients suffering from circulatory insufficiency of various origin. Midamor and moduretic of the "Merck" firm (USA) were used in a dose of 1 to 4 tablets. The duration of treatment was from 3 days to 18 months. It was found that under the effect of amyloride natriuresis increases moderately in patients with circulatory insufficiency with no simultaneous increase in the loss of potassium with the urine. As the circulatory insufficiency becomes more severe, the natriuretic and potassium-saving effect of the drug diminishes. Amyloride potentiates the diuretic and natriuretic effect of furosemide and hydrochlorothiazide well without increasing kaliuresis. In patients in whom the disease is less severe, two-week treatment with amyloride leads to an authentic increase in the total metabolic potassium in the organism. The patients tolerate the drug well. It is recommended for wide clinical use.
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Hyponatremia developed after AmHTZ but not after F challenge. A negative free water clearance (CH(2)O) was only observed during AmHTZ (-0.39 mL/min), while maximal CH(2)O during F was 3.17 mL/min. Based on the results obtained during WL, the calculated maximal daily electrolyte free water clearance ability was only 888 mL after AmHTZ but 10,166 mL after F therapy. Taking into account a measured mean daily water intake of 1830 mL, severe hyponatremia could be predicted to occur after a few days treatment with AmHTZ. In comparison, F appears to be safer, without risk of hyponatremia, during an equivalent period of time.
Rapid, precise, accurate and specific ratio spectra derivative spectrophotometry and high-performance liquid chromatographic procedures were described for the simultaneous determination of hydrochlorothiazide and amiloride hydrochloride in combined pharmaceutical dosage forms. For the first method, ratio spectra derivative spectrophotometry, the signals were measured at 285.7 nm for hydrochlorothiazide and at 302.5 nm for amiloride hydrochloride in the mixture, in the first derivative of the ratio spectra. The second method is based on high-performance liquid chromatography (HPLC) on LiChrosorb RP-C18 column (5 microm, 20 cm x 4.6 mm) using 0.025 M orthophosphoric acid (adjusted to pH 3.0 with triethylamine (TEA)), acetonitrile (84:16 v/v) as a mobile phase at a flow rate of 1.2 ml/min(-1). Detection was carried out using a UV detector at 278.0 nm. Commercial sugar-coated and laboratory-prepared mixtures containing both drugs in different proportions were assayed using the developed methods.
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Impaired salivary gland function can be a major cause of late morbidity following the treatment of head and neck cancer with radiotherapy. A large number of commonly prescribed medications can also reduce salivary gland function. We report three patients with already impaired salivary gland function following successful radiotherapy in whom additional prescribed medication led to an increased reduction in salivary flow, thus further impairing the quality of life of these patients. Stopping the medication resulted in subjective and objective improvement in salivary gland function.
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We did a prospective, randomised, double-blind trial in Europe and Israel in 6321 patients aged 55-80 years with hypertension (blood pressure > or = 150/95 mm Hg, or > or = 160 mm Hg systolic). Patients had at least one additional cardiovascular risk factor. We randomly assigned patients nifedipine 30 mg in a long-acting gastrointestinal-transport-system (GITS) formulation (n=3157), or co-amilozide (hydrochlorothiazide 25 mg [corrected] plus amiloride 2.5 mg; n=3164). Dose titration was by dose doubling, and addition of atenolol 25-50 mg or enalapril 5-10 mg. The primary outcome was cardiovascular death, myocardial infarction, heart failure, or stroke. Analysis was done by intention to treat.
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In a randomized double blind study 100 men (mean age 46 (22-64) years) with mild to moderate hypertension were followed every 3rd month for one year. Fifty were randomized to atenolol 50 mg and 50 to hydrochlorothiazide 25 mg+amiloride 5 mg (co-amiloride) once daily. The doses were doubled at 3 or 6 months if diastolic blood pressure (DBP) remained > or = 95 mmHg. If DBP was > or = 95 mmHg even at 6 or 9 months, patients were classified as non-responders, and nifedipine 20 mg b.i.d. was added. After one year 31/50 randomized to atenolol and 17/50 randomized to co-amiloride had responded to monotherapy (p < 0.05). Neither clinical findings nor haemodynamic measurements by Doppler at baseline could distinguish between co-amiloride responders and non-responders. Conversely, non-responders to atenolol as compared with atenolol responders had higher body weight (p = 0.02), higher systolic BP (p = 0.03), higher DBP (p = 0.009), stroke volume (p = 0.04), and cardiac output (p = 0.0002) combined with lower total systemic vascular resistance (p = 0.02). This suggests that some were apparent non-responders due to too low dosing of atenolol rather than true non-responders. Measurements of haemodynamics may be of importance in the assessment of optimal antihypertensive therapy according to baseline and follow-up haemodynamic aberrations.
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The Authors have studied the effects of fenquizone compared to those of hydrochlorothiazyde-amyloride therapy. They have found a good activity in hypertension and a powerful diuretic action, besides fenquizone has no remarkable side-effect.
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Thiazide diuretics frequently cause a decrease in serum potassium levels. In this study, 34 percent of patients taking hydrochlorothiazide had serum potassium levels below 3.5 meq/liter. The response of the serum potassium level was studied after treatment in 56 patients was switched from 50 mg of hydrochlorothiazide daily to either two capsules of hydrochlorothiazide/triampterene (Dyazide), or one tablet of hydrochlorothiazide/amiloride (Moduretic) daily, over nine to 15 months. The 24 patients whose treatment was changed to Dyazide had a rise in serum potassium levels from a mean of 3.56 meq/liter to 4.17 meq/liter in two to three weeks. The 32 patients whose treatment was changed to Moduretic had a rise in serum potassium levels from a mean of 3.76 meq/liter to 4.14 meq/liter in two to three weeks. The resultant rise in potassium levels was stable throughout the follow-up period in both groups. Patient acceptance of this change was excellent.
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To draw attention to primary hyperparathyroidism as a cause of severe hypertension.
Patients were diagnosed at a median age of 1.6 years (range, 0.16-6.33 years) and treated with a low osmotic diet, hydrochlorothiazide-amiloride and indomethacin, which decreased the diuresis from a median of 10.5 ml/kg/h to 4.4 ml/kg/h (p < 0.001). Three patients showed normal renal ultrasound before treatment until last control, while the remaining seven showed urinary tract dilation. In this second group, dilation was reduced with treatment in four patients and disappeared in the remaining three. Children without dilation or in whom the dilation disappeared were diagnosed and treated earlier than those with persistent dilation (median 1.66 versus 4.45 years, respectively). After a median of 10.4 (range, 2.3-20.3) years of follow-up, no patients showed urological complications.
Patients were referred from general and internal medicine practices following written invitations and included consecutively. Participants were examined and followed-up on an outpatient basis.
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Three patients with impaired renal function suffered complications of hyperkalaemia within 10 days of beginning therapy with hydrochlorothiazide and amiloride combination (Moduretic). The possible relationship between hyperkalaemia and this diuretic is discussed.
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A new beta-adrenoreceptor blocking drug (timolol) was used in two clinical studies. In the first double blind study administration of hydrochlorothiazide and timolol reduced the mean (formula: see text) blood pressure by 23 mm Hg, compared with a fall of nine mm Hg with administration of hydrochlorothiazide and a placebo. Plasma potassium (K+) levels fell with the administration of hydrochlorothiazide alone, but rose back to control values when patients were given timolol. In the second study (patient blind), Moduretic (hydrochlorothiazide, 50 mg and amiloride, 5 mg) and timolol were given once daily. The mean blood pressure fell by 20 +/- 2 mm Hg allowing hypertension to be controlled by this once-daily regimen; the control persisted throughout the day. Plasma potassium (K+) levels fell slightly after treatment with Moduretic, but the fall was not as great as with hydrochlorothiazide. Of the 65 patients who entered these studies, 35 had not been previously treated and had diastolic blood pressure between 105 mm Hg and 130 mm Hg. In 18 patients the diastolic blood pressure was reduced below 95 mm Hg after treatment with a diuretic alone, in 15 patients treatment with a diuretic and timolol (5 mg to 20 mg) reduced the diastolic blood pressure below 95 mm Hg. In two patients, the diastolic blood pressure was between 95 mm Hg and 100 mm Hg. The response achieved with a relatively simple therapeutic regimen that can be administered once daily suggests that the therapy of most hypertensive patients could be supervised by paramedical personnel.
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A randomized double-blind, crossover trial was carried out in twenty hypertensive patients to evaluate the hypotensive efficacy and safety of indapamide. Indapamide in doses of 2.5 mg per day in combination with other antihypertensive agents was as effective in reducing the blood pressure in hypertensive patients as one tablet of Moduretic (50 mg hydrochlorothiazide and 5 mg amiloride). Indapamide induced no changes in serum potassium or uric acid levels and there were no major side effects.
A woman with unresectable squamous cell carcinoma of the thymus was treated with combination chemotherapy consisting of cyclophosphamide, adriamycin, cisplatin, and prednisone. Rapid tumor response and hyperuricemia occurred within 10 days after the first course of chemotherapy. Mediastinal irradiation was given after two courses of chemotherapy. Chemotherapy was continued until the total dose of adriamycin reached 450 mg/m2. The patient is alive and well in remission more than 111 weeks after therapy was begun and more than 63 weeks after treatment was discontinued. Further study of this chemotherapeutic regimen in squamous cell carcinoma of the thymus is needed. Monitoring of serum uric acid levels may be required.
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We report a case of lithium overdose in a patient who presented in non-convulsive status epilepticus. The lithium toxicity was probably due to interaction with Moduretic. The diagnosis was not suspected until electroencephalography was performed. This case underscores the importance of therapeutic drug level monitoring of lithium, especially where toxicity is suspected, and the indispensable role electroencephalography plays by allowing a correct diagnosis to be made promptly.
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Forty-four patients with mild to moderate essential hypertension were entered in an open study to compare the efficacy and tolerability of the two diuretic combinations, frusemide (40 mg) plus amiloride (5 mg) and hydrochlorothiazide (50 mg) plus amiloride (5 mg), as first-line treatment. After a 2-week run-in period when no antihypertensive medication was given, patients were randomized to receive one or other combination at a dose of 1 tablet daily for 2 weeks. Patients either remained on this regimen for a further 8 weeks or, if their blood pressure was not controlled, dosage was increased to 2 tablets daily. In the latter case, patients were re-assessed after 2 weeks, and those who showed a positive response remained in the study for 8 additional weeks. In the 36 patients assessed (18 in each group), both treatments were found to reduce blood pressure effectively in a high percentage of patients treated. Hydrochlorothiazide/amiloride, however, caused a significant reduction in both plasma potassium and sodium levels whereas frusemide/amiloride did not. More adverse events were reported by patients taking frusemide/amiloride, but the majority of these were trivial.
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The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS)
In a double-blind parallel-group study 133 patients with mild to moderate essential hypertension were randomised to felodipine 5mg twice daily or Moduretic mite every morning after a run-in placebo period of 1 to 2 weeks. All previous antihypertensive therapy was withdrawn at the start of the run-in period. After 4 weeks the dose of felodipine was increased to 10mg twice daily, and Moduretic mite was replaced by Moduretic in patients with a diastolic blood pressure of greater than 80mm Hg. On the low dose, the supine blood pressure on felodipine was reduced by 24/14mm Hg from 174/105mm Hg, and on Moduretic mite by 19/11mm Hg from 171/103mm Hg. After the increase in dosage blood pressure was lowered further. There was no statistically significant difference in blood pressure reduction between the 2 groups. Severe adverse drug experiences (ADEs) were few and equally distributed. However, more felodipine patients were withdrawn because of ADEs. Potassium levels decreased and uric acid levels increased significantly in the Moduretic group.
73% (138) of the patients were on anti-hypertensive drug combinations, comprising 71.7% (99), 24.4% (34) and 3.6% (5) on combinations of two, three and four drugs respectively. Overall, Thiazide diuretic consisting mainly of fixed dose combination of Amiloride and Hydorchlorothiazide (Moduretic(r)) was the most frequently prescribed drug class in anti-hypertensive combination therapy (83.3%). ACE inhibitor, Lisinopril (Zestril(r)), was prescribed in combination with Moduretic(r), Calcium channel blocker and beta-blocker in 6.5%, 8.5% and 0.7% respectively. Blood pressure control was adequate in only 29% (40) of patients, though adherence with therapy was documented as adequate in 77.5% (107). Type-2 diabetes mellitus (32.7%) and osteoarthritis (21.8%) were the most frequent co-morbidities. Potentially harmful drug-drug interactions in the study sample were identified in 17.5% (46) of patients. Physician documentation of adverse drug reactions among patients was done in only 10.9% of cases. There appear to be no institutionalised system in place to monitor, detect and document adverse drug reactions among patients on anti-hypertensive drug therapy.
In 90 treatment-resistant hypertensive, 67% had plasma renin activity (PRA) below 0.5 nmol/l per hour. Of the 60 low-renin patients, 38 were studied on a fixed combination of amiloride and hydrochlorothiazide. Three weeks' treatment reduced blood pressure by 31/15 mmHg compared to placebo (P < or = 0.0001). Serum aldosterone and plasma renin activity increased substantially during active treatment. Through the subsequent 6-12 months of open treatment, seven patients (18%) showing an escape phenomenon had their high blood pressure effectively treated by extra amiloride. Of the 60 low-renin patients, eight had adrenal adenoma.
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Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community. Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0-137.1 mmol/l) was lower than in the 586 not prescribed diuretics (137.1-137.9 mmol/l). The difference was small but statistically significant (95% CI difference = 0.3-1.6 mmol/l; P less than 0.01). Hyponatraemia (serum sodium less than 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others. There was a significant positive correlation between the serum potassium and the log [serum urea] (r = 0.26, P less than 0.001) and a weak negative correlation existed between sodium and potassium (r = -0.14; P less than 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive.(ABSTRACT TRUNCATED AT 250 WORDS)
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The effect of hydrochlorothiazide 50 mg, amiloride 5 mg (HCTZ-A) (Moduretic; MSD) and its combination with pindolol and nadolol on renal function were compared in patients with mild to moderate essential hypertension (mean untreated supine blood pressure 179 +/- 5.7/108 +/- 2.6 mmHg) with compromised renal function (glomerular filtration rate (GFR) < 85 ml/min). After randomisation to a beta-blocker plus diuretic, the beta-blocker was washed out (diuretic-only period) and the other beta-blocker added. Eleven patients completed the randomised cross-over comparative study, 5 receiving pindolol 15 mg plus 1 dose of HCTZ-A daily for 6 weeks, and 6 nadolol 120 mg plus 1 dose of HCTZ-A daily. The beta-blocker was then withdrawn for 4 weeks, after which each group of patients received 1 dose of HCTZ-A plus the alternative beta-blocker daily for 6 weeks. The GFR was measured using chromium-51-ethylenediamine-tetra-acetic acid at the end of each treatment phase. The mean GFR (+/- SE) fell from 69.6 +/- 5.8 to 60.6 +/- 5.1 ml/min (P < 0.01) during HCTZ-A therapy, whereas the addition of pindolol or nadolol caused no further drop in the GFR. We conclude that mild degrees of renal impairment in essential hypertension may be aggravated by HCTZ-A therapy when given as one tablet of Moduretic daily.
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In a randomized double-blind study to compare the effect of atenolol vs. hydrochlorothiazide and amiloride (Moduretic) on left ventricular dimensions and systolic function, 100 hypertensive men were followed up during 1 year of treatment, 50 subjects being randomized to each drug. Echocardiography was performed at baseline, and after 3 and 12 months of treatment. A significant reduction in left ventricular mass with atenolol was paralleled by a decrease in left ventricular wall thickness and an increase in stroke volume. A similar reduction of left ventricular mass with Moduretic without a change in relative wall thickness and a decrease in stroke volume was observed. Cardiac output decreased in both groups.
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In an open two-period crossover study hydrochlorothiazide/amiloride and chlorthalidone were compared with regard to their anti-hypertensive and biochemical properties in ambulatory patients with mild to moderate hypertension. Twenty-five out of twenty-six patients completed the study. In the chlorthalidone group plasma potassium was consistently lower than in the hydrochlorothiazide/amiloride group, the difference achieved significance at 8 and 12 weeks after the start of treatment. With regard to the hypertension and other parameters no statistically significant differences were found.
A cross-over study was done to compare the effects of doxazosin, moduretic and amlodipine on biochemical values in 9 hypertensive Nigerians aged 35 to 65 years. Doxazosin therapy was characterized by significant increase in the levels of mean plasma total protein and albumin, while moduretic therapy showed significant reduction in the mean values of plasma creatinine and calcium. All other parameters did not show any significant variation during doxazosin and moduretic treatment phases; and amlodipine therapy did not have any effect on the biochemical values of the hypertensive patients.
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